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Clinical Updates on Metabolic and Bariatric Surgery

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (27 December 2025) | Viewed by 3769

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Dr. Maria-Jose Barahona

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Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, University of Barcelona, 08221 Terrassa, Spain
Interests: obesity and bariatric surgery; type 2 diabetes; frailty

Special Issue Information

Dear Colleagues,

Obesity has emerged as one of the most critical global health challenges, significantly contributing to the rise in metabolic disorders and comorbid conditions such as type 2 diabetes and cardiovascular diseases. Bariatric and metabolic surgery has become a crucial intervention for effectively treating obesity and its related comorbidities, offering significant improvements in long-term health outcomes and quality of life. Additionally, new pharmacological treatments for obesity and technological advancements in the surgical field have recently emerged. This Special Issue aims to publish reviews and original research articles on the latest clinical advances in metabolic and bariatric surgery, focusing on how recent innovations in this field can optimize patient selection, safety, and outcomes.

We look forward to receiving your contributions.

Dr. Maria-Jose Barahona
Guest Editor

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Keywords

obesity
bariatric surgery
metabolic surgery
weight loss
obesity treatment
metabolic disorders

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Published Papers (4 papers)

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Research

11 pages, 238 KB

Open AccessFeature PaperArticle

Association of Skeletal Muscle Strength with Cognitive Performance After Metabolic Bariatric Surgery

by María-José Barahona, Andreu Simó-Servat, Montse Ibarra, Mireia Libran, Verónica Perea, Judith Castejón, Carlos Puig-Jové, Carmen Quirós and Laura Casas

J. Clin. Med. 2026, 15(2), 818; https://doi.org/10.3390/jcm15020818 - 20 Jan 2026

Viewed by 345

Abstract

Background/Objectives: Obesity is associated with cognitive decline, and metabolic bariatric surgery (MBS) can improve both physical and cognitive outcomes. However, cognitive improvements post-surgery are variable. This study explores the role of skeletal muscle health, specifically muscle strength and mass, in cognitive performance after MBS, aiming to identify factors that influence cognitive recovery. Methods: In this prospective study, 55 patients scheduled for MBS were assessed 1 month before and 12 months after surgery. Body composition, including appendicular lean mass (ALM) and fat mass, was measured using dual-energy X-ray absorptiometry (DXA). Handgrip strength (HGS) was assessed via dynamometry, and neurocognitive performance was evaluated using a standardized test battery. Results: Significant improvements in cognitive performance were observed at 12 months post-surgery in attention, memory, language, executive functions and overall cognitive performance. Regarding body composition, significant reductions were observed in fat mass and body mass index (BMI). A decrease in ALM and no changes in HGS were observed; however, when adjusted for body size, both showed an increase. Regression analysis identified baseline HGS, but not muscle mass, as a significant predictor of cognitive performance at 12 months post-surgery. Conclusions: MBS leads to significant improvements in cognitive function. Our results suggest that baseline HGS may play a role in predicting cognitive outcomes post-surgery, highlighting the need for comprehensive assessments of both physical and cognitive health in patients undergoing MBS. Further longitudinal studies are needed to explore causal relationships and the potential reversibility of cognitive deficits post-surgery. Full article

(This article belongs to the Special Issue Clinical Updates on Metabolic and Bariatric Surgery)

9 pages, 1299 KB

Open AccessArticle

Sleeve Gastrectomy Leads to Immediate, Significant Intraoperative Increase in Lower Esophageal Distensibility and Opening Area

by Michael de Cillia, Christof Mittermair, Hannes Hoi, Martin Grünbart and Helmut Weiss

J. Clin. Med. 2026, 15(2), 701; https://doi.org/10.3390/jcm15020701 - 15 Jan 2026

Viewed by 295

Abstract

Background/Objectives: Functional impairment of the complex motility system in the upper gastrointestinal tract is high in patients suffering from obesity and even higher after metabolic bariatric surgery (MBS). Sleeve gastrectomy (SG) and gastric bypass (GB) represent the most common MBS procedures worldwide. Despite procedural standardization, no diagnostic method is able to depict the functional consequences resulting from intraoperative anatomical changes during MBS. This pilot study was conducted to reveal immediate intraoperative functional effects of MBS on the anti-reflux barrier in SG and GB. Methods: A prospective analysis was performed on consecutive patients with informed consent for MBS. A standard protocol for each procedure was established prior to study onset to analyze functional parameters at the lower esophageal sphincter (LES). Measurements were conducted intraoperatively during minimally invasive SG and GB. Distensibility index (DI), intra-balloon pressure, diameter (Dmin), and minimal cross-sectional area (CSA) at the LES served as points of interest for analyzation. Results: Intraoperative evaluation was performed successfully in 40 patients and no directly related adverse events were reported. DI and Dmin intraoperatively significantly increased immediately in SG (2.1 mm²/mmHg (±0.5) vs. 2.9 mm²/mmHg (±1.3), 95% CI: −1.6 to −0.14, p = 0.023 and 12.0 mm (±1.2) vs. 13.9 mmH (±2.8), 95% CI: −3.6 to −0.2, p = 0.028, respectively) whereas GB did not affect functional measurements. Conclusions: Sleeve gastrectomy immediately and significantly influences the LES and increases the opening area whereas gastric bypass surgery appears not to influence LES distensibility or opening diameters. Intraoperative standardized EndoFLIP^TM measurements are feasible and safe and add additional real-time information during MBS. Full article

(This article belongs to the Special Issue Clinical Updates on Metabolic and Bariatric Surgery)

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9 pages, 428 KB

Open AccessEditor’s ChoiceArticle

Body Composition Changes After Bariatric Surgery: Magnitude, Timing, and Determinants of Excessive Fat-Free Mass Loss

by Noelia Perez-Romero, Montse Adell Trapé, Assumpta Caixàs, Ariadna Cidoncha Secilla, Christian Jose Herrero Vicente, Marina Luengo Moral, Alba Hernandez-Lazaro and Alexis Luna Aufroy

J. Clin. Med. 2026, 15(2), 630; https://doi.org/10.3390/jcm15020630 - 13 Jan 2026

Cited by 1 | Viewed by 934

Abstract

Background: Bariatric surgery effectively treats severe obesity, but postoperative weight loss includes reductions in both fat mass (FM) and fat-free mass (FFM). Excessive FFM loss may increase the risk of sarcopenia, frailty, and long-term weight regain, yet its magnitude and determinants are not fully established. Methods: We conducted a retrospective analysis of a prospectively collected cohort of 179 patients who underwent laparoscopic or robotic Roux-en-Y gastric bypass between January 2020 and December 2022. Anthropometric parameters and body composition (bioelectrical impedance analysis) were measured preoperatively and at 6 and 12 months. The proportion of FFM loss relative to total weight loss (%FFML/WL) was calculated, and excessive FFM loss was defined using published cut-offs (≥25%, ≥30%, and ≥35%). Predictors of FFM preservation were assessed through stepwise regression. Results: Baseline BMI was 44.1 ± 4.6 kg/m², FM 54.6 ± 10.7 kg, and FFM 61.1 ± 11.9 kg. At 6 and 12 months, BMI decreased to 31.0 ± 4.2 and 28.8 ± 4.4 kg/m², respectively; FM decreased to 35.6 ± 11.0 and 22.0 ± 10.0 kg; and FFM to 54.7 ± 9.5 and 50.1 ± 7.0 kg (all p < 0.001). Most FFM loss occurred within the first 6 months (mean − 6.4 kg). Median %FFML/WL was 26.4% at 6 months and 28.7% at 12 months. Excessive FFM loss affected 41–46% of patients (≥25%), 27–31% (≥30%), and 14% (≥35%). In multivariable analysis, FFM at 6 months was the only independent predictor of FFM at 12 months (p < 0.001). Conclusions: Bariatric surgery leads to substantial FM and FFM reductions, with nearly half of patients exceeding established %FFML/WL alert thresholds. Early postoperative body composition monitoring may help identify individuals at higher risk of FFM depletion and guide preventive strategies such as adequate protein intake and resistance training. Full article

(This article belongs to the Special Issue Clinical Updates on Metabolic and Bariatric Surgery)

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10 pages, 714 KB

Open AccessArticle

Comparison of Efficacy of Intragastric Balloon Devices as Bridging Therapy Prior to Laparoscopic Sleeve Gastrectomy

by Tomasz Klimczak, Krzysztof Słowiński, Alicja Majos, Jacek Śmigielski and Wojciech Ciesielski

J. Clin. Med. 2025, 14(21), 7602; https://doi.org/10.3390/jcm14217602 - 27 Oct 2025

Viewed by 1616

Abstract

Background: Bridge therapy before surgery is one of indications for intragastric balloon (IGB) implantation. We aim to compare the outcomes of Medsil (non-adjustable), Orbera365 (non-adjustable), and Spatz3 (adjustable) IGBs used as a bridge therapy before laparoscopic sleeve gastrectomy (LSG). Methods: The data of 148 patients with super-obesity (BMI > 50 kg/m²) who underwent IGB implantation as bridge treatment prior to LSG between July 2018 and December 2022 were analyzed. Patients were allocated according to device availability in consecutive procurement periods: Orbera365 (47 patients), Medsil (53 patients), and Spatz3 (48 patients). Weight loss (kg), BMI reduction, and percentage of excess weight loss (%EWL) were measured at 6 months. Results: Weight loss after 6 months was greatest in the Spatz3 group (mean 25 kg; median 24.64 kg; 19.46–33.04 kg) compared to the Medsil (mean 16 kg; median 16 kg; 11.7–33 kg) and Orbera365 (mean 14 kg; median 14.53 kg; 11.54–18.26 kg) groups. %EWL and %TWL were also greatest in the Spatz3 group (%EWL: 22.98%; %TWL: 14.0%) compared to the Medsil (%EWL: 15.06%; %TWL: 9.4%) and Orbera365 (%EWL: 13.71%; %TWL: 8.3%) groups. Conclusions: In super-obese patients undergoing a 6-month bridging therapy before LSG, an adjustable IGB with mid-term volume increase achieved greater short-term weight loss than non-adjustable devices. Implications for peri-operative outcomes require confirmation in prospective studies. Full article

(This article belongs to the Special Issue Clinical Updates on Metabolic and Bariatric Surgery)

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