Laparoscopy-assisted transgastric rendezvous ERCP (LAERCP) is a perioperative treatment option for common bile duct stones (CBDS) in Roux-en-Y gastric bypass (RYGB) patients. Although rendezvous ERCP (RV-ERCP) is a safe treatment for CBDS, comparative data with LAERCP in larger cohorts are lacking. This study compares outcomes of laparoscopic cholecystectomy (LC) and LAERCP in RYGB patients with LC and rendezvous ERCP (RV-ERCP) in patients with unaltered anatomy, using an extensive validated national registry. A retrospective study on prospectively collected nationwide cohort data from the Swedish Registry of Gallstone Surgery and ERCP (GallRiks), including all patients from September 2016 to June 2021 who underwent LC with same-day rendezvous ERCP. Patients with prior RYGB (RYGB group) were compared to those without previous upper abdominal surgery (non-RYGB group). Outcome measures was therapeutic success, peri- and postoperative adverse events, procedural time and readmissions. Seventy RYGB and 4342 non-RYGB patients were identified. CBDS were detected in 60 and 3067 patients, respectively. Therapeutic success was 100% in the RYGB group versus 91.4% in the non-RYGB group (p = 0.018). Perioperative adverse events occurred in 8.8% and 2.3% of cases (p < 0.001), but none in the RYGB group had postoperative consequences. Postoperative adverse events, antibiotic use and readmissions were similar. Median procedural time (180 vs. 131min, p < 0.001) and hospital stay (2 vs. 1days, p < 0.001) were longer for the RYGB group. No mortality occurred in either group. Concomitant rendezvous LAERCP during LC is a safe and effective method for managing CBDS after RYGB. Despite a higher rate of perioperative events, outcomes were favorable relative to previously published data for non-concomitant LAERCP. These findings support LAERCP with rendezvous technique as the standard of care for RYGB patients in Sweden and provide registry-based evidence to inform future international guidelines.

Bariatric surgery patients with body mass index (BMI) ≥ 60kg/m2 present unique technical and perioperative challenges. While robotic-assisted bariatric surgery is thought to offer potential technical advantages, direct comparisons between robotic and laparoscopic approaches (R-BS and L-BS) in this population remains limited. An analysis of the 2020-2023 MBSAQIP database was conducted and all patients with BMI ≥ 60kg/m2 who underwent primary laparoscopic or robotic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) were included. Baseline demographics, operative characteristics, and 30-day postoperative outcomes were compared. Multivariable logistic regression identified independent predictors of serious complications. Of 32,295 patients, 22,211 (68.8%) were L-BS and 10,084 (31.2%) were R-BS. Significant baseline differences existed between groups, including higher rates of gastroesophageal reflux disease (28.6% vs. 26.1%, p < 0.001), and hypertension (54.7% vs. 52.8%, p = 0.001) in the R-BS group. From 2020 to 2023, the proportion of R-BS doubled from 20.4% to 41.3%, whereas the proportion of L-BS declined slightly from 79.6% to 58.7%. There was no significant difference in robotic versus laparoscopic utilization for RYGB. (27.4% vs 26.4%, p = 0.059) and operative time was significantly longer in R-BS (106.5 ± 51.4min vs. 83.5 ± 47.0min, p < 0.001). Rates of individual 30-day complications, including leaks, bleeding, reoperation, and readmission, were low with no significant difference between cohorts. Independent predictors of serious complications included older age, hypertension, gastroesophageal reflux disease, prior myocardial infarction, therapeutic anticoagulation, longer operative time and RYGB. The robotic approach was neither independently associated with nor protective against serious complications. In patients with a BMI ≥ 60kg/m2 undergoing elective bariatric surgery, there were no significant differences in 30-day postoperative outcomes between laparoscopic and robotic approaches despite baseline patient differences between groups. Although operative times were 27% longer for the robotic approach, its utilization increased substantially over the study period. These findings suggest that perioperative outcomes in this high-risk population are primarily determined by patient comorbidities and procedural factors rather than surgical approach, and that neither approach demonstrates superior short-term safety.

Human gut microbiota is associated with obesity. Gut microbiota-derived extracellular vesicles (EVs), lipid coated nanoparticles secreted by bacteria, have been suggested as a communication mechanism between gut microbiota and the host. This study characterized the effect of Roux-en-Y gastric bypass (RYGB) on gut microbiota and gut microbiota-derived EVs in patients with obesity. Fecal samples were collected from 30 recruited patients at baseline and 6 months after surgery. EVs were isolated from fecal samples, and their origin and protein content were analyzed. The number of unique proteins was increased in gut microbiota-derived EVs after the surgery as compared to baseline. A significant difference in both microbiota composition (p = 0.001; PERMANOVA) and microbiota-derived EVs (p = 0.001; PERMANOVA) was observed in response to surgery. Based on 16S rRNA gene sequencing data, a random forest classifier accurately classified both gut microbiota (AUC = 0.93) and EVs (AUC = 0.80) to baseline and after surgery groups. This study found that gastric bypass surgery altered both the composition and characteristics of gut microbiota and gut microbiota-derived EVs in patients with obesity. Thus, gut microbiota-derived EVs may play a role in obesity and influence the health effects of bariatric surgery beyond the gut. Trial Registration: ClinicalTrials.gov identifier: NCT00950003.

Morbid obesity is frequently associated with high-risk behaviors such as eating disorders (EDs). This study aimed to investigate the prevalence, changes, and predictive factors of EDs before and one year after metabolic and bariatric surgeries (MBS) in Iranian adults. This prospective observational study included 96 MBS candidates with class II (BMI 35-40kg/m² with comorbidities) or class III obesity (BMI ≥ 40kg/m²). Patients underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or one-anastomosis gastric bypass (OAGB). Demographic data, nutritional status [assessed by a food frequency questionnaire (FFQ)], BMI, and EDs symptoms were collected before and one year after surgery via the EDs Questionnaire (EDE-Q 6.0), and psychological status was assessed via the Symptom Checklist-90-Revised (SCL-90-R). A total of 22.9% of the participants were identified as having EDs. These individuals had a significantly higher BMI compared to those non-eating disorders (non-Eds) (49.9 ± 9.1 vs. 45.4 ± 5.8; p = 0.039). All MBS types (SG RYGB and OAGB) led to significant reductions in EDs global and subscale scores (p < 0.05), with SG surgery group showed notable numerical improvements in weight and shape concerns. Female sex (β = 0.87; p = 0.002) and younger age (β = - 0.03 per year; p = 0.014) were significant predictors of higher EDs scores after surgery. MBS reduce symptoms of EDs, with a trend towards SG showing the most prominent effect. Younger age and female sex were independently associated with greater severity of symptoms after surgery. These findings highlight the importance of targeted postoperative psychological support and underscore the interplay between biological and psychological factors.

Background: Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), is an effective treatment for extreme obesity, but some patients experience inadequate weight loss or weight regain. This study aimed to identify blood biomarkers that predict effective weight loss following RYGB. Methods: A microarray profile (GSE83223) was utilized to identify differentially expressed genes (DEGs) that could preoperatively predict body mass index (BMI) reduction after RYGB. Thirteen patients were divided into two groups based on their postsurgery BMI reduction: high (group A, n = 4) and low (group B, n = 9). DEGs were identified based on significant log fold change (LFC) ( p &lt; 0.05, │LFC│&gt;1). Analyses included data preprocessing, protein-protein interactions, gene ontology, pathway analysis, and identification of hub genes. Results: Notable DEGs before surgery included SEBOX, NOCT, and TYK2, primarily involved in chromosome organization and macromolecule metabolism. Seventeen genes were consistently down-regulated pre and postsurgery, with SNRPB and BCL11A showing the highest │LFC│. Transcription factors MYC and ATF2 were identified as upstream regulators of these DEGs. Conclusion: The expression levels of these genes may serve as prognostic indicators for predicting the efficacy of bariatric surgery in obese individuals, potentially guiding clinical decisions for improved outcomes.

Gastroesophageal reflux disease (GERD) affects 20%-30% of patients after sleeve gastrectomy (SG). In patients with a body mass index (BMI) <30 kg/m2, the optimal surgical approach-magnetic sphincter augmentation (MSA) or conversion to Roux-en-Y gastric bypass (RYGB)-remains unclear. We retrospectively compared outcomes of MSA (n = 20) and RYGB (n = 25) in patients with BMI <30 kg/m2 and refractory post-SG GERD at King Abdulaziz University Hospital (2019-2024). Inclusion required objective evidence of GERD despite ≥6 months of optimized proton pump inhibitor therapy. The primary outcome was GERD resolution. Secondary outcomes included proton pump inhibitor cessation, complications, weight trajectory, and diabetes remission at a minimum follow-up of 18 months. GERD resolution occurred in 70% of patients who underwent MSA and 85% of those who underwent RYGB. Proton pump inhibitor cessation rates were 65% and 80%, with lower postoperative GERD-health-related quality of life (HRQL) scores in the RYGB group. Early dysphagia was more common after MSA (30% vs. 4%). MSA was associated with weight stability, whereas RYGB resulted in significant weight reduction. Diabetes remission occurred in 75% of patients, who underwent RYGB. Both procedures effectively managed post-SG GERD in patients with low BMI. MSA offers weight-neutral reflux control, shorter operative time, and no supplementation requirements. RYGB provides superior symptom control and metabolic benefits, including diabetes remission.

Roux-en-Y gastric bypass (RYGB) is a standard bariatric surgical technique, associated with suboptimal response and recurrent weight gain in 25%-50% of cases. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a simplification of duodenal switch with promising results. However, a comparison of the two techniques in a randomized clinical trial (RCT) has not yet been reported. This RCT aims to compare SADI-S and RYGB. BYPSADIS is a randomized, open-label, multicentre clinical trial comparing SADI-S with RYGB. Patients aged 18-60 years with body mass index (BMI) = 40-50 kg/m2 will be recruited in six hospitals. Primary endpoints are as follows: (1) efficacy, measured as percentage of patients with total weight loss (TWL) > 30% at 5 years; and (2) safety, defined as percentage of patients experiencing at least one severe complication either at 90 days postoperatively (Clavien-Dindo >2) or up to 5 years, including severe malnutrition, diarrhea, dumping, hypoglycemia, or need for surgical reintervention. Sample size was calculated for both primary outcomes, needing 432 patients to prove superiority of SADI-S in efficacy and 423 to prove non-inferiority in safety, with statistical power of 0.8, alpha risk of 0.025, assuming 10% loss throughout follow-up. To ensure power for both primary endpoints, 450 subjects will be included, 225 SADI-S and 225 RYGB. Secondary outcomes include metabolic comorbidities, quality of life, digestive symptoms (dumping, bowel habits, and GERD), need of extra supplementations, and alimentary habits. Outcomes will be compared using one-sided 95% confidence interval of proportion difference between groups. To our knowledge, there is only one ongoing RCT comparing SADI-S with RYGB (SADISLEEVE trial, ClinicalTrials.gov identifier NCT03610256), which includes primary and revisional surgeries, without BMI restrictions and with varying limb lengths. The BYPSADIS trial will complement its findings and help to bridge the knowledge gap on whether SADI-S is more effective than RYGB, while offering a similar safety profile. The study protocol has been approved by the Ethics Committee of the six participating hospitals and has been registered in ClinicalTrials.gov, NCT06789965.

Revisional single anastomosis duodeno-ileal bypass with sleeve gastrectomy after failed adjustable gastric band or sleeve gastrectomy: a meta-analysis of efficacy and safety.

Metabolic and bariatric surgery is the most effective treatment for severe obesity. While short- and mid-term results are well documented, very long-term data (≥10 years) remain scarce, particularly for newer procedures. This review aims to synthesize the available evidence on weight loss outcomes, comorbidity resolution, and complications at 10 years and beyond for the five main bariatric procedures. A comprehensive literature review was performed using PubMed, MEDLINE, and Cochrane databases. Studies reporting outcomes at ≥10 years for sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single-anastomosis duodeno-ileal bypass with sleeve (SADI-S) were included. At 10 years, weighted mean %TWL ranged from 24.4% for SG to approximately 40% for BPD-DS. The SLEEVEPASS randomized controlled trial demonstrated superior weight loss with RYGB compared to SG (%EWL 51.9% versus 43.5%, P < .05). OAGB showed excellent durability with a %EWL of 64.1% at 10 years. BPD-DS achieved the highest sustained weight loss (%EBMIL 76.5%-78%) but with significant nutritional concerns. SADI-S data at 10 years showed %EWL of 80% with acceptable complication rates. Type 2 diabetes remission rates varied from 26% to 33% (SG/RYGB) to >90% (BPD-DS). Gastroesophageal reflux disease (GERD) emergence was a major concern after SG (31% esophagitis at 10 years versus 7% after RYGB). All five procedures demonstrate durable weight loss at 10+ years, with a clear hierarchy favoring malabsorptive procedures for weight loss efficacy. Procedure selection should consider patient-specific factors, including baseline BMI, presence of GERD, metabolic comorbidities, and capacity for long-term nutritional follow-up.

This study aimed to evaluate long-term effectiveness of metabolic and bariatric surgery (MBS) over a 10-year period, to identify predictors of therapeutic success and weight loss, and to compare differences between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). A retrospective cohort study was conducted on patients who underwent MBS between 2010 and 2013 at a Portuguese tertiary hospital (n = 909). Patients who underwent laparoscopic adjustable gastric banding or revisional surgery during follow-up were excluded (n = 280). The 10-year loss to follow-up rate among included participants was 37.2% (n = 147). Clinical data were collected over a 10-year period. Therapeutic success was defined as a percentage excess weight loss (%EWL) of at least 50%. Multivariate logistic or linear regression analyses were performed to identify independent predictors of long-term outcomes. Of 395 participants included, 89.6% were females, with a mean age of 41.9 ± 10.8 years and a median body mass index (BMI) of 43.8 [40.9; 47.8]Kg/m2; 88.1% underwent RYGB. After 10.0 ± 1.30 years, the mean weight loss was 31.0 ± 14.4 kg, corresponding to a percentage of total weight loss (%TWL) of 26.4 ± 11.0% and %EWL of 61.9 ± 26.6%. Therapeutic success was achieved by 70.6% of patients, and 39.0% lost at least 30.0% of baseline weight. Eighteen patients (4.55%) lost less than 5%. RYGB was associated with higher odds of long-term therapeutic success compared to SG (OR = 2.158 [95% CI 1.083-4.303], p = 0.029). Weight loss at one year also predicted long-term success (OR = 1.111 [95% CI 1.075-1.149], p < 0.001), while a higher BMI predicted lower %EWL (β = -1.684 [95% CI: -2.366 to -1.001], p < 0.001). MBS remains an effective long-term treatment for obesity, with RYGB offering superior outcomes compared to SG in our cohort. Our findings highlight the importance of early postoperative weight loss, and baseline BMI as key predictors of long-term outcomes and success after bariatric surgery.

Small bowel obstruction (SBO) is a known complication of Roux-en-Y gastric bypass (RYGB) but rarely results from intraluminal bleeding (ILB) and hemobezoar formation. ILB-related SBO usually occurs in the first 72 h after surgery and may be potentiated by prophylactic anticoagulation or non-steroidal anti-inflammatory drugs. We present the case of a 41-year-old female with prior sleeve gastrectomy who underwent robotic-assisted RYGB and developed early post-operative abdominal pain, distention and tachycardia. Computed tomography demonstrated SBO with hyperdense intraluminal contents distal to the jejunojejunostomy. Emergency re-exploration revealed a consolidated haematoma obstructing the bowel lumen, managed successfully with enterotomy and clot evacuation; anastomotic revision was unnecessary. Post-operative recovery was complicated by an intra-abdominal abscess, managed percutaneously. This rare case highlights the importance of early recognition of ILB as a cause of SBO, prompt imaging and timely surgical management to prevent ischaemia or perforation or anastomotic dehiscence.

Characterization of concurrent bariatric surgery and abdominal wall hernia repair prevalence and outcomes: a multi-centered study of 180,544 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program patients.

The effects of metabolic and bariatric surgery on bone health still require further investigation. Osteometabolism biomarkers, bone microarchitecture (BM), and mineral density (BMD) of patients who have undergone Roux-en-Y gastric bypass (RYGB) within 2-5 years from surgery were compared to non-surgical age-, sex-, and BMI-matched controls. This cross-sectional study included 39 patients following RYGB (BG: aged = 39 ± 5 years, BMI = 42.2 ± 3.8 kg/m2) and 21 controls (CG). Circulating levels of albumin, calcium, phosphorus, magnesium, 25(OH) vitamin D, parathyroid hormone (PTH), carboxy-terminal telopeptide of type 1 collagen (CTX-1), and amino-terminal propeptide of type 1 procollagen (P1NP) were assayed. BMD and BM were assessed by dual-energy X-ray absorptiometry (DXA) and three-dimensional high-resolution peripheral quantitative computed tomography system (HR-pQCT). BG presented with higher circulating phosphorus, PTH, CTX-1, and P1NP and lower 25(OH) vitamin D compared to CG. DXA parameters did not differ between groups. However, HR-pQCT revealed significant derangements in BM (trabecular thickness, cortical bone density, and outer trabecular volumetric BMD) in BG. BG showed tibia-specific trabecular microarchitecture impairment, while sex and BMI showed the expected associations with BM measures. RYGB was associated with detrimental effects on osteometabolism biomarkers, as well as on density and structural parameters of BM. Early preventive strategies aimed at mitigating these deleterious effects should be systematically evaluated to minimize their long-term impact. ClinicalTrials.gov (NCT04193397).

Background/Objective: Bariatric surgery is an established treatment for individuals with severe obesity, providing sustained weight loss and improvement in obesity-related comorbidities. However, evidence on long-term outcomes and predictors of metabolic resolution, particularly among Asian populations, remains limited. We aimed to evaluate metabolic outcomes after bariatric surgery and identify predictive factors associated with remission. Methods: We retrospectively reviewed the data of 581 patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) at a tertiary care center between January 2012 and December 2022. Surgical techniques, postoperative follow-up, and baseline characteristics were recorded. Remission and improvement of metabolic comorbidities were assessed during 1-5 years of follow-up. Predictive factors were analyzed, and remission rates between SG and RYGB were compared using propensity score matching. Results: A total of 154 (26.5%) individuals had type 2 diabetes mellitus (T2DM), 162 (27.8%) hypertension (HT), 173 (29.7%) dyslipidemia (DLP), and 407 (70.0%) metabolic syndrome (MetS). Remission occurred in 79.1% of individuals with T2DM, 36.0% with HT, 33.9% with DLP, and 79.6% with MetS. Predictive factors included T2DM duration < 3 years, younger age for HT and DLP remission, male sex, body mass index < 43 kg/m2, and fasting blood glucose level < 126 mg/dL for MetS. RYGB achieved higher remission of DLP than did SG, whereas other outcomes were comparable. Conclusions: Bariatric surgery effectively improves metabolic comorbidities, and several predictive factors influence outcomes. RYGB resulted in superior remission of DLP, while other metabolic outcomes were comparable between the two procedures.

Morbid obesity is a systemic endocrine-metabolic disease characterized by chronic low-grade inflammation, insulin resistance, hormonal dysregulation (hyperestrogenemia, hyperghrelinemia, reduced GLP-1/PYY), gut microbiota dysbiosis, and endothelial dysfunction. In Kyrgyzstan, the prevalence of obesity reaches 25–28%, with more than 40% of patients with BMI &gt;35 kg/m² suffering from type 2 diabetes mellitus (T2DM). A systematic review of 68 studies (2010–2025), including 18 randomized controlled trials and large registries (SOS, LABS, etc.), was conducted. Bariatric/metabolic surgery (primarily sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB)) provides sustained loss of 50–75% of excess weight over 5–20 years, T2DM remission in 70–92% (RYGB) and 50–70% (LSG), arterial hypertension remission in 60–70 %, dyslipidemia normalization in 70–80%, and resolution/improvement of obstructive sleep apnea in 85–90%. A significant reduction in cardiovascular risk was demonstrated (overall mortality ↓49 %, cardiovascular mortality ↓59%, myocardial infarction ↓42%, stroke ↓36%) and obesity-associated cancer risk by 38–60% (endometrial cancer ↓62%, hepatocellular carcinoma ↓65%). RYGB shows superiority over LSG in metabolic, cardiovascular, and oncological outcomes due to a more pronounced incretin effect and gut microbiota remodeling. The contemporary safety profile (30-day mortality 0.08–0.3%) and rapid cost-effectiveness (payback period in Kyrgyzstan 2–3 years) confirm the method’s priority status. In cases of morbid obesity unresponsive to conservative treatment, bariatric surgery should be considered first-line therapy. In Kyrgyzstan and Central Asia, it is essential to establish a national registry, implement ERABS protocols, train specialists, and include these procedures in the mandatory health insurance system.

Obesity is a global epidemic frequently associated with gastroesophageal reflux disease (GERD). Metabolic and bariatric surgery (MBS) is the most effective treatment for weight reduction in patients with obesity, with the most commonly performed procedures being sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one-anastomosis gastric bypass (OAGB). Many recent studies focused on determining the best procedure for patients with obesity and GERD; however, results from these studies vary, and the optimal procedure remains uncertain. To compare the effects of MBSs - SG, RYGB, and OAGB - and their combinations with antireflux procedures on weight loss and GERD outcomes. A systematic search was performed to identify randomized controlled trials evaluating MBS in patients with obesity and GERD. A network meta-analysis was conducted to estimate the relative effectiveness of different procedures on body mass index reduction, percent excess weight loss, GERD remission, GERD onset, postoperative proton pump inhibitor use, esophagitis, and complication rates. Sixteen randomized controlled trials including SG, RYGB, OAGB and their combined procedures (i.e., SGantiflux and OAGBantiflux), were analyzed. OAGBantiflux showed the highest body mass index reduction, and OAGB and RYGB had similar efficacies. In terms of percent excess weight loss, OAGB and RYGB ranked higher than other MBSs, whereas SGantiflux was the least effective. RYGB had the highest probability of GERD remission, followed by SG, SGantiflux, OAGB, and OAGBantiflux. SGantiflux showed the highest probability of the postoperative GERD onset, while SG was most likely to require postoperative proton pump inhibitor use and cause esophagitis. SGantiflux also demonstrated the highest complication rate, whereas OAGBantiflux was associated with the lowest, with OAGB, RYGB, and SG yielding intermediate rates in a descending order. RYGB and OAGB were more effective than SG in patients with obesity and GERD, and addition of antireflux procedures to MBS did not improve GERD outcome.

Metabolic bariatric surgery (MBS) such as the Roux-en-Y gastric bypass (RYGB) is effective in the treatment of obesity. However, not every patient achieves optimal clinical response and recurrent weight gain remains a concern. Hypothetically, a narrow longer pouch could lead to better results by preventing pouch dilatation and slowing down gastric emptying rates. The aim of this study is to evaluate the effect of an extended pouch gastric bypass (EP-RYGB) on weight loss and quality of life 5 to9years (median 109 months [104-116]) postoperatively. Follow-up study of a single-blinded RCT including 62 patients who underwent a standard Roux-en-Y gastric bypass (S-RYGB, n = 30) versus EP-RYGB (n = 32) between September 2014 and October 2015. Outcomes on weight loss, obesity related complications, health-related quality of life (HRQoL), and gastro-intestinal symptomswere compared between S-RYGB and EP-RYGB. Mean total weight loss (%TWL) was higher in EP-RYGB compared to S-RYGB (26.1 ± 11.2%, versus 24.1 ± 10.1%) although not statistically significant. More patients in the S-RYGB group tended to experience recurrent weight gain compared to EP-RYGB (70% versus 47%, p = 0.07). HRQoL and gastro-intestinal symptoms were comparable between groups (p > 0.05 for all). EP-RYGB results in slightly better weight loss outcomes and similar HrQoL compared to S-RYGB 5 to 9 years postoperatively. However, due to loss to follow up, the current study is underpowered and a definitive long term advantage of EP-RYGB cannot be concluded.

Background: Phase angle (PhA), a parameter derived from bioelectrical impedance analysis, is associated with lean mass and muscle mass. Bariatric surgery can result in significant changes in body composition. The objective of this meta-analysis was to determine the impact of bariatric surgery on PhA. Methods: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including studies up to January 2025 from five databases. Eligible studies assessed PhA alterations before and after bariatric surgery. Results: Thirteen studies with a total of 825 patients were included. Significant PhA reduction was observed following bariatric surgery (weighted mean difference: −0.922; 95% confidence interval [CI]: −1.063, −0.781; p &lt; 0.001). Random-effects meta-regression showed a significant association between ΔPhA and ΔBMI (slope: 0.072; 95% CI: 0.033, 0.112; p = 0.0003) and Δfat-free mass (slope: 0.080; 95% CI: 0.052, 0.107; p &lt; 0.001), but no association with Δfat mass. PhA values decreased significantly with following bariatric surgery, but there were no differences between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Conclusions: This meta-analysis offers evidence regarding the impact of bariatric surgery on bioimpedance parameters, including PhA, in individuals with obesity.

BackgroundHypoalbuminemia is associated with worse postoperative outcomes, but data is limited in the bariatric population. Patients with BMI ≥50 may represent a higher-risk group for malnutrition.MethodsWe analyzed MBSAQIP data (2015-2022) for patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Propensity score matching was used to control for 22 preoperative variables. We compared 30-day outcomes and bariatric-specific complications in patients with albumin <3.5g/dL vs ≥3.5g/dL across four groups: SG with BMI ≥50 (analysis 1), RYGB with BMI ≥50 (analysis 2), SG with BMI <50 (analysis 3), and RYGB with BMI <50 (analysis 4).ResultsAmong 728,915 patients, matched cohorts in analyses 1 (n = 17,548), 2 (n = 9459), 3 (n = 16,025), and 4 (n = 6787) had similar preoperative characteristics. Hypoalbuminemia was associated with increased complications across all groups. In patients with BMI ≥50, hypoalbuminemia was significantly associated with increased mortality (SG 0.2% vs 0.1%, P = 0.011; RYGB 0.3% vs 0.1%, P < 0.001), unplanned ICU admission (SG 1.0% vs 0.7%, P = 0.020; RYGB 1.6% vs 1.2%, P = 0.034), and non-home discharge (SG 0.8% vs 0.5%, P < 0.001; RYGB 0.9% vs 0.6%, P = 0.009). These mortality differences were not observed in patients with BMI <50.ConclusionHypoalbuminemia is associated with higher complications rates after bariatric surgery and increased mortality in patients with BMI ≥50. Preoperative nutritional optimization is strongly recommended in this high-risk group.

Dumping Syndrome (DS) and Reactive Hypoglycaemia (RH) are common occurrences post bariatric surgery, particularly post Roux-En-Y Gastric Bypass (RYGB). We present our initial results using Transoral Outlet Reduction Endoscopy (TORE) in the management of patients who failed to respond to dietary and medical treatment for DS. All patients identified to have symptoms consisting with DS were discussed in the complex bariatric MDT and assessed for suitability of TORE via an upper gastro-intestinal endoscopy to assess the length of the pouch, size of the gastro-jejunostomy and the presence of alternative pathologies. Since the onset of our TORE services in January 2025, we identified 17 patients for treatment with TORE. The median age was 45yrs (IQR 36-55). Sixteen patients (94%) were women and all patients scored ≥ 7 on the Sigstad scoring questionnaire. Two patients had previously undergone conversion of gastric sleeve to a RYGB whilst all others had a primary RYGB. 2 patients were found to have unfavourable anatomy and was not safe to proceed with the procedure whilst one patient was followed up privately hence no data were available for review. The data showed a complete response to treatment at 2years for 66% of patients. Four patients did not respond to treatment with TORE and are being considered for surgical intervention. TORE is an effective treatment for patients with DS not responsive to medical and dietary therapy. We believe it is an effective non-surgical treatment method prior to considering reversal of the original surgery (RYGB) with its associated weight regain. Further work is planned to assess its outcomes in larger groups of patients.