Sleeve to gastric bypass conversion: a multiinstitutional study of 217 patients.

Background: Revision of a sleeve gastrectomy (SG) to a Roux-en-Y gastric bypass (RYGB) is indicated for gastroesophageal reflux disease (GERD) and for weight recurrence. Existing literature is conflicting and lacks long-term follow-up.

Objectives: To evaluate the resolution of GERD and additional weight loss after conversion of SG to RYGB.

Impact of Metabolic Surgery on the Severity and Outcomes of Acute Pancreatitis: A Retrospective Matched Cohort Study.

Background: Patients with a history of Metabolic and Bariatric Surgery (MBS) face an increased risk of acute pancreatitis (AP) due to factors like rapid weight loss and altered gastrointestinal anatomy. However, data on the severity and outcomes of AP in these patients are limited. This study evaluates whether a history of MBS, particularly Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS), affects the severity and clinical outcomes of AP.

Secondary Peristalsis Is More Affected Than Primary Peristalsis by Increased Intragastric Pressure After Metabolic Bariatric Surgery: Findings From Functional Lumen Imaging Probe and High-Resolution Esophageal Manometry.

Introduction: Esophageal dysmotility following metabolic bariatric surgery (MBS) may relate to decreased gastric compliance. We investigated high-resolution esophageal manometry (HRM) and secondary peristalsis assessed by functional lumen imaging probe (FLIP) and their association with intragastric pressure after MBS.

Methods: Patients undergoing HRM, FLIP, and barium esophagram (BE) after MBS were included.

Trends in bariatric surgery revisions: a 25-year single-institution experience.

Background: Revisional bariatric surgery (RBS) is now the third most performed metabolic and bariatric surgery (MBS) in the USA. This study aims to describe trends in MBS revisions at a single large academic institution over 25 years.

Methods: We identified patients who underwent an MBS revision between 2000 and 2024 at a single large quaternary referral center from a prospectively maintained database.

Single-anastomosis duodenal-ileal bypass with sleeve gastrectomy for diabetes: predictors of remission and metabolic outcomes in a multicenter study.

Background: The single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) combines the restrictive aspects of a sleeve gastrectomy (SG) with the hypoabsorptive advantages of a gastric bypass. SADI-S has demonstrated excellent weight loss outcomes and technical feasibility.

Objectives: To evaluate the benefits of SADI-S in patients with obesity and type 2 diabetes mellitus.

Impact of Sleeve Gastrectomy on Kidney Function and Preemptive Transplant in Kidney Transplant Candidates With Obesity.

Objective: To compare the impact of sleeve gastrectomy (SG) on kidney function, comorbidities, and kidney transplant (KT) rates in KT candidates with obesity with a nonsurgical cohort.

Methods: Twenty-one KT candidates with body mass index (BMI) above 35 kg/m underwent SG between February 26, 2021, and October 27, 2023, and were compared with 19 who did not have SG. The secondary endpoints included changes in BMI, requirements for antihyperglycemic and antihypertension medications, and preemptive KT rates.

Mechanisms of Gastroesophageal Reflux Post-Roux-en-Y Gastric Bypass: Universal Alteration of the Antireflux Barrier is the Culprit.

Introduction: Gastroesophageal reflux disease (GERD) symptoms and the use of proton pump inhibitors (PPIs) remain prevalent after Roux-en-Y Gastric Bypass (RYGB), despite it being known to alleviate reflux. The physiological changes behind long-term GERD and hiatal hernia (HH) prevalence post-RYGB are not commonly investigated.

Methods: In this consecutive cohort study, we examined patients who underwent RYGB and subsequent upper endoscopy, conducted by an expert bariatric endoscopist.

Rediscovering Sweetness: The Evolution and Impact of Non-Nutritive and Natural Sweeteners.

Purpose Of The Review: The escalating incidence of obesity and metabolic syndromes has catalyzed a critical evaluation of dietary sugars, leading to an increased interest in non-nutritive and natural sweeteners as viable alternatives. This manuscript reviews the historical developments, safety profiles, and health-related consequences of these sweeteners, tracing the evolution from early discoveries such as saccharin and cyclamate to contemporary compounds like aspartame, sucralose, and plant-derived sweeteners.

Recent Findings: We explore the physiological mechanisms underpinning sweet taste perception, including the roles of T1R and T2R receptors, and the neurochemical pathways involving dopamine in mediating the rewarding effects of sugar consumption.

Hypoabsorption in Bariatric Surgery: Is the Benefit Worth the Risk?

Metabolic and bariatric surgery has been well described in the existing literature to be an effective and safe modality for weight loss in patients with obesity. Recently, hypoabsorptive procedures such as one-anastomosis gastric bypass (OAGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single-anastomosis duodenoileostomy with sleeve (SADI-S) have gained traction, particularly among patients with severe obesity. These procedures combine restrictive and hypoabsorptive mechanisms, resulting in significant and sustainable weight loss, especially in those with severe obesity and associated comorbidities.

International expert consensus on the current status and future prospects of artificial intelligence in metabolic and bariatric surgery.

Artificial intelligence (AI) is transforming the landscape of medicine, including surgical science and practice. The evolution of AI from rule-based systems to advanced machine learning and deep learning algorithms has opened new avenues for its application in metabolic and bariatric surgery (MBS). AI has the potential to enhance various aspects of MBS, including education and training, decision-making, procedure planning, cost and time efficiency, optimization of surgical techniques, outcome and complication prediction, patient education, and access to care.

Choice of Anesthetic for Laparoscopic Bariatric Surgery Can Reduce the Use of Rescue Antiemetics in Postanesthesia Recovery Room: A Retrospective Observational Study.

Objective: Postoperative nausea and vomiting (PONV) is a frequent adverse event after bariatric surgery and is associated with patient dissatisfaction and increased health care burden. Aggressive multimodal antiemetic prophylaxis and the use of propofol infusion during anesthesia are associated with the reduction of PONV. In this study, we examined the use of rescue antiemetics following bariatric surgery performed with 3 different anesthetic strategies designed to reduce PONV: (1) primary volatile (VOL) anesthetic and propofol (PROP) infusion (VOL+PROP), (2) volatile anesthetic with propofol and dexmedetomidine (DEX) infusions (VOL+PROP+DEX), or (3) opioid-sparing total intravenous anesthesia (PROP+DEX).

Impact of immunosuppression medication management on short-term complications following sleeve gastrectomy.

Background: Sleeve gastrectomy (SG) is the most performed bariatric procedure in the United States due to its favorable safety profile. However, managing patients on chronic immunosuppressive therapy (CIT) during bariatric surgery poses challenges, particularly in balancing surgical outcomes with the risks associated with CIT interruption. This study aims to compare the short-term outcomes of SG in patients who temporarily discontinued CIT versus those who continued it perioperatively.

Advances in Metabolic Bariatric Surgeries and Endoscopic Therapies: A Comprehensive Narrative Review of Diabetes Remission Outcomes.

: Type 2 diabetes (T2D), closely associated with obesity, contributes to increased morbidity and mortality due to complications such as cardiometabolic disease. This review aims to evaluate the effectiveness of metabolic and bariatric surgeries (MBS) and endoscopic bariatric therapies (EBTs) in achieving diabetes remission and to examine key predictors influencing remission outcomes. : This review synthesizes data from studies on MBS and EBT outcomes, focusing on predictors for diabetes remission such as preoperative insulin use, diabetes duration, HbA1c, and C-peptide levels.

Long-Term Safety and Efficacy Profile of Bariatric Surgery in Patients Classified with ASA IV Status.

Introduction: Metabolic and bariatric surgery (MBS) is a safe and effective treatment option to reduce weight and manage obesity-related medical conditions in patients with obesity. However, due to limited data, there is uncertainty regarding the short-, mid-, and long-term safety and efficacy profile of MBS in patients with a preoperative ASA IV status.

Methods: A single-center retrospective cohort study was performed on patients with ASA IV status who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion with duodenal switch (BPD-DS) between 2008 and 2020.

Social media use among patients before and after metabolic and bariatric surgery: a systematic review.

Social media (SM) use among individuals before and after metabolic and bariatric surgery (MBS) has dramatically increased in recent years, yet the benefits and risks to patients remain unclear. This systematic review sought to synthesize the literature on SM use among individuals pre- and post-MBS. Objectives were to: 1) explore the patterns of SM use in this population, 2) identify the benefits and risks of MBS-focused SM use, and 3) inform clinicians and patients about strategies to more effectively engage with MBS-focused SM.

Iron deficiency anemia after one anastomosis gastric bypass: A systematic review and meta-analysis.

Background: One anastomosis gastric bypass (OAGB) currently stands as the third most common metabolic and bariatric surgical procedure with increasing popularity worldwide. Iron deficiency anemia (IDA) is the most prevalent anemia observed after gastric bypass procedures.

Methods: This systematic review and meta-analysis aimed to assess the overall incidence of IDA and identify the effect of biliopancreatic limb (BPL) length on the incidence of IDA in patients undergoing OAGB by a systematic literature search in PubMed, Web of Sciences, and Scopus.

Bariatric surgery and relevant comorbidities: a systematic review and meta-analysis.

Background: Obesity is a growing epidemic in the United States, and with this, has come an increasing volume of metabolic surgery operations. The ideal management of obesity-associated medical conditions surrounding these operations is yet to be determined. This review sought to investigate the routine use of intraoperative cholangiogram (IOC) with cholecystectomy during or after a bypass-type operation, the ideal management of post-sleeve gastrectomy gastroesophageal reflux disease (GERD), and the optimal bariatric operation in patients with known inflammatory bowel disease (IBD).

The Diabetes Remission Index (DRI): A Novel Prognostic Calculator Model Predicting Diabetes Remission Before and After Metabolic Procedures.

Objective: To develop and validate two predictive models, the Diabetes Remission Index (DRI) and the Weight Loss-Adjusted Diabetes Remission Index (W-DRI), for assessing type 2 diabetes (T2D) remission following metabolic and bariatric surgery (MBS).

Summary Background Data: Metabolic and bariatric surgery, including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), is highly effective in achieving T2D remission, but outcomes vary across populations. Predicting remission remains critical for individualized patient care and optimizing surgical outcomes.

Comparative effectiveness of Roux-en-Y gastric bypass and sleeve gastrectomy in achieving diabetes remission in patients with diabetes-related vascular diseases: A multicentred study.

Metabolic and bariatric surgeries (MBS), including Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG), have proven effective in promoting long-term diabetes remission among patients with type-2 diabetes (T2D). In this multicentre retrospective cohort study, we investigated the effectiveness of RYGB and SG in achieving diabetes remission, specifically among patients with T2D and vascular complications, while accounting for similar baseline diabetes severity. Although various scores predict diabetes remission after bariatric surgery, they do not consider diabetes-related vascular complications, which can influence outcomes even in patients with similar baseline T2D severity.

Effect of Limb Length on Weight Loss Outcomes Following Biliopancreatic Diversion with Duodenal Switch: A Multi-Centered Study.

Purpose: The effectiveness of biliopancreatic diversion with duodenal switch (BPD/DS) for weight loss is well established, yet there remains ongoing debate over optimal limb lengths to maximize weight loss without compromising safety. We aimed to evaluate the impact of BPD/DS limb lengths on weight loss outcomes and comorbidity resolution.

Material And Methods: A multicenter review of patients who underwent primary BPD/DS between 2008 and 2022.

Internal hernia in patients after duodenal switch: A multi-centred comparative analysis.

Biliopancreatic diversion with duodenal switch (BPD-DS) and single anastomosis duodeno-ileostomy with sleeve (SADI-S) are associated with superior and sustained weight loss outcomes. Despite their growing popularity, long-term safety profiles, particularly the risk of internal hernia (IH), remain underexplored. This study aimed to evaluate the incidence and characteristics of IH following BPD-DS and SADI-S procedures, comparing their clinical presentation, diagnostic methods, and outcomes.

SAGES guidelines for the management of comorbidities relevant to metabolic and bariatric surgery.

Background: Patients who are under consideration for or have undergone metabolic and bariatric surgery frequently have comorbid medical conditions that may make their perioperative care more complex. These recommendations address routine intraoperative cholangiography in patients with bypass-type anatomy, the management of reflux disease after sleeve gastrectomy, and the optimal bariatric procedure for patients with comorbid inflammatory bowel disease.

Methods: A systematic review was conducted including studies published from 1990 to 2022 to address these questions.