Comparative midterm ramifications of one anastomosis gastric bypass, Roux-en-Y gastric bypass, and sleeve gastrectomy: A retrospective cohort study of 6,234 patients.

Bariatric metabolic surgery (Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]) effectively treats obesity and type 2 diabetes; however, weight loss varies, necessitating predictive factors. We analysed 12- and 24-month weight loss data from 811 patients (RYGB or SG). Factor Analysis of Mixed Data and neural network (NN) modelling identified distinct patient phenotypes and predicted weight-loss patterns. A comparative analysis evaluated weight loss and recurrence between the two procedures. RYGB showed significantly greater weight loss than SG at both 12 (30.3% vs. 25.4%; p<0.001) and 24months (26.3% vs. 21.4%; p<0.001). SG revealed greater variability with bimodal weight loss distributions. Unsupervised clustering of SG patients highligheted three phenotypes: the highest responders were women with favourable metabolic profiles; the lowest responders were mostly men with insulin resistance and diabetes. A NN achieved an overall accuracy of 72.5% in predicting 12-month weight loss from baseline characteristics. In RYGB, clustering was less distinct, though baseline metabolic health influenced weight trajectories. A NN predicted weight recurrence versus sustained loss with 74% accuracy. Poor outcomes were associated with higher baseline glucose, insulin resistance, and dyslipidemia; younger age and absence of diabetes predicted better responses. RYGB was superior to SG, even for metabolic high-risk individuals. Baseline metabolic health predicts weight-loss outcomes and recurrence risk. RYGB offered greater and more consistent mid-term weight loss, especially benefiting metabolically high-risk patients. Procedure choice must be individualized accounting for specific risk profile and potential complications. These results advocate for a precision-medicine approach in bariatric procedure selection.

Comparison of Erector Spinae Plane Block and Intravenous Lidocaine in Opioid-Free Anesthesia for Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial.

Ultrasound-guided subcostal transversus abdominis plane (USG-subcostal TAP) block is commonly used for post-operative analgesia in laparoscopic sleeve gastrectomy (LSG). Laparoscopic-guided subcostal TAP (L-subcostal TAP) offers a practical alternative, especially in resource-limited settings. However, comparative evidence in the LSG population is limited. This prospective, randomised trial included 50 patients undergoing LSG, assigned to either L-subcostal TAP or USG-subcostal TAP groups. Pain scores at rest and during movement (Numeric Rating Scale), rescue analgesic requirements, antiemetic use and patient satisfaction (Quality Improvement in Post-operative Pain Survey) were assessed at post-operative 30 min, 1, 2, 6, 12 and 24 h. Pain scores were similar across the groups during the first 12 h. At 24 h, USG-subcostal TAP was associated with significantly lower pain scores at rest and during movement (P < 0.05). Additional analgesics were required in four patients in the L-subcostal TAP group, while none were needed in the USG group (P = 0.037). Satisfaction levels were high in both the groups, and no complications occurred. A negative correlation was found between satisfaction and the need for rescue analgesia. Both USG-subcostal and L-subcostal TAP blocks provide effective early post-operative analgesia in LSG. While USG-subcostal TAP had a longer duration of effect, L-subcostal TAP offers practical advantages including ease of use, shorter application time and no requirement for specialised equipment. In settings with limited access to ultrasound or trained personnel, L-subcostal TAP can be considered a safe and effective alternative within multimodal analgesia strategies.

Metabolic and bariatric surgery (MBS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are both effective strategies for obesity management, but their comparative efficacy remains uncertain. This systematic review and meta-analysis aimed to compare weight loss outcomes between MBS and GLP-1 RA therapy in adults with obesity. A systematic search of PubMed, Scopus, and Cochrane Library was conducted from inception to September 22, 2025. Eligible studies included randomized and observational comparisons between MBS-specifically sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB)-and GLP-1 RA therapy in adults with obesity. Pooled mean differences (MDs) for total weight loss (TWL) and body mass index (BMI) change were calculated using a DerSimonian-Laird random-effects model. Risk of bias was assessed using ROBINS-I V2, and certainty of evidence was graded with GRADE. Five retrospective observational studies (n = 5,944; 3,489 MBS, 2,455 GLP-1 RA) met the inclusion criteria. Pooled analysis showed significantly greater TWL in the MBS group (MD - 18.15%; 95% CI 16.41 to 19.90; p < 0.0001; I² = 95%) and larger BMI reduction (MD 8.73kg/m²; 95% CI 5.87 to 11.58; p = 0.0001; I² = 94.6%). Sensitivity analyses confirmed the robustness of these results. Overall risk of bias was moderate, primarily due to non-randomized designs and treatment selection bias. Certainty of evidence was rated as moderate. MBS achieves significantly greater and more durable weight loss compared with GLP-1 RA therapy, reaffirming its role as the most effective intervention for severe obesity. While GLP-1 RAs represent valuable noninvasive or adjunctive options, surgery remains the benchmark for sustained metabolic and weight outcomes.

With the increasing prevalence of sleeve gastrectomy, complications and insufficient weight loss have become more common, making conversion to Roux-en-Y gastric bypass (RYGB) a frequent revisional approach. Given the higher risk of revisional surgery, we aimed to compare primary versus conversion RYGB surgery and assess whether robotic assistance impacts outcomes. This retrospective study included 378 patients after 2:1 propensity score matching based on demographic and clinical characteristics, comparing primary Roux-en-Y gastric bypass (P-RYGB) with sleeve gastrectomy-to-Roux-en-Y gastric bypass (SG-RYGB). The matched cohort included both robotic and laparoscopic cases performed at a single tertiary center between 2012 and 2024. A secondary 2:1 matched sub-analysis of robotic cases (n = 297) evaluated whether robotic assistance reduced differences between primary and revisional surgery. Weight-loss outcomes were assessed at 6 and 12 months in the full cohort, with an additional sub-analysis limited to SG-RYGB performed for weight-loss indications. In the full cohort (n = 378), SG-RYGB was associated with longer operative time, greater blood loss (P < .001), longer hospital stay (P = .04), and higher late complication rates (P = .04). In the robotic-only matched analysis (n = 297), differences in operative time and blood loss were no longer significant, and early and late outcomes were comparable, although length of stay still remained longer for SG-RYGB (P = .05). Among patients undergoing SG-RYGB for weight loss purposes only, total body weight loss percentage reached 16.5% ± 6.6% at 6 months and 20.4% ± 7.1% at 12 months but remained lower than that observed in the P-RYGB group (P < .001). SG-RYGB conversion demonstrated favorable outcomes and meaningful weight loss. Robotic assistance was associated with improved operative time, reduced blood loss, and fewer late complications in the SG-RYGB group, further narrowing differences with P-RYGB, supporting its role in complex revisional bariatric surgery at high-volume centers.

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.

Bariatric surgery (BS) can modulate drug pharmacokinetics. This review sought to provide an overview of the available literature and to establish practical recommendations pertaining to the use of drugs commonly used in dermatology in the post-BS setting. PubMed, EMBASE and Cochrane Library databases were systematically reviewed. This study utilised the PRISMA guidelines and was registered on PROSPERO (ID CRD42024505309). Data collection and risk of bias analysis were conducted in duplicate. This review identified 132 eligible studies. Key inclusion criteria included: primary clinical publication, contains information on the implications of BS on medications used in dermatology and full-text availability. Key exclusion criteria included secondary clinical publications, editorials, animal studies and conference abstracts, not providing information on the impact of BS on drugs commonly used in dermatology, articles written in languages other than English and unavailability of the full-text. Oral liquid formulations, crushed tablets, opened capsules or non-oral alternatives may be preferred over solid formulations. Avoidance of enteric-coated and extended-release formulations has been suggested. Dose escalation may be required for highly lipophilic drugs such as acitretin and isotretinoin. Switching to non-oral contraceptive options may be favoured due to reports of reduced efficacy with oral contraception. Avoidance of non-steroidal anti-inflammatory drugs and oral corticosteroids has been recommended due to the risk of gastrointestinal bleeding and marginal ulceration. The use of direct oral anticoagulants may also increase bleeding risk, post-BS. Dose modifications for mycophenolate mofetil may not be required post-laparoscopic sleeve gastrectomy. The bioavailability of oral tyrosine/Janus kinase inhibitors may be decreased; dose escalation may be required in cases of suboptimal treatment response. Consideration of the potential pharmacokinetic effects of BS on drugs used in dermatology is fundamental to ensure optimal patient care. Until more robust data are available, management should be individualised with frequent monitoring of clinical response, laboratory markers and plasma drug levels. Collaboration with a clinical pharmacist is strongly advised.

Obesity is a chronic condition characterized by low-grade systemic inflammation, oxidative stress, and impaired fibrinolysis, all of which contribute to elevated cardiovascular risk. This study aimed to investigate the association between carotid intima-media thickness (CIMT), oxidized Low-Density Lipoprotein (ox-LDL), plasminogen activator inhibitor-1 (PAI-1), and inflammatory biomarkers in patients with obesity undergoing sleeve gastrectomy (SG), a widely performed metabolic and bariatric surgery (MBS) procedure. This prospective study included 93 patients with obesity who underwent SG. CIMT, body mass index (BMI), and waist-hip ratio were measured preoperatively and one year postoperatively. Concurrently, serum levels of ox-LDL, PAI-1, lipid profile, HOMA-IR, leptin, and high-sensitivity C-reactive protein (hs-CRP) were assessed. One year after surgery, significant reductions were observed in CIMT, anthropometric parameters, inflammatory biomarkers (leptin, hs-CRP), insulin resistance, ox-LDL, and PAI-1 levels, along with improvement in lipid profile. PAI-1 was positively correlated with ox-LDL (MD: 5.94, 95% CI: 4.48-7.39; p < 0.001), and ox-LDL was a predictor of PAI-1 levels (MD: 0.05, 95% CI: 0.04-0.06; p < 0.001). In ROC analysis for predicting CIMT ≥ 1mm, ox-LDL showed acceptable discriminative ability (AUC: 0.73; sensitivity: 82.1%, specificity: 64.8%), while PAI-1 demonstrated limited performance (AUC: 0.64; sensitivity: 48.7%, specificity: 79.6%). Weight loss following SG was associated with improvement in inflammatory, oxidative, and fibrinolytic biomarkers. Ox-LDL was more strongly linked to CIMT than PAI-1, which showed limited predictive value. Further studies are needed to evaluate the relationship between CIMT and other fibrinolysis biomarkers such as thrombin-activatable fibrinolysis inhibitor (TAFI) and D-dimer in the context of MBS.

What is the frequency of ovulatory recovery (OvR) after different degrees of total weight loss (TWL) in women with polycystic ovary syndrome (PCOS) and obesity, and can an excessive degree of TWL be identified that is harmful to the chance of OvR? Any degree of TWL was associated with a higher likelihood of OvR, and no upper threshold of TWL associated with reduced OvR was identified. Modest weight loss (5-10%) improves reproductive function in women with PCOS. However, the relationship between greater degrees of TWL and OvR remains uncertain. Secondary post hoc analysis of a multicentre, open-label, randomised controlled trial (BAMBINI) conducted in the UK between February 2020 and April 2023. Eighty women were randomised (1:1) to standard medical care or vertical sleeve gastrectomy. Seventy-five were included in this analysis and followed up for 52 weeks. Participants had PCOS, a BMI of 35 kg/m2 or higher, and oligomenorrhea/amenorrhoea. OvR was defined as two consecutive biochemically confirmed ovulatory events (serum progesterone 16.0 nmol/l or higher), occurring 3-5 weeks apart within the 52 week follow up period. Associations between TWL, reproductive hormones, and OvR were analysed using logistic regression. Analyses were exploratory and not prespecified. At 52 weeks, 50.8% (38/75) achieved OvR. OvR occurred in 19% of participants without weight loss and in >50% of those who lost weight. Each 1% reduction in body weight was associated with a 5.6% increase in the odds of OvR (OR 0.944, 95% CI 0.900-0.990). Higher baseline serum anti-Müllerian hormone (OR 0.963, 95% CI [0.938-0.988]; P = 0.004) and higher plasma total testosterone (OR 0.324, 95% CI [0.142-0.742]; P = 0.008) were associated with lower odds of OvR. Greater TWL following bariatric surgery was associated with increased sex hormone-binding globulin and reduced free androgen index. This was an exploratory post hoc analysis not designed to define optimal or upper TWL thresholds. The study was not powered to detect potential adverse reproductive effects at higher degrees of TWL. These findings suggest that OvR in women with PCOS and obesity improves progressively with increasing TWL, supporting weight loss strategies including bariatric surgery in appropriately selected women not seeking imminent pregnancy. The Jon Moulton Charity Trust funded the BAMBINI trial. This work was supported by grants from the National Institute of Health Research (NIHR), the NIHR/Wellcome Trust Imperial Clinical Research Facility, and the NIHR Imperial Biomedical Research Centre. The Section of Endocrinology and Investigative Medicine was funded by grants from the Medical Research Council (MRC), Biotechnology and Biological Sciences Research Council (BBSRC), and the NIHR, and was supported by the NIHR Biomedical Research Centre Funding Scheme. The views expressed are those of the author(s) and not necessarily those of the MRC, the NHS, the NIHR, or the Department of Health. S.N.S.S. was supported by an Imperial post-doctoral post-CCT Fellowship. A.A. was supported by an NIHR Clinician Scientist Award CS-2018-18-ST2-002. All authors acknowledge infrastructure support for this research from the NIHR Imperial Biomedical Research Centre (BRC).A.D.M. has received research funding from the Medical Research Council (MRC), National Institute for Health and Care Research (NIHR), Jon Moulton Charitable Foundation, PEACEPLUS programme (EU and UK government), Anabio, Fractyl, Boehringer Ingelheim, Eli Lilly, Gila, Randox, and Novo Nordisk. A.D.M. has received honoraria for lectures and presentations from Novo Nordisk, AstraZeneca, Currax Pharmaceuticals, Boehringer Ingelheim, Screen Health, GI Dynamics, Algorithm, Eli Lilly, Ethicon, and Medtronic. A.D.M. is a shareholder in the Beyond BMI clinic, which provides clinical obesity care. H.R. is on the advisory board for Novo Nordisk and is the national lead for the REDEFINE 3 trial. N/A.

Is All Weight Loss Equal Following Sleeve Gastrectomy? Defining Body Composition and Anthropometric Thresholds for Hyperglycemia Remission in Women from a Prospective Cohort Study.

This study aimed to assess depressive and anxiety symptoms after bariatric surgery and to identify clinical, socioeconomic and psychosocial factors associated with postoperative psychological outcomes. This cross-sectional study included 300 adults who had undergone bariatric surgery at least 12 months previously (172 sleeve gastrectomy and 128 gastric bypass). Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and anxiety symptoms using the Generalized Anxiety Disorder-7 (GAD-7). Psychosocial factors were assessed using the Rosenberg Self-Esteem Scale (RSES), Body Shape Questionnaire (BSQ), Emotional Eating Scale (EES) and Multidimensional Scale of Perceived Social Support (MSPSS). Socioeconomic status, psychotropic medication use and percentage of total weight loss (%TWL) were recorded. Group comparisons, correlation analyses and multivariable linear regression were performed. Patients who underwent gastric bypass reported significantly higher depressive and anxiety symptoms compared with sleeve gastrectomy patients (PHQ-9: 9.7±4.2 vs 7.3±3.7; GAD-7: 8.5±4.0 vs 6.5±3.9; both p<0.01). Greater %TWL was inversely associated with depressive (r = -0.29, p<0.001) and anxiety symptoms (r = -0.24, p<0.001). Participants with struggling socioeconomic status had higher PHQ-9 scores than those with comfortable status (10.4±4.5 vs 7.1±3.4; Cohen's d=0.73), and psychotropic medication users reported greater symptom severity than non-users (PHQ-9: 10.8±4.3 vs 7.3±3.6; p<0.001). Depressive and anxiety symptoms were moderately correlated with lower self-esteem (RSES), greater body image dissatisfaction (BSQ), higher emotional eating (EES) and lower perceived social support (MSPSS) (all |r|=0.30-0.55). In multivariable regression, surgery type, %TWL, socioeconomic status and psychotropic medication use independently predicted depressive symptoms, with the model explaining approximately 33% of the variance. Bariatric surgery affects physical and mental health. Gastric bypass patients report more depression and anxiety, sleeve gastrectomy boosts self-esteem, and weight loss improves well-being, though social and medication factors raise psychological risk.

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.

To evaluate 10-year outcomes after laparoscopic sleeve gastrectomy (LSG), focusing on weight loss, quality of life, patient satisfaction, physical activity, and psychosocial factors. A prospective cohort of 300 patients who underwent LSG between January 2013 and July 2014 was evaluated. Inclusion criteria were first-time metabolic bariatric surgery, age ≥18 years, and absence of perioperative complications. Long-term follow-up was achieved for 193 patients (64.3% retention). At baseline, mean BMI was 42.54 ± 5.10 kg/m² and mean age 42.86 ± 10.65 years. Substantial weight loss occurred, with BMI decreasing to 29.15 kg/m² at one year (p < .001). Weight regain began after three years, reaching a mean BMI of 31.89 kg/m² at 10 years, while 51.5% maintained ≥25% excess weight loss. Overall, quality of life improved in 86.1% of patients, with over half reporting excellent outcomes. The greatest improvements occurred in the self-esteem, physical activity, and social engagement domains of the MA-II, with smaller gains in sexual satisfaction and eating behavior. A significant decline in global quality of life (QOL) was observed over time (p < .001). Postoperatively, 59.3% participated in structured physical activity programs, while 40.7% remained sedentary. Psychosocial benefits included enhanced interpersonal relationships (35.6%) and greater social participation, although a minority reported marital strain (8.3%) or reduced overall satisfaction. LSG provides durable weight loss and significant improvements in quality of life across multiple MA-II domains, accompanied by high patient satisfaction (85.6%) and healthier lifestyle behaviors. Nonetheless, partial weight regains, sedentary habits, and variable psychosocial outcomes persist.

Safe establishment of pneumoperitoneum is essential in laparoscopic surgery because most access-related injuries occur during peritoneal entry. In Veress needle procedures, this step is performed blindly, and conventional verification tests are subjective and often unreliable. The negative pressure-based visualization (NPV) technique enables real-time confirmation of peritoneal entry using a saline column. We therefore developed a manometric modification (NPMV) and a four-forceps technique (NPMV4) to improve practicality and applicability in obese patients. This retrospective study included two cohorts: a standard-weight cohort of 475 patients undergoing laparoscopic groin hernia repair (243 NPMV, 232 NPV) and an obese cohort of 53 patients undergoing laparoscopic sleeve gastrectomy (33 four-forceps, 20 two-forceps). In the NPMV, the Veress needle was connected to an insufflator with a manometric display, and peritoneal entry was confirmed at a pressure of minus 2mmHg or lower. Primary outcomes were pneumoperitoneum success and access-related complications; secondary outcomes included access time and puncture attempts. In the standard-weight cohort, pneumoperitoneum success was 99% in both groups, with no differences in complications or puncture attempts. The NPMV group achieved a significantly shorter time to insufflation (median 1.0 vs 2.0min, p < 0.001). In the obese cohort, the four-forceps group showed fewer failed entries (3% vs 15%) and significantly fewer puncture attempts (median 1.0 vs 3.5, p = 0.019), without increased gas-related complications. Replacing the saline column with a manometric display did not increase access-related complications and improved procedural efficiency. The NPMV4 technique furtherimproved the reliability of laparoscopic access in obese patients. These stepwise modifications provide a simple, reproducible, and reliable approach to Veress needle access across diverse surgical populations.

Ultra-early Physiotherapy Mobilization within ERAS (Enhanced Recovery after Surgery) with Incentive Spirometry after Laparoscopic Sleeve Gastrectomy in Metabolic Bariatric Surgery: Randomized Clinical Trial.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely linked to obesity and insulin resistance, and sustained weight loss is associated with histological improvement. Whether different obesity-management modalities exert weight-independent hepatic effects remains uncertain. We conducted a systematic review and network meta-analysis (NMA) of randomised controlled trials evaluating lifestyle intervention, obesity management medications, endoscopic sleeve gastroplasty and metabolic and bariatric surgery in adults with BMI ≥ 27 kg/m2 and biopsy-confirmed MASH. The primary endpoint was MASH resolution without worsening of fibrosis. Study-level meta-regressions explored associations between total body weight loss (TBWL%) and histologic outcomes. Six RCTs (n = 1379) met inclusion criteria. Tirzepatide, semaglutide, sleeve gastrectomy and Roux-en-Y gastric bypass were superior to placebo or standard care for achieving MASH resolution. Because the network was weakly connected and largely placebo-anchored, indirect estimates were imprecise. Across study arms, greater TBWL% was associated with higher rates of MASH resolution and fibrosis improvement; however, these associations were strongly influenced by a small number of high-weight-loss surgical arms. Weight loss was consistently associated with histologic improvement across available RCTs. However, the limited evidence base, sparse network structure and ecological nature of the meta-regression preclude causal inference. These findings should be considered exploratory and hypothesis-generating, underscoring the need for adequately powered head-to-head trials.

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.

Sex disparities in patients undergoing metabolic bariatric surgery: Data from a national registry.

The post anesthesia recovery phase following bariatric surgery is a high-risk period characterized by increased susceptibility to respiratory and hemodynamic complications, warranting prolonged monitoring and targeted interventions. Despite advancements in perioperative care, the identification of risk factors for extended recovery remains a critical unmet need in obese populations. This single-center retrospective study analyzed 169 consecutive patients undergoing laparoscopic sleeve gastrectomy for metabolic syndrome and extubated in post anesthesia care unit (PACU) at Peking University Third Hospital (2015-2025). Patients were stratified by PACU length of stay (LOS) into extended (≥ 42min, 75th percentile) and control (< 42min) groups. Comprehensive perioperative variables were evaluated, including ‌preoperative data of demographic profiles, American Society of Anesthesiologists (ASA) physical status, higher body mass index (BMI), obesity surgery mortality risk score (OS-MRS), and obstructive sleep apnea syndrome (OSAS) comorbidity; ‌Intraoperative and postoperative‌ data including procedure duration, hypoxemia incidence, pain scores, rate of postoperative nausea and vomiting, number of rescue antiemetic administered, postoperative complications, reoperation rates, length of hospital stay, 30-day readmission rates and mortality. Univariate analysis and binary Logistic regression analysis were performed to find the risk factors of prolonged LOS. The extended PACU-LOS group (n = 45, 26.6%) demonstrated significantly higher BMI (40.6 [38.1, 47.2] vs. 38.7 [34.9, 44.0] kg/m², p = 0.007), ASA III prevalence (66.7%% vs. 25.8%, p < 0.001), existence of OSAS (71.1% vs. 33.1%, p < 0.001), intraoperative peak end-tidal carbon dioxide partial pressure (41 [39, 46] vs.39 [36, 42] p < 0.001) and post-extubation hypoxemia incidence (62.2% vs. 9.7%, p < 0.001). Logistic regression analysis identified three independent predictors: post-extubation hypoxemia (OR = 14.771, 95%CI: 5.557 ~ 39.268), ASA III (OR = 3.924, 95%CI: 1.362 ~ 11.304), and OSAS (OR = 3.122, 95%CI:1.091 ~ 8.934). ASA III classification, preexisting OSAS, and post-extubation hypoxemia independently predict extended PACU-LOS in patients undergone laparoscopic sleeve gastrectomy. These findings underscore the imperative for preoperative risk stratification using standardized scoring systems, protocolized post-extubation oxygenation strategies, and resource allocation for high-dependency monitoring in at-risk patients. While this study establishes predictors of extended PACU-LOS, its correlation with postoperative complications warrants dedicated future investigation.