Search Results (1,207)

The vascular anatomy of the stomach is both complex and highly variable, with direct implications for oncologic, bariatric, esophageal, and interventional procedures. This comprehensive review combines anatomical, radiological, and surgical evidence on arterial and venous variations in the stomach. The left gastric artery, traditionally the first branch of the coeliac trunk, often shows variants such as a direct aortic origin or association with an abnormal left hepatic artery. The right gastric artery most frequently arises from the proper hepatic artery, but its origin can vary significantly. The gastroepiploic arteries exhibit diversity in their origin, size, and connection patterns, with occasional duplication or absence. Additional vessels, including the posterior gastric artery and the short gastric arteries, also contribute to variations in arterial supply. Venous drainage largely follows the arterial pattern. The left and right gastric veins and the gastroepiploic venous arcade are major routes, while variants of the left gastric vein and the gastrocolic trunk (Henle’s trunk) contribute to complexity through different convergence patterns. These vascular variations have significant clinical implications, as they impact the safety of D2 lymphadenectomy, the risk of ischemic complications during laparoscopic sleeve gastrectomy, the success of gastric conduit formation in esophagectomy, and the effectiveness of transarterial embolization for upper gastrointestinal bleeding. Preoperative vascular mapping with multidetector computed tomography angiography and 3D reconstruction reliably defines individual anatomy, allowing for customized surgical planning and reducing operative risks. Recognizing both common and rare gastric vascular variants is essential for safe and effective surgical and endovascular management of gastric disease. Full article

Background: Preoperative evaluation in bariatric surgery aims to minimize perioperative risks and identify comorbid abdominal pathologies that may influence surgical planning. The role of routine abdominal ultrasonography (USG) remains debatable. Methods: This retrospective study included 1119 consecutive candidates for bariatric surgery who underwent routine preoperative ultrasonography (USG) between January 2022 and October 2024. Patients were stratified by BMI and categorized according to USG findings as normal, incidental, requiring follow-up/concomitant procedures, or necessitating cancellation. Baseline characteristics, USG findings, surgical outcomes, and predictors of cancellation were analyzed using univariate, multivariate, and Firth’s penalized logistic regression analyses. Ultrasonographic findings were further stratified as clinically significant (requiring intervention) or non-clinically significant (not requiring intervention) to standardize interpretation. Results: Abnormal USG findings were present in 77.5% of patients, with hepatic steatosis (60.8% [n = 680]), hepatomegaly (21.5%), and gallstones (13.9%) being the most frequent. Higher BMI was significantly associated with hepatomegaly, steatosis, and gallstones (all p < 0.05), but not with surgical cancellation. Bariatric surgery was cancelled in 11 patients (1.0%) due to critical findings exclusively identified on USG, including large ovarian/uterine masses, choledochal cysts, and suspected malignancies. In multivariate and Firth-adjusted regression, large ovarian/uterine masses (adjusted OR 12.9, 95% CI 3.0–55.2, p = 0.001; Firth OR 11.4, 95% CI 2.5–51.4, p = 0.002) and choledochal cysts (Firth OR 29.7, 95% CI 1.8–489.5, p = 0.048) emerged as independent predictors of cancellation. Conclusions: Although the overall cancellation rate was low, the detection of critical USG findings in 1.0% of patients had major clinical implications, preventing inappropriate or unsafe surgery and enabling timely referral for specialist management. Routine preoperative ultrasonography thus offers a clinically meaningful safeguard in bariatric surgery, supporting its inclusion in preoperative assessment algorithms. Full article

Background and Clinical Significance: Sleeve gastrectomy is an effective and widely performed bariatric procedure that provides long-term, sustained weight loss, but it carries risks of early and late complications. Among these, gastric fistula is a rare occurrence associated with an increased mortality rate and must be carefully considered to ensure timely diagnosis and appropriate management. Case Presentation: We will present the complex case of a patient who was referred to the general surgery department due to severe abdominal pain, exertional dyspnea, nausea, fever and fatigue, symptoms that appeared one month after a robotic gastric sleeve. The investigations led to the diagnostic of high gastric fistula secondary to a gastric sleeve procedure. The patient underwent exploratory laparotomy with jejunostomy, peritoneal lavage, drainage, and endoscopic placement of an endoluminal vacuum assisted closure (E-VAC) system. Close clinical, laboratory, imaging, and endoscopic monitoring demonstrated progressive improvement, with complete resolution of the fistula achieved after seven weeks of E-VAC therapy. Conclusions: The particularity of this case lies in the occurrence of a delayed mechanical gastric suture dehiscence, with late diagnosis, managed using E-VAC. Even though rare, gastric fistulas represent a potentially life-threatening complication of sleeve gastrectomy. Early diagnosis and a multidisciplinary approach, which includes infection control, surgical intervention and minimally invasive techniques like E-VAC, are essential for effective management and favorable outcomes. Full article

Type 2 diabetes (T2D) is a complex metabolic disease characterized by insulin resistance, progressive β-cell dysfunction, and persistent hyperglycemia. While GLP-1 receptor agonists have revolutionized the management of T2D by improving glycemic control and reducing body weight, their insulinotropic effects increase the workload on pancreatic β-cells, which may hasten β-cell decline in certain individuals. Peptide YY (PYY), a gut-derived hormone secreted alongside glucagon-like peptide-1 (GLP-1) from L-cells, presents a unique and complementary therapeutic approach. In contrast to GLP-1, PYY does not directly induce insulin release but confers metabolic advantages by suppressing appetite through Y2 receptor pathways, enhancing insulin sensitivity via peripheral Y1/Y4 receptors, and slowing gastric emptying to minimize postprandial glucose surges. Notably, recent research suggests PYY supports the preservation and restoration of pancreatic islets by improving their structure and function without increasing the secretory demand. PYY levels are substantially increased after bariatric surgery, where it plays a pivotal role in weight-loss-independent improvements in glycemic regulation and islet hormone dynamics. These attributes position PYY as a strong candidate for use in combination with GLP-1 analogs, especially in individuals with advanced β-cell impairment or those who respond inadequately to GLP-1 monotherapy. This review discusses PYY’s physiological functions, mechanistic actions, and therapeutic opportunities in T2D, highlighting its potential as a valuable adjunct or alternative in gut-hormone-oriented treatment strategies. Full article

Bariatric surgery is a highly effective therapeutic strategy in the treatment of severe obesity, but it carries significant risks, both in the short and long terms. However, many of these complications can be avoided by appropriate patient selection, comprehensive assessment of clinical conditions, and structured follow-up including clinical, nutritional, and psychological monitoring. Achieving these objectives requires a meticulous program involving the entire multidisciplinary team and lays the foundations for proper patient compliance. Furthermore, recent studies have begun to explore the systemic effects of bariatric–metabolic surgery, with benefits extending far beyond simple weight loss and effects on both morbidity and mortality. Research has documented improvements in cardiovascular risk factors, insulin sensitivity, and hormonal balance, with substantial effects on the three main comorbidities of obesity: cardiovascular risk and hypertension, T2DM, and OSAS. In conclusion, bariatric surgery, while highly effective in treating severe obesity and its comorbidities, involves significant anatomical and physiological changes that alter nutrient absorption and digestion. These changes can lead to a number of short-, medium-, and long-term nutritional complications that require close monitoring and targeted dietary interventions. Full article

Obesity has become increasingly prevalent, impacting up to 41 percent of women in the United States between 2021 and 2023, leading to a rise in short- and long-term adverse health events. With regard to reproductive health, obesity is associated with menstrual irregularities, poorer reproductive and obstetric outcomes, and an increased risk of endometrial cancer. Obesity can lead to hyperandrogenism and anovulation, which is consistent with polycystic ovarian syndrome (PCOS). The prevalence of obesity is higher in women with PCOS compared to the general population. Although PCOS increases the risk of obesity, not all women with PCOS are obese, and not all women with obesity develop PCOS. However, individuals with both PCOS and obesity often present with a more extreme phenotype, with increased risk of chronic anovulation, glucose intolerance, dyslipidemia, metabolic syndrome, vitamin D deficiency, and decreased fertility. Therefore, weight loss is the backbone of patient management in women with obesity and PCOS, and is associated with improvement in cardiovascular risk, as well as improvement in menstrual cycles, ovulation, and pregnancy rate. Lifestyle modifications are often the first-line intervention, with data supporting low glycemic index diets, including ketogenic and DASH diets, along with vitamin D supplementation to improve hormonal imbalances, insulin sensitivity, and menstrual cycles in those who do not have normal vitamin D levels. Furthermore, with the recent widespread adoption of newer FDA-approved medications for weight loss, including GLP-1 (glucagon-like peptide) receptor agonists, new data are emerging regarding the impact of PCOS and longer-term cardiovascular risk. The treatment of PCOS requires a personalized approach, with consideration of a patient’s reproductive goals, tolerance of risk, and acceptance of behavioral and financial commitments, as well as consideration of other medical comorbidities. This narrative review explores different weight loss treatment options, comparing lifestyle modifications (including diet, physical activity, mindfulness, stress management, and cognitive behavioral training), weight loss medications, and bariatric surgery and their respective impact on PCOS to assist clinicians in guiding their patients towards an effective, individualized intervention. Full article

Background/Objectives: Laparoscopic sleeve gastrectomy (SG) is the most performed bariatric procedure, providing effective weight loss and comorbidity improvement. However, its association with new-onset or worsening gastroesophageal reflux disease (GERD) remains a limitation. To address this, fundoplication sleeve gastrectomy (FSG) has been proposed by combining SG with an anti-reflux procedure. This systematic review and meta-analysis evaluates the efficacy and safety of FSG in patients with severe obesity. Methods: PubMed, Scopus, and Web of Science were systematically searched up to December 2023. Eligible studies included adults with BMI ≥ 40 kg/m² or ≥35 kg/m² with comorbidities undergoing FSG or SG with ≥12 months of follow-up. Random-effects meta-analysis compared FSG and SG in terms of weight loss, postoperative GERD, and complications. Results: Twelve studies (n = 543) were included; five contributed to the meta-analysis. Pooled analysis showed no significant difference in percentage of excess weight loss (%EWL) between FSG and SG (Hedges’ g = −0.11; 95% CI: −0.99–0.76; I² = 86%), and similar %TWL outcomes (Hedges’ g = −0.28; 95% CI: −0.70–0.13). FSG demonstrated a significantly lower postoperative GERD prevalence (RR = 0.08; 95% CI: 0.01–0.47) and greater GERD resolution (RR = 1.86; 95% CI: 0.80–4.20), but higher complication (RR = 2.95; 95% CI: 1.02–8.50) and reoperation rates (RR = 4.39; 95% CI: 1.47–13.12). Conclusions: FSG achieves weight loss comparable to SG and may reduce postoperative GERD prevalence, but carries an increased complication and reoperation risk. Further randomized trials with standardized GERD definitions and longer follow-up are required. Full article

Background: Chronic post-surgical pain (CPSP) is a phenomenon that negatively influences patients’ quality of life and well-being. By definition, CPSP is a pain in the surgical area of injury that develops or increases after the operation and persists beyond the healing process. One of the populations that is especially vulnerable to CPSP is patients undergoing bariatric surgery, as obesity, chronic inflammation, pre-existing chronic pain, and severe postoperative pain are its risk factors. Therefore, we conducted a cross-sectional study assessing the prevalence of CPSP in patients undergoing laparoscopic sleeve gastrectomy (LSG). We also aimed to explore the potential influence of the promising opioid-free anesthesia (OFA) technique, assess if the CPSP after LSG had a potential neuropathic component, and additionally, determine whether the bariatric surgery altered chronic pain in this patient population. Methods: The study was registered on 11 November 2024, at ClinicalTrials.gov (NCT06686875). A cross-sectional study using e-survey.io was conducted among the patients who underwent LSG 3 months to 5 years earlier. Clinical data were retrieved from the hospital database. Results: Of the 135 patients who responded to our e-survey, 4.4% (n = 6, 95% CI 0.9–8%) reported CPSP. None of them had a PAIN DETECT score above 19, which would indicate a neuropathic component. Of the 32 patients who had pre-existing chronic pain, 31 reported a reduction in its intensity, and of the 16 patients on chronic opioid treatment, 10 discontinued opioid therapy. In a subgroup analysis, there was no significant difference in the prevalence of CPSP and long-term opioid therapy between the patients who had OFA and standard anesthesia (p > 0.05). Conclusions: The main finding of our study is that a minor, yet significant, portion of patients who underwent LSG develop CPSP, and OFA does not alter the risk. LSG appears to reduce pre-existing chronic pain and opioid use. Full article

Obesity and bariatric surgery are both associated with disrupted iron homeostasis. These alterations may be mediated by newly identified iron metabolism regulators. The aim of this study was to conduct a short-term, detailed analysis of hepcidin, soluble hemojuvelin, ferroportin, and erythroferrone—as well as whole-body composition—before and five months after sleeve gastrectomy. This approach may help elucidate the potential impact of bariatric surgery on iron metabolism and the timing of these changes. The study included 40 obese patients aged 26–64 eligible for laparoscopic sleeve gastrectomy. Iron parameters were assessed with immunoenzymatic methods. We found significantly increased iron levels (79 µg/dL vs. 95 µg/dL, p = 0.0016) as well as reduced hepcidin concentrations five months after bariatric surgery (54.46 ng/mL vs. 33.88 ng/mL, p = 0.0177). The change in the reduction in mean body fat (delta MBF) and body fat percentage (delta BPF) was positively associated with delta hepcidin levels with correlation coefficients of R = 0.36 (p = 0.0228) for MBF and R = 0.42 (p = 0.0070) for BPF. Moreover, significant correlations were observed between the reduction in body fat and soluble hemojuvelin (R = 0.31 p = 0.0489 for MBF) (R = 0.45 p = 0.0032 for PBF). No patient showed laboratory signs of iron deficiency. Decreased serum hepcidin levels observed five months after sleeve gastrectomy are associated with improved iron status, as indicated by increased serum iron and red blood cell indices. Positive correlations between body fat reduction and both hepcidin and soluble hemojuvelin levels suggest that the resolution of adipose tissue-related inflammation may contribute to improved iron bioavailability. Full article

Obesity is a multifactorial metabolic disease characterized by chronic low-grade inflammation, extracellular matrix (ECM) dysfunction, and systemic metabolic dysregulation. Matrix metalloproteinases (MMPs), especially MMP-2 and MMP-9, are key regulators of ECM remodeling and inflammation in obesity. This narrative review aimed to synthesize and critically discuss current evidence on the effects of bariatric surgery and pharmacological therapies, including GLP-1 and dual GLP-1/GIP receptor agonists, on MMP activity and metabolic outcomes. Literature from PubMed and Scopus and Web of Science (2015–2024) was analyzed, focusing on studies evaluating MMPs, inflammation, and metabolic parameters. Bariatric surgery consistently reduces MMP-9 levels and normalizes MMP-2 activity, contributing to improved ECM integrity, reduced inflammation, and enhanced insulin sensitivity. Pharmacological therapies achieve substantial weight loss and glycemic control, but evidence regarding their direct effects on MMP activity remains limited. This review highlights bariatric surgery as the most effective strategy for modulating obesity-related MMP dysregulation and emphasizes the need for further research into the mechanistic effects of modern pharmacotherapy on ECM remodeling. Full article

Background: Bariatric surgery is a well-established intervention for severe obesity, resulting in substantial weight loss and cardiometabolic benefits. However, the physiological mechanisms driving changes in functional capacity postoperatively remain incompletely characterized. Methods: Fourteen patients scheduled for bariatric surgery underwent serial assessments preoperatively and at 3 and 6 months postoperatively. Evaluations included body composition analysis, cardiopulmonary exercise testing (CPET), and non-invasive measurement of cardiac output (CO) and arteriovenous oxygen difference (AVDiff) using the inert gas rebreathing (IGR) method. Patients were stratified into four hemodynamic response profiles (Q1–Q4) based on directional changes in CO and AVDiff. Repeated measures changes were analyzed using Friedman and Wilcoxon signed-rank tests; correlations were assessed using Spearman’s rank method. Results: Following surgery, patients exhibited significant reductions in BMI, body fat percentage, and CO at both rest and peak exercise (all p < 0.05). VO₂ peak was preserved or modestly improved. Notably, the majority of patients exhibited a response pattern of reduced CO accompanied by increased AVDiff (Q1), both at rest and during exertion. At three months, VO₂ rest correlated positively with both CO rest and AVDiff rest, while VO₂ peak correlated with AVDiff peak. At six months, VO₂ rest and VO₂ peak both correlated positively with CO peak. Conclusions: Aerobic performance following bariatric surgery is not solely determined by peak oxygen uptake but also depends on the interaction between cardiac output and oxygen extraction, as reflected by AVDiff. These findings align with the Fick principle (VO₂ = CO × AVDiff) and emphasize the importance of comprehensive physiological profiling—beyond VO₂ peak alone—in understanding adaptation after bariatric surgery. Full article

Obesity is a major, modifiable driver of endometrial carcinogenesis. This review distills how excess adiposity promotes malignant change and synthesizes prevention strategies across the hyperplasia–cancer continuum. Three converging axes underpin risk: aromatase-mediated estrogen excess; insulin resistance with hyperinsulinemia activating PI3K–AKT–mTOR signaling; and adipokine-driven low-grade inflammation with downstream NF-κB/STAT3 activity. Within this framework, EIN is the key precursor in which these pathways coalesce. Risk can be attenuated through progestin-based therapy (levonorgestrel-releasing intrauterine system or continuous oral regimens), structured weight management, and metabolic adjuncts in selected phenotypes (e.g., metformin for insulin resistance; incretin-based anti-obesity agents as emerging options). Bariatric surgery produces substantial weight loss and favorable metabolic shifts, though evidence for cancer risk reduction is largely observational. Overall, a practical precision-prevention approach—combining progestins with durable weight control and metabolic optimization under guideline-concordant surveillance—appears feasible in routine gynecologic care. Future research should establish causal effects, durability, and optimal sequencing/combination of interventions in trials with endometrial endpoints. Full article

Obesity is a multifaceted disorder influenced by various factors, with heredity being a significant contributor. Bariatric surgery is the most effective long-term intervention for morbid obesity and associated comorbidities, while outcomes vary significantly across individuals. Recent studies indicate that genetic and molecular determinants, particularly alterations in the leptin–melanocortin signalling pathway involving the fat mass and obesity-associated gene (FTO), pro-opiomelanocortin (POMC), melanocortin 4 receptor (MC4R), leptin (LEP), and leptin receptor (LEPR), influence the efficacy of weight loss and metabolic adaptations post-surgery. This narrative review consolidates evidence from peer-reviewed papers available in PubMed and Scopus until July 2025. The emphasis was on novel research and systematic reviews examining genetic polymorphisms, gene–environment interactions, and outcomes following bariatric procedures such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Recent research emphasised the integration of genetic screening and precision medicine models into clinical bariatric workflows. Variants in FTO (e.g., rs9939609), MC4R (e.g., rs17782313), LEPR, and POMC are associated with diminished weight loss post-surgery, an increased likelihood of weight regain, and reduced metabolic enhancement. Patients with bi-allelic mutations in MC4R, POMC, or LEPR exhibited poor long-term outcomes despite receiving effective physical interventions. Furthermore, genes regulating mitochondrial metabolism (such as PGC1A), adipokine signalling (such as ADIPOQ), and glucose regulation (such as GLP1R) have been demonstrated to influence the body’s response to sugar and the extent of weight gain or loss. Two recent systematic reviews elucidate that candidate gene investigations are beneficial; however, larger genome-wide association studies (GWAS) and machine learning techniques are necessary to enhance predictive accuracy. Integrating genetic and molecular screening with bariatric surgery planning possesses significant therapeutic potential. Genotyping can assist in patient selection, procedural decisions, and medication additions, particularly for those with variants that influence appetite regulation or metabolic flexibility. Advancements in precision medicine, including the integration of polygenic risk scores, omics-based profiling, and artificial intelligence, will enhance the customisation of surgical interventions and extend the lifespan of individuals with severe obesity. The epigenetic regulators of energy balance DNA methylation, histone changes, and microRNAs that may affect individual differences in weight-loss patterns after bariatric surgery are also briefly contextualised. We discuss the concept that epigenetic modulation of gene expression, mediated by microRNAs in response to food and exercise, may account for variations in metabolic outcomes post-surgery. Full article

Introduction: IgA nephropathy (IgAN) is the most common primary glomerulonephritis in the world. In addition to genetic and immunological factors, visceral obesity and metabolic syndrome (MetS) are the main determinants of disease progression. This review aims to critically assess the role of visceral obesity and metabolic syndrome in driving the progression of IgA nephropathy (IgAN), with an emphasis on their underlying pathophysiological mechanisms and clinical implications. Methods: A systematic review was carried out in accordance with PRISMA guidelines. PubMed was searched (2015–2025) using terms related to IgA nephropathy, obesity, metabolic syndrome, and immunometabolic pathways. Only English-language observational and clinical studies in adults, excluding pediatric and animal studies, were included in the review. Additional sources were consulted to give context to the mechanistic aspects of obesity-related IgAN progression. Results: Visceral obesity and MetS accelerate IgAN progression through endocrine, inflammatory, and immune pathways, including cytokines derived from visceral adipose tissue, adipokines, intestinal dysbiosis, and BAFF/APRIL-mediated immune activation. MetS patients had higher proteinuria, a faster decrease in eGFR, and a higher risk of end-stage renal failure (23/65 vs. 15/60 endpoints, p < 0.001). Nutritional and metabolic interventions—including weight reduction, GLP-1 receptor agonists, dual GLP-1/GIP agonists, and bariatric/metabolic surgery—demonstrate renoprotective effects in obesity-related kidney disease and may have implications for IgAN. Conclusions: Obesity should be considered a chronic disease and a modifiable risk factor for IgAN. Nutrition-focused interventions targeting visceral obesity and metabolic dysfunction can slow the progression of the disease and should be included in renal guidelines. This review expands current knowledge by demonstrating that when sequential steps of IgAN pathophysiology are mapped with respect to endocrine and immunological effects of visceral adipose tissue, they converge on the same proinflammatory and immune pathways. This convergence suggests a bidirectional amplification loop in which obesity accelerates IgAN progression and increases the burden of complications. Full article