Current Issues and Developments in Bariatric and Metabolic Surgery for Severe Obesity

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: 31 July 2026 | Viewed by 8346

Special Issue Editor


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Guest Editor
Clinical Department of Surgery, University of Edinburgh, Royal Infirmary, Edinburgh EH8 9YL, UK
Interests: Bariatric and metabolic surgery; emergency general surgery; surgical outcomes

Special Issue Information

Dear Colleagues,

Severe obesity is an increasing problem worldwide and a leading cause of early mortality and health concerns. Bariatric and metabolic surgery is a safe and effective treatment with excellent long-term results regarding weight loss, comorbidity, and disease prevention. Bariatric surgery continues to develop, in terms of safety, indications, and improved outcomes. Endobariatric surgery is a subsequent new subset of bariatric interventions that have been shown to have promising outcomes.

This Special Issue aims to promote current research into updates, new issues, or developments in bariatric and endobariatric surgery and treating obesity.

We are soliciting all cutting-edge papers on bariatric and metabolic surgery, endobariatric treatments, and obesity and its management.

Dr. Andrew G Robertson
Guest Editor

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Keywords

  • bariatric and metabolic surgery
  • obesity
  • endobariatric surgery

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Published Papers (4 papers)

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Research

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13 pages, 772 KB  
Article
A Comprehensive Analysis of Predictors of Marginal Ulcers After Roux-en-Y Gastric Bypass: A Cohort Review of 2106 Patients
by Tala Abedalqader, Alberto Migliorini, Leonardo Garcia Cerecedo, Nour El Ghazal, Joseph Klim, Tony Boutros, Simon J. Laplante and Omar M. Ghanem
Medicina 2026, 62(5), 838; https://doi.org/10.3390/medicina62050838 - 28 Apr 2026
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Abstract
Background and Objectives: Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed metabolic and bariatric surgeries worldwide. Marginal ulcers (MU) are a common complication following RYGB, yet their pathophysiology and the contributing risk factors to their development are not fully understood. [...] Read more.
Background and Objectives: Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed metabolic and bariatric surgeries worldwide. Marginal ulcers (MU) are a common complication following RYGB, yet their pathophysiology and the contributing risk factors to their development are not fully understood. Materials and Methods: This retrospective cohort study examined patients who underwent RYGB between January 2008 and December 2023, with 1 to 5 years of follow-up. Data collected included patient- and procedure-related risk factors, as well as postoperative MU events. Statistical analysis methods included the independent samples t-tests, multivariate regression, and Cox regression analyses. Results: Our final cohort included 2106 patients and was predominantly female (80.5%), with a mean age of 47.8 ± 12.1 years and body mass index (BMI) of 45.5 ± 7.5 kg/m2. MU occurred in 241 (11.4%) patients, with a mean time to occurrence of 4.5 ± 0.02 years. History of smoking (HR = 1.87, p < 0.001) and gastroesophageal reflux disease (HR = 2.36, p < 0.001) significantly increased hazard for MU, while proton pump inhibitor use (HR = 0.18, p < 0.001) was associated with reduced hazard. Aspirin exposure, regardless of dose and chronicity, did not impact MU. Conclusions: Our findings highlight the importance of preoperative assessment and counseling in patients planning to undergo RYGB. Patient-related factors should guide postoperative monitoring and prophylaxis of MU, as this remains a debated topic amongst experts. Full article
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16 pages, 358 KB  
Article
Multimodal Evaluation of Body Composition and Muscle Strength in Women Before and After Bariatric Surgery: A Clinical Observational Study
by Paulo Cesar Grippa, Karina Quesada, Gabriella de Oliveira Barboza, Maria Eduarda Garcia Marvulle, Daniele Candido, Nathália Mendes Machado, Lucas Fornari Laurindo, Adriano Cressoni Araújo, Enzo Pereira de Lima, Elen Landgraf Guiguer, Marcelo Dib Bechara, Cláudia Rucco Penteado Detregiachi, Eduardo Federighi Baisi Chagas and Sandra Maria Barbalho
Medicina 2026, 62(1), 182; https://doi.org/10.3390/medicina62010182 - 16 Jan 2026
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Abstract
Background and Objectives: Obesity has been increasing sharply worldwide and is related to diabetes, cardiovascular diseases, liver disease, and cancer. Sleeve gastrectomy is the most used surgical approach to reduce body weight and treat metabolic implications observed in patients with moderate-to-severe obesity. [...] Read more.
Background and Objectives: Obesity has been increasing sharply worldwide and is related to diabetes, cardiovascular diseases, liver disease, and cancer. Sleeve gastrectomy is the most used surgical approach to reduce body weight and treat metabolic implications observed in patients with moderate-to-severe obesity. On the other hand, this procedure affects the musculoskeletal system, and investigating skeletal muscle is not routinely recommended for bariatric surgery. This study aimed to evaluate the psoas muscle in patients in the preoperative period of sleeve gastrectomy and six months after the procedure using abdominal computed tomography scans. Materials and Methods: This clinical, exploratory, and observational study, with a prospective longitudinal observational study design, was conducted at a single center with 31 women who underwent sleeve gastrectomy. The evaluations were performed before and after six months of the procedures. Results: Anthropometric, muscle strength, hepatic ultrasound, and psoas computerized tomography evaluations were performed. A significant reduction in body weight, body mass index, waist, neck, and calf circumference was observed. There was also a substantial reduction in right-hand strength and the area and index of the psoas muscle (but with an increase in density). Most presented a routine abdominal ultrasound. Conclusions: Our results suggest that muscle evaluation provides valuable information for clinical monitoring before and after bariatric surgery, helping to identify potential risks and guide multidisciplinary follow-up. Psoas muscle area and psoas muscle index decreased, but psoas muscle density increased, all significantly. These results indicate that conducting a muscle evaluation is helpful for patients undergoing bariatric surgery, supporting the use of the clinical approach before and after the procedure, predicting possible complications, and providing more accurate prognoses. Full article
11 pages, 1409 KB  
Article
Intravenous Iron Infusion in the Treatment of Iron Deficiency Anaemia Following Bariatric and Metabolic Surgery and Correlation with Gynaecological Disorders: Retrospective Review of Experience from a Tertiary Centre
by Emma MacVicar, Nivar Saleh, Joy Tneoh, James Lucocq, Georgios Geropoulos, Beverley Wallace, Anne Ewing, Peter J. Lamb, Gillian Drummond, Brian Joyce and Andrew G. Robertson
Medicina 2025, 61(9), 1647; https://doi.org/10.3390/medicina61091647 - 11 Sep 2025
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Abstract
Background and Objectives: Iron deficiency anaemia (IDA) is a common consequence of bariatric and metabolic surgery (BMS). Women are at higher risk, and some patients cannot tolerate oral iron. This study aimed to report the demographics of patients with IDA that required [...] Read more.
Background and Objectives: Iron deficiency anaemia (IDA) is a common consequence of bariatric and metabolic surgery (BMS). Women are at higher risk, and some patients cannot tolerate oral iron. This study aimed to report the demographics of patients with IDA that required iron infusion post-BMS and to investigate risk factors including gynaecological dysfunction. Materials and Methods: The medical records for all patients (n = 383) post-BMS at a large tertiary centre from January 2017 to December 2024 were reviewed, and those who received intravenous iron infusion (n = 32) for IDA were included. The criteria for iron infusion were ferritin < 50 µg/L or intolerance to oral iron. Demographic information including co-morbidities—gynaecological and other—age, pre-operative weight, body mass index (BMI), and ferritin levels were collected to investigate possible risk factors for IDA. Results: Thirty-two patients, all female, received one or more parenteral iron infusions. Eighteen had surgery locally; 14 had surgery elsewhere. Operations varied and included 14 Roux-en-Y gastric bypasses, 14 sleeve gastrectomy’s, and 4 gastric bands or other procedures. Eleven patients had a history of gynaecological disorders. Pre-infusion ferritin levels in the cohort with gynaecological disorders versus the cohort without were lower (median 11.0 vs. 14.5 µg/L), with a shorter time to presentation (median 6.9 vs. 10.2 years), and more patients requiring >2 infusions for resolution of symptoms (36.4% vs. 9.5%). Conclusions: Locally, 95% of our patients did not require iron infusion post-BMS. Eighty percent of those who did require iron infusion responded to ≤2 infusions. Women with a history of gynaecological disorder who underwent BMS required a significantly higher number of iron infusions and presented with symptoms sooner post-operatively vs. those without gynaecological disorders, particularly following Roux-en-Y gastric bypass. This is an important observation to consider both pre- and post-operatively for patients undergoing bariatric surgery, and additional well-designed studies that investigate this further are needed. Full article
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13 pages, 1598 KB  
Systematic Review
Outcomes of Endoscopic Sleeve Gastroplasty: A Systematic Review
by Vanessa Pamela Salolin Vargas, Omar Thaher, Moustafa Elshafei, Sjaak Pouwels and Carolina Pape-Köhler
Medicina 2025, 61(10), 1821; https://doi.org/10.3390/medicina61101821 - 11 Oct 2025
Cited by 1 | Viewed by 4206
Abstract
Background and Objectives: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic procedure that has demonstrated both safety and effectiveness in the treatment of obesity. By reducing the stomach’s volume without the need for surgical incisions, ESG promotes weight loss and can [...] Read more.
Background and Objectives: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic procedure that has demonstrated both safety and effectiveness in the treatment of obesity. By reducing the stomach’s volume without the need for surgical incisions, ESG promotes weight loss and can improve obesity-related comorbidities. However, patient responses to ESG can vary significantly. Materials and Methods: A comprehensive search was performed on PubMed, Embase, and Cochrane for studies with endoscopic sleeve gastroplasty; the main outcomes of interest are BMI, weight loss, and postinterventional complications. The search strategy employed a combination of keywords and Medical Subject Heading (MeSH) terms, including “endoscopic sleeve gastroplasty,” “endoscopy,” and “overweight”. To ensure the thoroughness of the review, additional manual searches of key journals and the reference lists of identified studies were performed. Grey literature, such as dissertations and conference abstracts, meta-analysis, and systematic reviews, was excluded to maintain a focus on peer-reviewed evidence. Duplicate records were identified and removed using Rayyan software to streamline the screening process. The I2 test was employed for heterogeneity assessment, while the risk of bias was evaluated utilizing ROBINS-I. Results: Our literature search resulted in the inclusion of 38 studies. Endoscopic sleeve gastroplasty for weight loss is important since it is more effective than pharmacological treatments and lifestyle changes and presents lower adverse event rates compared to bariatric surgery. Long-term weight loss outcomes varied, with total body weight loss ranging from 16% to 20.9% over a period from 2 to 5 years, while excess weight loss ranged from 13% to 79%. Revisional procedures showed higher failure rates, with up to 34.3% of patients experiencing insufficient weight loss. Most interventions led to clinically significant and sustained weight loss, though variability in outcomes highlights the need for further research to optimize long-term weight management strategies. Conclusions: Endoscopic sleeve gastroplasty (ESG) emerges as a promising minimally invasive option for weight loss, offering significant improvements in both weight reduction and obesity-related comorbidities, such as diabetes, hypertension, and dyslipidemia. Full article
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