Search Results (265)

Background/Objectives: Gastroesophageal reflux disease (GERD) seems to be a common complaint which persists or develops after metabolic bariatric surgery (MBS). Endoscopic evaluation is vital in both the preoperative and postoperative phases to ensure optimal patient outcomes. The aim of this study was to evaluate the prevalence of GERD after MBS in a 10-year follow-up and analyze the endoscopic outcomes. Methods: This retrospective, multicenter study included 368 patients who underwent single bariatric procedure. The data came from five bariatric centers in Poland, part of the BARI-10-POL project. Data on symptoms of GERD, endoscopic findings, demographics, and surgical outcomes were collected for a 10-year follow-up period. Surgical procedures included SG, Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). Results: Of the 305 patients without symptoms of GERD, 12.3% developed de novo GERD postoperatively. There was no statistical significance regarding the new-onset symptoms and the type of MBS (p = 0.074) and the presence of symptoms of GERD and the type of MBS (p = 0.208). However, SG was associated with a significantly lower likelihood of GERD remission after MBS (p = 0.005). Endoscopic evaluation showed abnormal findings in asymptomatic patients in both preoperative (35.8%) and postoperative (14.1%) examinations (p < 0.001). Conclusions: GERD may be a common issue after MBS. One-quarter of patients after MBS may experience symptoms of GERD, regardless of the type of MBS. SG appears to be associated with a higher risk of persistent symptoms of GERD and a lower likelihood of GERD remission after MBS. Asymptomatic patients both before and after MBS may have abnormal findings in gastroscopy. Full article

Background: Despite being one of the most performed bariatric procedures, there is no consensus regarding optimal limb lengths for Roux-en-Y gastric bypass (RYGB), which may impact weight loss and obesity-related comorbidity resolution. We hypothesize that a ratio-adjusted small bowel to Roux and BP limb lengths in RYGB results in superior outcomes. Objectives: This study aims to define total intestinal length (TIL) and the feasibility of its intraoperative measurement during RYGB. The findings will serve as a foundation for a subsequent randomized trial evaluating different limb length ratios and their effect on postoperative outcomes. Setting: This was a single-center prospective cohort study conducted at Cleveland Clinic Foundation-Main Campus, a tertiary referral center in the United States. Methods: Between January and June 2023, 25 patients with BMI > 40 undergoing RYGB were enrolled. Total small bowel length was measured intraoperatively, and feasibility of measurement was assessed. Patient outcomes, including total weight loss, 30-day complications, and comorbidities at 1 year were captured. Results: Mean preoperative BMI was 47.6 ± 8.0 kg/m². Mean total small bowel length was 592 ± 93.3 cm, with a mean biliopancreatic (BP) limb length of 109 ± 29 cm (18.86% ± 5.84 of total length) and Roux limb length of 103 ± 15 cm (17.71% ± 3.06 of total length). Measurement added an average of 11.5 min to operative time. Measurement feasibility was rated as “moderate” or easier in 80% of cases. One-year postoperative outcomes included a mean total weight loss of 31% and significant reductions in antihypertensive and anti-diabetic medication use. Conclusions: Total small bowel length measurement during RYGB is safe and feasible. High variability in bowel length was observed, with no significant correlation to demographic factors. Establishing individualized limb length ratios may improve weight loss outcomes and comorbidity resolution. Further studies are warranted to evaluate the impact of tailored limb length strategies. Full article

Roux-en-Y gastric bypass (RYGB) surgery induces profound gut microbiota alterations that may impact metabolic outcomes. This study investigated site-specific effects of a multicomponent bovine colostrum-honey-serviceberry (CHJ) complex on post-RYGB microbiome changes in obese rats. Twenty-nine Wistar rats underwent RYGB surgery with CHJ supplementation, followed by mucosal-associated microbiota analysis from five gastrointestinal segments using 16S rRNA sequencing and serum metabolite profiling. RYGB caused regional-specific changes: decreased alpha diversity, systematic Proteobacteria increases (31.2 ± 5.1% in duodenum), and reductions in SCFA-producing bacteria (Romboutsia, Roseburia). CHJ supplementation exhibited dual effects on the microbiome: restoration of beneficial bacteria (Lactobacillus, Bifidobacterium) in distal segments while concurrently promoting Enterobacteriaceae growth in proximal regions. CHJ also maintained alpha diversity levels of the mucosa-associated microbiota comparable to those observed in the control group. Disconnects emerged between predicted microbial functions and systemic metabolites: thiamine pathway activation accompanied 78.5% serum vitamin B1 reduction, indicating severe absorption deficits. Three distinct patterns emerged: pro-inflammatory (proximal), decolonization (widespread Helicobacteraceae loss), and restorative (selective CHJ-mediated recovery). Results demonstrate that post-RYGB dysbiosis exhibits profound regional heterogeneity requiring segment-specific interventions and highlight complex interactions between nutritional supplementation and surgically altered gut ecology in determining metabolic outcomes. Full article

Short bowel syndrome (SBS) is characterized by insufficient intestinal length to support absorption causing malnutrition. The bowel adapts to SBS via intestinal dilation and delayed gastric emptying but still often requires long-term parenteral nutrition. Current surgical options to lengthen the bowel pose significant risks and often provide limited expansion. ‘Distraction enterogenesis’ has been proposed as a technique to induce intestinal lengthening for SBS. The deployment of the intestinal expansion sleeve (IES) device is hypothesized to result in significant intestinal lengthening in vivo. A Roux-en-Y was created in the jejunum of seven rats for isolated IES deployment. The IES was precontracted over a Bucatini noodle and inserted into the isolated roux limb. After 4 weeks of deployment, rats were sacrificed, Roux-en-Y length recorded, and histology analyzed. A paired t-test was performed to compare initial and final roux limb lengths and histopathological tissue remodeling. Intestinal distraction evaluated at 4 weeks post deployment of the IES resulted in a significant 30.2% elongation in roux limb length (43.6 ± 14.4 mm to 56.4 ± 20.8 mm (p = 0.043, n = 7). IES samples showed changes in mucosal and submucosal integrity and bowel wall thickness in response to IES lengthening. In samples with partial mucosal erosion, the basal/regenerative layers of the mucosa were preserved. Distraction enterogenesis with significant intestinal lengthening in vivo has been achieved with the IES device. Histologic changes suggest all bowel functional layers and attributes are maintained through distraction enterogenesis. Future constructs of the IES may benefit from the addition of immunomodulators. Increasing intestinal mass with these devices may complement the treatment paradigm for SBS. Full article

Background: Bariatric surgeries, specifically laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), are a common intervention for morbid obesity, significantly affecting food tolerance and quality of eating. Understanding these changes is crucial for improving postoperative care and long-term success. Methods: This observational study at University Hospital Mannheim involved 91 patients, aged between 18 and 65 year, who underwent SG or RYGB between 2009 and 2019. Food tolerance was assessed between 25 days and 117 months after surgery using the validated score by Suter et al. (Food Tolerance Score, FTS) and an additional score evaluating tolerance to specific food groups and quality of life. Data on body composition were collected through Bioelectrical Impedance Analysis (BIA) at follow-up visits. Statistical analyses included linear mixed models to analyze the association of food tolerance with body composition changes. Results: The FTS indicated moderate or poor food tolerance in 62.6% of patients, with no significant differences between SG and RYGB. Considering the results of the additional score, food groups such as red meat, wheat products, raw vegetables, carbon dioxide, fatty foods, convenience food, and sweets were the most poorly tolerated food groups. A total of 57 of the participants had a baseline and follow-up BIA measurement. Postoperatively, a significant reduction in body weight and BMI as well as in BIA parameters (fat mass, lean mass, body cell mass, and phase angle) was found. Quality of life improved after bariatric surgery and 76.9% rated their nutritional status as good or excellent, despite possible food intolerances. Conclusions: Bariatric surgery significantly reduces weight and alters food tolerance. Despite moderate or poor food tolerance, patients reported high satisfaction with their nutritional status and quality of life. Detailed food tolerance assessments and personalized dietary follow-ups are essential for the early detection and management of postoperative malnutrition, ensuring sustained weight loss and improved health outcomes. Full article

Background/Objectives: Many patients with obesity require conversion bariatric surgery (CBS) after sleeve gastrectomy (SG). The objective of this study was to assess the evolution of LDL cholesterol and other cardiometabolic parameters in patients who have undergone an SG and require a CBS, as the metabolic effects of such conversion procedures remain insufficiently understood. Methods: A retrospective analysis was conducted in a non-randomized prospective cohort of patients with severe obesity who were previously treated with SG and undergoing CBS. Changes in LDL cholesterol levels after SG were compared to those following CBS using repeated-measures ANOVA. Results: Twenty-eight patients were included (mean age 44.5 ± 7.2 years; 68% female; mean BMI 47.3 ± 7.2 kg/m²). Of these, 57% underwent Roux-en-Y gastric bypass (RYGB), and 43% underwent single-anastomosis duodeno–ileal bypass with sleeve gastrectomy (SADI-S) as conversion procedures. The mean time between SG and CBS was 93.5 ± 45.3 months for RYGB and 31.0 ± 45.2 months for SADI-S. The change in LDL cholesterol pre- vs. post-SG was 3.3 mg/dL (95% CI: −13.6 to 20.1), whereas the change pre- vs. post-CBS was −25.7 mg/dL (95% CI: −37.5 to −13.9) (p < 0.001). Remission of high LDL-C was 18.8% after SG and 73.3% after CBS (p = 0.023). The cardiometabolic profile showed a marked improvement profile during the SG period, followed by maintenance of these improvements during the CBS period. Conclusions: CBS (with either RYGB or SADI-S) results in a reduction in LDL-C, in contrast to the initial surgery with SG. However, CBS does not appear to provide additional benefits over SG in terms of other cardiometabolic parameters. Full article

Background: The oral microbiome differs in obese patients compared to normal-weight subjects. Microbiologic shifts very often appear after surgical interventions such as bariatric surgery (BS) and in immunocompromised patients. However, the oral microbiome composition and load in subjects after bariatric surgery are unclear. Aim: The aim of this review is to summarize the current state of the art related to the oral microbiome shift induced by bariatric surgery and to discuss its implications on oral cavity health. Methods: Electronic databases: PubMed/Medline, Web of Science, and Cochrane Library were searched for articles published up to March 30, 2025, describing prospective studies focused on changes in the oral microbiota of patients who underwent bariatric surgery. Results: Eight studies measuring the oral microbiome with different approaches—16S ribosomal RNA (16S rRNA) sequencing, polymerase chain reaction (PCR), culture, and matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI TOF MS)—were included in this review. The following bariatric techniques were used: sleeve gastrectomy, Roux-en-Y gastric bypass, Omega loop gastric bypass, and laparoscopic gastric plication. The follow-up period ranged from 3 to 12 months. The results of microbiologic studies were unequivocal. There was an increment in Streptococcus mutans reported, high levels of Candida species, and increased rates of some periodontitis-associated bacteria (Porphyromonas gingivalis) in the post-bariatric surgery period, though some studies suggested a shift towards non-pathogenic composition of the oral microbiome in prospective observations. Conclusions: The local oral microbial homeostasis becomes strongly impacted by the bariatric surgical treatment itself as well as its consequences in the further post-operative period. Therefore, obese patients undergoing BS require very careful dental observation. Full article

Background: Despite losing weight, the majority of subjects retained an obese view of themselves. The aim of the study was to evaluate the usefulness of a 3D modeling tool in improving the body image of patients who have undergone bariatric surgery. Methods: Morbidly obese subjects involved in a medico-surgical obesity management program and having undergone a Roux en Y Gastric Bypass (RYGB) or a sleeve gastrectomy (SG) were prospectively included during their usual postoperative medical follow-up. The figure rating scale (FRS), body image questionnaire, and Hospital Anxiety Depression Scale test were performed. The FRS was assessed before and after visualizing their body image using a 3D modeling tool. Distributions between the groups for gender (female vs. male) and type of surgery (gastric bypass vs. sleeve gastrectomy) were tested with a Pearson’s chi² independence test. The significance threshold was p < 0.05. Results: We included 140 adults with sleeve gastrectomy (72.9%; n = 102) or gastric bypass (27.1%; n = 38). The mean time from surgery was 308.3 ± 111.4 days (63–511). Participants were mostly female (77.9%; n = 109). Nearly half of the subjects who had undergone bariatric surgery almost one year before modified their body perception after visualizing their avatar thanks to a 3D modeling tool. One third reduced their FRS score (“perceived body”) after visualizing their avatar. FRS score and body mass index (BMI) following surgery (“real body”) were significantly correlated before and after visualizing the 3D avatar, with a stronger correlation after visualizing the 3D avatar. Conclusions: A 3D modeling tool may improve body perception after weight loss in subjects with bariatric surgery. Being simple, non-invasive, not expansive, and easy to use during a consultation and to understand for the patient, a regular use of this tool may be largely implemented in clinical practice. Its usefulness in improving body image, mood disorders, and eating disorders and the further success of the surgery should be further evaluated. Full article

Background: Metabolic bariatric surgery is a highly effective and long-lasting treatment for obesity and related chronic conditions. Women of reproductive age represent the largest group undergoing these procedures. Observational studies suggest an increased risk of preterm birth and impaired foetal growth in this population, though the underlying mechanisms remain unclear. A key hypothesis is that altered glucose metabolism, characterised by frequent hypoglycaemia and glycaemic fluctuations, may contribute to these adverse outcomes. While glycaemic variability following metabolic bariatric surgery has been documented, its pattern during pregnancy and impact on pregnancy outcomes are still underexplored. Methods: In this Belgian multicentre prospective cohort study, we will investigate glycaemic patterns during pregnancy in women who have undergone metabolic bariatric surgery. Women aged 18–45 years with a confirmed singleton pregnancy up to 11 weeks and 6 days and a history of Roux-en-Y gastric bypass or sleeve gastrectomy will be eligible for inclusion. Women with pregestational diabetes or those taking medication known to interfere with glucose metabolism will be excluded. All participants will receive blinded continuous glucose monitoring (Dexcom^® G6) for a 10-day period at four time points throughout the pregnancy. Foetal body composition and growth will be measured during routine ultrasound; skinfolds will be measured in the neonate. The primary outcome is the association between mean glycemia and glycaemic variability on continuous glucose monitoring and birth weight. The planned sample size is ninety-five women. Linear mixed models for repeated measurements will be used for analysis. Confounders such as smoking, micronutrient deficiency, and surgery-to-conception interval will be added to the model as covariates. In a second exploratory phase, each participant in the surgical group will be matched with a control participant—without a history of metabolic bariatric surgery—based on pre-pregnancy BMI and age. Control participants will undergo the same study procedures, allowing for exploratory comparison of glycaemic patterns and other study outcomes. Discussion: This prospective longitudinal study will be the largest study using continuous glucose monitoring to investigate glucose metabolism during pregnancy after metabolic bariatric surgery and its impact on foetal growth and newborn body composition. Trial registration: ClinicalTrials.gov: NCT05084339. Registration date: 15 October 2021. Full article

Metabolomics has emerged as a vital tool for understanding the body’s responses to therapeutic interventions. Metabolic bariatric surgery (MBS) is widely recognized as the most effective treatment modality for severe obesity and its associated comorbidities. This review seeks to analyze the current evidence on the metabolomic profiles of patients with obesity and the impact of various bariatric surgical procedures, with the objective of predicting clinical outcomes, including weight loss and remission of type 2 diabetes (T2D). The data gathered from original studies examining metabolomic changes following MBS have been meticulously compiled and summarized. The findings revealed significant alterations in metabolites across various classes, including amino acids, lipids, energy-related compounds, and substances derived from the gut microbiota. Notably, elevated preoperative levels of specific lipids, such as phospholipids, long-chain fatty acids, and bile acids, were correlated with postoperative remission of T2D. In conclusion, metabolite profiling holds great promise for predicting long-term responses to different bariatric surgery procedures. This innovative approach has the potential to facilitate personalized treatment strategies and optimize the allocation of healthcare resources. Full article

Background: Food addiction (FA) is prevalent among individuals with severe obesity and has been associated with poorer weight loss (WL) outcomes after dietary interventions. However, its long-term impact after bariatric surgery (BS) remains unclear. Objective: This study aimed to evaluate the effect of preoperative FA on WL and weight regain (WR) three years after different BS techniques. Methods: An ambispective study was conducted in 165 patients undergoing BS (41.1% sleeve gastrectomy [SG], 13.3% Roux-en-Y gastric bypass [RYGB], and 45.6% hypoabsorptive procedures [HA]). FA was assessed preoperatively using the Yale Food Addiction Scale 2.0. WL outcomes were evaluated at 1 and 3 years postoperatively. Mixed-effects models were used to assess longitudinal changes, adjusted for baseline weight, sex, type 2 diabetes (T2D), and height. Results: FA was present in 17.6% of patients. At 3 years, total WL was lower in FA patients compared to those without FA (−27.1% vs. −31.0%; p = 0.023), driven by greater WR from nadir (+8.3% vs. +1.7%; p = 0.03). The effect was particularly pronounced after RYGB and HA, but not after SG. Nevertheless, a substantial proportion of FA patients (58%) were no longer classified as having obesity at 3 years. The presence of FA was not associated with insufficient WL or lower T2D remission rates. Mixed models confirmed a significant interaction between FA and time, indicating a trend toward reduced WL over time in FA patients. Conclusions: Preoperative FA was not associated with a reduced likelihood of achieving satisfactory WL following BS. Our data does not support the use of preoperative FA as a decisive factor in guiding the choice of BS type. Although FA was associated with increased WR over time, clinically meaningful WL was achieved in most patients. Long-term multidisciplinary follow-up remains essential in this subgroup. Full article

This review examines the effectiveness of various surgical and endoscopic bariatric interventions in improving several components of metabolic dysfunction-associated steatotic liver disease (MASLD). Roux-en-Y gastric bypass (RYGB) consistently showed substantial long-term reductions in liver fat, inflammation, and fibrosis, achieving resolution of steatosis in up to 95% of cases. Vertical sleeve gastrectomy (VSG) provided comparable hepatic benefits, significantly reducing liver fibrosis and steatosis in approximately 60% of patients. Adjustable gastric banding (AGB) demonstrated meaningful though comparatively modest hepatic improvements, with steatosis resolution in about 42% of patients. More aggressive procedures like biliopancreatic diversion with duodenal switch (BPD-DS) showed profound metabolic effects, though with increased nutritional risk. Endoscopic therapies, including intragastric balloon (IGB) and endoscopic sleeve gastroplasty (ESG), offered notable short- to medium-term hepatic improvements, significantly reducing steatosis and fibrosis markers. Newer therapies like duodenal mucosal resurfacing (DMR) and the duodenal-jejunal bypass liner showed promising preliminary results, warranting further investigation. Overall, surgical interventions remain superior for sustained liver health improvements, while endoscopic therapies present viable alternatives for patients requiring less invasive interventions. Full article

Purpose: Forme fruste choledochal cyst (FFCC) is a choledochal cyst with minimal or no dilatation of the extrahepatic bile duct (EHBD) and is usually associated with an anomalous pancreaticobiliary junction (APBJ). While sharing similar symptoms, inflammation, and malignant potential with classic biliary cysts, FFCC is often overlooked on ultrasound. This paper aims to present the experience of two tertiary pediatric centers in managing FFCC. Methods: In this retrospective study, the clinical data of pediatric patients treated for FFCC at two tertiary pediatric surgical centers between 1 January 2008 and 31 December 2023 were analyzed. The primary outcome was the clinical success of the surgical procedure, defined by the resolution of symptoms and the absence of major complications. Secondary outcomes included postoperative complications, type and duration of surgical procedures, and length of hospital stay. All patients underwent biliary reconstruction via either Roux-en-Y hepatico-jejunostomy or hepatico-duodenostomy. Clinical outcomes, including postoperative complications and patient follow-up, were evaluated. Results: Fourteen children (9 girls, 5 boys; aged 18 months to 12 years) underwent surgical treatment of FFCC. The mean age at surgery was 5.3 ± 3.8 years, and the mean diameter of the common bile duct was 7.9 ± 1.2 mm. Thirteen patients underwent Roux-en-Y hepatico-jejunostomy, and one underwent hepatico-duodenostomy. Over a mean follow-up period of 6.2 ± 3.6 years, no cholangitis or anastomotic stricture cases were observed. Two patients (14.3%) experienced minor wound infections managed conservatively. Conclusions: FFCC remains a diagnostic challenge due to its subtle imaging findings and non-specific clinical presentation. However, once identified, surgical excision with biliary reconstruction, most commonly via Roux-en-Y hepatico-jejunostomy, is a safe and effective treatment with excellent long-term outcomes. Given the potential for serious complications if left untreated, FFCC should be actively considered in pediatric patients with unexplained pancreatitis or biliary symptoms, even in the absence of overt ductal dilatation. Full article

Background: Obesity is a complicated, chronic condition that has a major impact on reproductive health, leading to infertility, anovulation, and poor pregnancy outcomes. It alters the hypothalamic–pituitary–ovarian (HPO) axis, promotes insulin resistance, and causes persistent low-grade inflammation, all of which result in hormonal abnormalities that compromise normal ovarian function. Because standard weight loss procedures frequently fail to provide significant and long-term reproductive benefits, bariatric surgery is becoming increasingly popular as a therapeutic option for obese women trying to conceive. However, continuous research is being conducted to determine the degree of its advantages and potential hazards to fertility and pregnancy outcomes. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and entered into the PROSPERO database. Comprehensive searches in the PubMed, Scopus, and Web of Science databases turned up relevant studies. Studies that examined the effects of bariatric surgery on female fertility, ovulatory function, pregnancy rates, and neonatal outcomes were considered. Methodological quality and risk of bias were evaluated using the Newcastle–Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias Tool for randomized controlled trials. Results: This review comprised 34 studies. More than 75% of the studies analyzed showed improvements in ovulatory function, monthly regularity, or spontaneous pregnancy after bariatric surgery. Post-surgical pregnancies are related to a lower incidence of gestational diabetes, hypertension, and macrosomia. However, several studies raised concerns about nutritional inadequacies and the possibility of small-for-gestational-age newborns, particularly following Roux-en-Y gastric bypass. Studies suggest delaying conception for 12 to 18 months after surgery to reduce nutritional hazards and improve pregnancy outcomes. Variability in study design, follow-up duration, and surgical methods reduces the generalizability of findings, emphasizing the importance of uniform research protocols. Conclusions: Bariatric surgery is a highly effective treatment for increasing fertility and pregnancy outcomes in obese women, particularly those with PCOS. However, rigorous preconception planning, postoperative nutritional monitoring, and multidisciplinary follow-up are required to reduce the related hazards. Future research should concentrate on long-term reproductive outcomes, standardizing fertility assessment criteria, and improving clinical guidelines for managing post-bariatric pregnancies. These findings support the incorporation of bariatric surgery into fertility treatment regimens for obese women, and they may shape future revisions to clinical guidelines on reproductive care following weight loss surgery. Full article

Background and objective: Studies using metabolomics to study bariatric surgery have shown that amino acids are one of the most changed groups of metabolites after the intervention. However, the surgery-related variation in individual amino acids, as well as the long-term impact and the differences between the types of surgeries, have been poorly studied. The aim of this study was to investigate the changes in circulating amino acids after three types of bariatric surgery up to 36 months after the intervention. Methods: We studied 63 participants diagnosed with T2D at baseline, who received either a sleeve gastrectomy, a Roux-en-Y gastric bypass or a biliopancreatic diversion with duodenal switch. We measured the concentrations of 16 circulating amino acids in fasting plasma before the surgery as well as after 4, 12, 24 and 36 months via liquid chromatography coupled with mass spectrometry (LC-MS/MS). Results: Eleven circulating amino acids were significantly modified by bariatric surgery. Glutamate, leucine and isoleucine showed the greatest decrease. Most of the changes in circulating amino acids occurred within 1 year of the operations. Only one measured plasmatic amino acid (threonine) had a significantly different change pattern according to surgery types. In repeated-measure correlations, changes in circulating amino acids were significantly associated with changes in adiposity and metabolic markers. Conclusions: Bariatric surgery changes the levels of most circulating amino acids, and the effect occurs in the short term without major differences between surgery types. The mechanisms explaining these changes are not elucidated but likely include modifications in amino acid metabolism. Full article