Sleeve Gastrectomy Research Articles

Long-Term Cancer Outcomes Following Bariatric Surgery: A Comparative Analysis of Surgical Procedures

Background/Objectives: Metabolic and bariatric surgery (MBS) is known to reduce cancer risk. However, the association between specific bariatric procedures and cancer incidence is not well-studied. This study examined the association between four different MBS procedures and cancer incidence. Methods: Bariatric surgery registry data were linked with statewide cancer registry data from 1979 to 2018. The study included 27,092 adult subjects (aged ≥ 18 years old at surgery) who underwent MBS (BMI ≥ 30 kg/m2 at surgery) from 1979 to 2017. Cancer records were linked to MBS patient records, resulting in 1547 cancer cases. Cox proportional hazards regression was used to examine the association between MBS procedure types and cancer incidence. Results: Of all patients, 75% underwent Roux-en-Y gastric bypass (RYGB), 9% adjustable gastric banding (AGB), 10% sleeve gastrectomy (SG), and 6% duodenal switch (BPD-DS). The overall cancer incidence during the follow-up period was 6.4% for RYGB, 4.6% for AGB, 1.6% for SG, and 5.9% for BPD-DS. The mean follow-up duration from surgery to cancer incidence or censoring was 167 months (standard deviation = 121 months). Compared to RYGB, patients who underwent AGB (Hazard Ratio [HR] = 1.26, p = 0.03) and BPD-DS (HR = 1.91, p < 0.01) had a significantly higher hazard of developing cancer, while SG (HR = 1.17, p = 0.33) showed no significant difference. Conclusions: These findings suggest that AGB and BPD-DS may be associated with higher cancer risks compared to RYGB. Additional large population studies are needed to better understand the long-term cancer risks and mechanisms associated with different MBS types.

Exploring the Molecular Mechanisms underlying SADI-S Improves Glucose Metabolism in Type 2 Diabetic Rats through Liver Transcriptomics and Proteomics Analysis.

Metabolic surgery could improve or even reverse type 2 diabetes mellitus (T2DM). Single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is one of the most effective metabolic surgeries for T2DM. However, the molecular mechanisms behind the SADI-S-induced T2DM improvement are not fully understood.Here,T2DM rats received SADI-S and were sacrificed after 8 weeks; the controls received sham surgery; Liver tissues were collected for transcriptomics and proteomics analysis to identify differentially expressed genes (DEGs) and proteins (DEPs). Parallel reaction monitoring (PRM) was performed to validate the accuracy of the proteomics results.SADI-S significantly improved glucose metabolism in T2DM rats.A total of 120 genes/proteins(e.g., phosphoenolpyruvate carboxykinase (Pck1) and pyruvate kinase (Pklr)) exhibited consistent expression trends at both mRNA and protein levels. Among the upregulated genes/proteins involved in glucose metabolic pathways, enrichment was observed in pathways such as the pyruvate metabolic pathway, insulin signaling pathway, glycolysis/gluconeogenesis biological processes, glucagon signaling pathway, and AMPK signaling pathway. Downregulated genes/proteins were enriched in the pyruvate metabolic pathway. The above-mentioned signaling pathways are implicated in glucose metabolism, suggesting a potential mechanism for SADI-S-mediated alleviation of T2DM. The PRM validation results indicated that all selected proteins showed consistent trends between PRM and proteomics data. This consistency suggests the reliability of the proteomics results.

Bariatric Surgery in Adolescent Age Group

Obesity in children is a problematic condition which interfere with physical and mental health. It is a complicated disorder with interwoven environmental, genetic, biological components, developmental, and behavioral. A combination of medical treatment and behavioral and lifestyle modifications was typically what causes poor short-term weight loss and long-term failure. For this reason, adolescents who suffer from moderate to severe obesity and have attempted lifestyle interventions in the past but had no success should think about having bariatric surgery. Specifically, laparoscopic sleeve gastrectomy is thought to be the most often carried out bariatric procedure globally. The technique is safe and doable. It has been demonstrated that this surgical weight loss procedure is effective in young patients. However, there are obstacles that need to be removed at the levels of patients, providers, and the healthcare system. Above all, for ensuring successful long-term treatment and permit healthy growth, more should be done to stop the nutritional status decline that frequently follows bariatric surgery, as well as to prevent insufficient weight loss and weight regain. With a focus on LSG, nutritional management, and the resolution of metabolic comorbidities, we examined the clinical indications, surgical treatment options, and outcomes in adolescents with severe obesity in this narrative review.

Efficacy of One Anastomosis Gastric Bypass Versus Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for the Treatment of Type 2 Diabetes Mellitus: a Systematic Review and Meta-Analysis of Randomized Clinical Trials.

The worldwide prevalence of type 2 diabetes mellitus (T2DM) is increasing in parallel with obesity. One anastomosis gastric bypass (OAGB) is considered effective to treat both T2DM and obesity. The aim of this study was to evaluate the efficacy of OAGB versus sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for treatment of T2DM, analyzing data exclusively from randomized control trials (RCTs). Α systematic review of published RCTs comparing OAGB versus RYGB or SG (control groups) in T2DM patients regarding diabetes remission and weight loss was performed. Primary endpoints were T2DM remission rate and 1-year and 5-year % weight loss postoperatively. Initial search identified 39 references, of which 8 RCTs were considered eligible for meta-analysis inclusion, comprising 636 patients (311 OAGB, 122 RYGB, 203 SG patients). Main meta-analysis findings were: i) higher 1-year %EWL for OAGB than control group (p = 0.04); ii) higher 5-year %EWL for OAGB than control group (p < 0.01); iii) no difference in 1-year remission rate of T2DM between OAGB and control group (p = 0.14); iv) 28% higher 5-year remission rate of T2DM for OAGB than control group (p < 0.01). OAGB had statistically significant better outcomes compared to RYGB and SG regarding T2DM remission and %EWL at 5years. Further pathophysiologic studies are needed to indicate the most potent bariatric procedure in patients with T2DM and obesity.

Long-Term Outcomes of Sleeve Gastrectomy Versus Gastric Bypass.

Extremely obese patients can benefit greatly from bariatric surgery, a common and successful therapeutic procedure for treating obesity and accompanying medical issues. Although sleeve gastrectomy and gastric bypass have already demonstrated their effectiveness in this demographic, long-term results were not stated in the literature. The purpose of this research is to examine the long-term outcomes of sleeve gastrointestinal surgery and gastric bypass. This retrospective, single-center study compares 100 patients aged 25 years and older who visited the gastrointestinal tract surgical unit at Dar El-Fouad Hospital in Cairo, Egypt, between January 1 and August 31, 2019, according to the inclusion and exclusion criteria. The patients underwent either a Roux-en-Y gastric bypass (RYGB-50%) or sleeve gastrectomy (SG-50%) for severe obesity. Follow-up occurred at one year and up to four years following surgery to collect information from the study subjects. Two tools were used to assess BMI, weight loss, complications after surgery, and incidence outcome of comorbidities after the two surgeries. Qualitative data were presented as number and percentage and frequency distribution tables, and every analysis was done at a significance value < 0.05. The average age of patients within the SG group was 43.02 ± 9.19 years, whereas the average age of patients within the RYGB group was 41.02 ± 11.06 years. In addition, 74% of patients were women in both procedures. The BMI mean of the SG group was 43.90 ± 5.78, the BMI mean of the RYGB group was 42.73 ± 5.12, and the main comorbidity in both techniques was joint pain. The mean BMI at one year was 29.70 kg/m2 after SG compared with 28.64 kg/m2 after RYGB. After four years, BMI was regained within the obese range in both techniques - 30.67 kg/m2 and 30.32, respectively. Fewer postoperative complications occurred in SG than in RYGB. RYGB was superior to SG in managing dyslipidemia (DL), hypertension (HT), type 2 diabetes (T2DM), joint pain, and gastroesophageal reflux disease (GERD). There are no significant differences between the SG and RYGB in long-term outcomes regarding BMI before surgery and at follow-up, after four years, while there were statistically significant differences between them after four years than one year after surgery, and both groups showed a significant decrease in weight. However, RYGB shows improvement to some extent in comorbidities within follow-up period, including BMI, T2DM, HT, DL, HT, DL, GERD, and joint pain than SG, but with a higher rate of minor complications, while greater resolution of OSAS occurred in SG. Finally, at four years, there were no discernible variations in BMI between SG and RYGB because the patients' mean BMI was within the obese range once more.

Successful Management of Gastric Leakage Post Gastric Sleeve by Gastric Bypass Conversion

Gastric leak represents one of the most common, serious and challenging complications in bariatric procedures, and it is caused by both ischemic and mechanical failure. The management of these leaks remains controversial. In this clinical case, we describe the occurrence of a gastric leak after a gastric sleeve, which was successfully treated by gastric bypass using a laparoscopic technique.

Effect of bariatric surgery on the pharmacokinetics of drugs used for attention-deficit hyperactivity disorder-A case series.

Changes in gastrointestinal physiology following bariatric surgery may affect the pharmacokinetics of drugs. Data on the impact of bariatric surgery on drugs used for attention-deficit/hyperactivity disorder (ADHD) are limited. In patients treated with ADHD medication and undergoing bariatric surgery, serial drug concentrations were measured for 24 h preoperatively and one, six and 12months postoperatively. Primary outcome was change in area under the concentration-time curve from 0 to 24 h (AUC0-24), with other pharmacokinetic variables as secondary outcomes. Eight patients treated with lisdexamphetamine (n= 4), dexamphetamine (n= 1), methylphenidate (n= 1) and atomoxetine (n= 2) were included. In total, 409 samples were analysed. Patients underwent sleeve gastrectomy (n= 5) and Roux-en-Y gastric bypass (n= 3). AUC0-24 and Cmax of dexamphetamine increased after surgery in those using the prodrug lisdexamphetamine. There was no clear-cut reduction in tmax postoperatively. For ritalinic acid and atomoxetine, no changes in AUC0-24 were observed, but for atomoxetine, a higher Cmax and a shorter tmax were observed postoperatively. Bariatric surgery may increase the systemic exposure of dexamphetamine after intake of lisdexamphetamine. Patients using lisdexamphetamine should be followed with regard to adverse drug reactions after bariatric surgery, and, if available, therapeutic drug monitoring should be considered.

066. Sleeve Gastrectomy Decrease of TNF-a and Increase TGF-a Gene Expression in the Abdominal Aorta of Rats with Obesity and Diabetes Mellitus

Background: Sleeve gastrectomy (SG) is one option to significantly reduce body weight while also protecting the cardiovascular system by controlling hyperglycaemia and inflammatory markers. Secretion of tumour necrosis factor (TNF)-? could induce inflammation, meanwhile, the transforming growth factor-? (TGF-?) are anti-inflammatory cytokines, both of which play a role in the process of atherosclerosis. This study aimed to analyse the effect of SG procedure on TNF-? and TGF-? gene expression in the abdominal aorta of obese and DM rats. Method: Fifteen rats were divided into 3 groups: lean-non-DM rats model (C1 group), obese-DM rats model (C2 group), and obese-DM rats model underwent SG (T group). Before and 10 days after the SG procedure, rats’ body weight and fasting blood glucose (FBG) were measured. Ten days after the procedure, TNF-? and TGF-? gene expression were also evaluated by PCR. Results: At the end of the study, mean body weight, FBG levels, and TNF-? gene expression in the C1 group (231.80±4.32 gram; 68.60±2.07 mg/dL; 1.01±0.01 rfu) and T group (232.00±5.33 gram; 114.40±3.20 mg/dL; 1.97±0.57 rfu) were significantly lower than in C2 group (264.60± 3.28 gram; 271.00±6.89 mg/dL; 224.12±47.59 rfu). TGF-? gene expression was found to be considerably higher in T group (25.62 ± 3.03 rfu) compared to C1 group (1.05 ± 0.01 rfu) and C2 group (1.63 ± 0.21 rfu). Conclusion: SG could decrease body weight and FBG, as well as TNF-? gene expression, and increase TGF-? gene expression in the abdominal aorta of rats with obesity and DM.

Comparison of calcium citrate and calcium carbonate absorption in patients with a Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, and One-Anastomosis Gastric Bypass: A double-blind, randomized cross-over trial.

Comparison of calcium citrate and calcium carbonate absorption in patients with a Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, and One-Anastomosis Gastric Bypass: A double-blind, randomized cross-over trial.

Liver transplantation and bariatric surgery: is sleeve gastrectomy really the panacea?

Liver transplantation and bariatric surgery: is sleeve gastrectomy really the panacea?

A Predictive Nomogram for the Occurrence of Gastroesophageal Reflux Disease After Sleeve Gastrectomy: A Study Based on Preoperative HERM.

Gastroesophageal reflux disease (GERD) is a common complication after laparoscopic sleeve gastrectomy (LSG); This study aimed to construct a model that can predict the incidence of GERD after LSG by exploring the correlation between the results of high-resolution esophageal manometry (HREM) and the incidence of GERD after LSG. We collected the clinical data of patients who had undergone HREM before bariatric surgery from September 2013 to September 2019 at the bariatric center of our hospital. The Gerd-Q scores during the postoperative follow-up were collected to determine the incidence of GERD. A logistic regression analysis was performed to explore the correlation of the HREM results and general clinical data with the incidence of GERD after LSG. The percentage of synchronous contractions, lower esophageal sphincter (LES) resting pressure, and history of smoking were correlated with the development of GERD after LSG, with the history of smoking and percentage of synchronous contractions as risk factors and LES resting pressure as a protective factor. The training set showed an area under the ROC curve (AUC) of the nomogram model of 0.847. The validation set showed an AUC of 0.761. The decision and clinical impact curves showed a high clinical value for the prediction model. The HREM results correlated with the development of GERD after LSG, with the percentage of synchronous contractions and LES resting pressure showing predictive value. Combined with the history of smoking, the predictive model showed a high confidence and clinical value.

The association of higher offspring early-childhood weight gain with prepregnancy metabolic and bariatric surgery.

The objective of this study was to assess maternal gestational outcomes and offspring growth trajectories following prepregnancy metabolic and bariatric surgery (MBS) compared with non-MBS controls. Single-center deliveries between January 2020 and March 2023 with prepregnancy Roux-en-Y gastric bypass (herein referred to as "bypass"), sleeve gastrectomy (herein referred to as "sleeve"), and non-MBS controls were included. Offspring growth trajectories were compared with the World Health Organization child growth standards. Linear mixed models assessed MBS-bypass and MBS-sleeve offspring weight, length, and BMI trajectories with a prepregnancy BMI 27 to 37 kg/m2 and propensity score-matched controls. The study included 440 participants with prepregnancy MBS (MBS-bypass, 185; MBS-sleeve, 225; 76% Hispanic/Latino) and 13,434 non-MBS controls. Gestational weight gain and gestational diabetes mellitus were similar, whereas hypertensive disorders of pregnancy were more common after MBS. The post-MBS offspring had lower birth weight but higher weight gain at 24 months (sleeve, +1.4 kg [95% CI: 1.0-1.9]; bypass, +0.5-0.7 kg [95% CI: 0.0-1.2]) compared with non-MBS groups. Male children had higher weight gain than females. The post-MBS-sleeve but not the post-MBS-bypass offspring had higher BMI z scores. The higher early-life weight gain and sex differences in the post-MBS-sleeve group compared with the post-MBS-bypass group provide a window toward elucidating pathways to mitigate intergenerational metabolic risk transfer.

Rates and Risk Factors for 30-Day Morbidity After One-Stage Vertical Banded Gastroplasty Conversions: A Retrospective Analysis.

Background: The vertical banded gastroplasty (VBG) is a historic restrictive bariatric operation often requiring further surgery. In this investigation utilizing the 2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national dataset, we aim to better define the outcomes of VBG conversions.Methods: We queried the 2021 MBSAQIP dataset for patients who underwent a conversion from a VBG to Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Demographics, comorbidities, laboratory values, and additional patient factors were examined. Rates of key consequential outcome measures 30-day readmission, reoperation, reintervention, mortality, and a composite endpoint (at least 1 of the 4) were further calculated.Results: We identified 231 patients who underwent conversion from VBG to SG (n = 23), RYGB (n = 208), or other anatomy (n = 6), of which 93% of patients were female, and 22% of non-white race. The median age was 56years and body-mass index (BMI) was 43kg/m2. The most common surgical indications included weight considerations (48%), reflux (25%), anatomic causes (eg, stricture, fistula, and ulcer; 10%), and dysphagia (6.5%). Thirty-day morbidity rates included reoperation (7.8%), readmission (9.1%), reintervention (4.3%), mortality (.4%), and the composite endpoint (15%). Upon bivariate analysis, we did not identify any specific risk factor for the 30-day composite endpoint.Discussion: One-stage VBG conversions to traditional bariatric anatomy are beset with higher 30-day morbidity relative to primary procedures. Additional MBSAQIP data will be required for aggregation, to better characterize the risk factors inherent in these operations.

Efficacy of single anastomosis sleeve-ileal bypass in weight control and resolution of type 2 diabetes mellitus – a retrospective cohort study

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder exacerbated by obesity. Single Anastomosis Sleeve-Ileal Bypass (SASI) has emerged as a promising metabolic bariatric procedure that combines sleeve gastrectomy and ileal bypass, facilitating substantial weight loss and T2DM remission through restrictive and malabsorptive mechanisms. This study aims to evaluate the effects of SASI on T2DM remission, weight loss, and safety in one year follow-up. A retrospective cohort study analyzed 31 patients with obesity and T2DM who underwent SASI. Data collected included demographic characteristics, preoperative and postoperative BMI, HbA1c levels, and bariatric outcomes, including %TWL and T2DM changes. The mean age was 45 years, with a mean preoperative BMI of 40.7 kg/m². One year postoperatively, the mean %EWL was 85.6% and %TWL was 31.7%. T2DM remission was achieved in 24 (77.4%) patients, improvement in 4 (12.9%), and no change in 3 (9.7%). Hypertension improved in 21 (87.5%) patients, with 12 (50%) achieving remission. Significant reductions in BMI and HbA1c levels were observed (p < 0.001). Responders (R) and non-responders (NR) groups showed significant differences in postoperative BMI and %EWL (p = 0.007, p = 0.023). One patient experienced a Clavien-Dindo Grade III complication; no deaths occurred. SASI is an effective and safe procedure for treating T2DM, resulting in significant weight loss and metabolic improvements over a one-year follow-up. SASI seems to be a favorable option for T2DM management in metabolic bariatric surgery.

The role of gut hormonal aspect in Iraqi patients subjected to sleeve Gastrectomy

ان هناك عدة انواع من العمليات الجراحية التي تجرى للاشخاص ذوي الاوزان العالية لعلاج السمنة المفرطة عندهم . وذلك عن طريق التغيير الحاصل في مستوى الهرمونات المعوية المسؤلة عن الجوع والشبع . ونتيجة لهذه العمليات سيحصل فقدان كبير بالوزن بعد اجراء الجراحة الناظورية وهو من خيارات علاج السمنة المرضية ونتيجة لذلك فأن افراز هرمون الكريلين ممكن ان يتعدل او يتغير. الهدف من الدراسة هو توضيح او اكتشاف اي تأثير لعمليات تكميم المعدة على بعض الهرمونات المعوية. لقد قمنا بأجراء دراسة مستقبلية في مركز البصرة لجراحة الأيض والسمنة ، في جنوب العراق من كانون الأول (ديسمبر) 2021 إلى آذار (مارس) 2022 ، على 24 مريضاً كانو يعانون من السمنة المرضية واجريت لهم عمليات تكميم المعدة. تم تصنيف المرضى المشمولين إلى مجموعتين رئيسيتين حسب فترات العملية. وقد عولجت النتائج باستخدام الإصدار 25 من برنامج SPSS (شركة SPSS) للحسابات الإحصائية. و قمنا بحساب قيمة P. النتائج: انخفض معدل GLP -1 و Ghrelin و Leptin و BMI بشكل ملحوظ بعد الجراحة. لم نلاحظ اي تأثير معنوي سوى علاقة ذات دلالة إحصائية واحدة بين مؤشر كتلة الجسم ومستوى اللبتين للمريض بعد ثلاثة أشهر من الجراحة ، بينما كان هناك ارتباط معنوي بين مؤشر كتلة الجسم ومستوى GLP-1 قبل الجراحة. الاستنتاج نستنتج أن الهرمونات الثلاثة GLP-1 و Ghrelin و Leptin تنخفض بعد ثلاثة أشهر من الجراحة ويزداد مؤشر كتلة الجسم بمقدار وحدة واحدة (Kg / m2) ، وسوف يزيد GLP-1 بمقدار نصف وحدة 0.45 (50٪).

Revision of Laparoscopic Roux-en-Y Gastric Bypass to Laparoscopic Sleeve Gastrectomy with Proximal Jejunal Bypass and Hiatal Hernia Repair.

Revision of Laparoscopic Roux-en-Y Gastric Bypass to Laparoscopic Sleeve Gastrectomy with Proximal Jejunal Bypass and Hiatal Hernia Repair.

Do Abdominoplasties in Patients with Prior Sleeve Gastrectomy Impact De Novo Gastroesophageal Reflux Disorderand the Need for Conversion to Roux-en-Y Gastric Bypass?

Introduction: The sleeve gastrectomy (SG) often requires conversion to Roux-en-Y gastric bypass (RYGB) due to gastroesophageal reflux disorder (GERD). Many postbariatric patients seek body-contouring surgery such as abdominoplasty to remove unwanted skin and fat. Although the number of abdominoplasties performed in postbariatric patients is increasing each year, the number of conversion surgeries is increasing in accordance. This study evaluates the impact of abdominoplasties in patients with prior SG on the development of GERD and the need for conversion to RYGB. Methods: A retrospective study was conducted with 630 patients who underwent conversions from SG to RYGB at our institution between January 2014 and December 2023. Outcomes were stratified for comparison between patients with GERD as an indication for conversion and patients with inadequate weight loss as an indication for conversion. Between the two groups we compared the number of patients with post-SG abdominoplasty and the number of hiatal hernias (HH) seen during conversion surgery. A logistic regression analysis was performed to identify factors independently associated with GERD. Results: There was a statistically significant higher number of abdominoplasties in patients who underwent conversion to RYGB for GERD (29 patients, 8.6%) compared to inadequate weight loss (12 patients, 4.1%), P value .034. However, these patients also had statistically significantly more HH (98 patients, 28.9%) compared to patients with inadequate weight loss as an indication for conversion (46 patients, 15.8%), P value <.001. In the logistic regression comparing these two variables, only the presence of HH seen during surgery was found to be a significant predictor of GERD (odds ratio 2.7, confidence interval 1.7-4.1, P < .001). Conclusion: Our data shows that abdominoplasty surgery does not directly influence the development of GERD in post-SG patients. However, the presence of HH in this population significantly impacts the development of GERD, often necessitating conversion to RYGB.

The Effect of Single Anastomosis Gastric bypass and Sleeve Gastrectomy on Morbidly Obese Patients' Lipid Profile. A Comparative Study

The Effect of Single Anastomosis Gastric bypass and Sleeve Gastrectomy on Morbidly Obese Patients' Lipid Profile. A Comparative Study

Surgical treatment strategies for gastroesophageal reflux after laparoscopic sleeve gastrectomy.

Bariatric surgery has emerged as an effective therapeutic approach for combating obesity. As the most commonly performed bariatric surgery, laparoscopic sleeve gastrectomy (LSG) has a long-term and effective outcome in weight reduction. However, studies have reported an increased incidence of gastroesophageal reflux disease (GERD) among patients after LSG. For those who fail to respond to conventional oral acid-suppressing medication, surgical intervention comes into consideration. The most commonly performed revisional surgery for sleeve gastrectomy is the Roux-en-Y gastric bypass, which can effectively alleviate the symptoms of reflux in patients and also continues to promote weight loss in patients who have not achieved satisfactory results or have experienced weight regain. In addition to this established procedure, innovative techniques such as laparoscopic magnetic sphincter augmentation (MSA) are being explored. MSA is less invasive, has good reflux treatment outcomes, and its safety and efficacy are supported by the literature, making it a promising tool for the future treatment of gastroesophageal reflux. This article also explores the role of endoscopic interventions for GERD treatment of post-sleeve gastrectomy patients. Although these methods have shown some therapeutic effect, their efficacy still requires further study due to a lack of support from more clinical data. For patients with preoperative hiatal hernia or gastroesophageal reflux symptoms, some experts now consider performing LSG combined with hiatal hernia repair or fundoplication to alleviate or prevent postoperative reflux symptoms. Both of these surgical approaches have demonstrated favorable outcomes; however, the addition of fundoplication requires further investigation regarding its long-term effects and potential postoperative complications. This article gathers and examines the current laparoscopic and endoscopic treatments for refractory gastroesophageal reflux following LSG, as well as the concurrent treatment of LSG in patients with preoperative gastroesophageal reflux or hiatal hernia.

Robotic Single Anastomosis Duodenal-ileal Bypass With Sleeve Gastrectomy (SADI-S) for Morbid Obesity: A Systematic Review.

The global obesity epidemic has seen a dramatic increase in prevalence since 1975, posing significant health and economic challenges worldwide. Robotic-assisted single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) has emerged as a promising surgical intervention for morbid obesity, offering potential advantages over traditional laparoscopic approaches in terms of precision, safety, and recovery outcomes. This study aimed to evaluate the efficacy and safety of robotic-assisted SADI-S, focusing on perioperative and postoperative outcomes including intraoperative complications, operative time, conversion rates, mortality, length of hospital stay, weight loss, and postoperative complications. A comprehensive literature search was conducted on PubMed, Scopus, and Cochrane Library, adhering to inclusion and exclusion criteria focused on obese adult humans undergoing robotic SADI-S. Seven studies, published between 2015 and 2024, involving 204 patients, were ultimately included for analysis. The analysis revealed a low rate of intraoperative complications (0.49%), no mortality, and varied operative times (138 to 205.7 min). The median hospital stay ranged from 2 to 6.7 days, with minimal readmission rates. Postoperative complications occurred in 6.37% of patients, but no late complications (>30 days) were reported. Notably, significant weight loss outcomes were documented, with mean excess weight loss (EWL) up to 113.74% at 24 months follow-up. Robotic-assisted SADI-S demonstrates a favourable safety profile with promising weight loss outcomes, highlighting its potential as a primary or revisional treatment for morbid obesity. Further research, including randomized controlled trials, is needed to establish its long-term efficacy and cost-effectiveness compared to traditional laparoscopic methods.