Search Results (734)

Adjuvant XELOX (capecitabine plus oxaliplatin) and TS-1 (S-1) monotherapy are both guideline-recommended following D2 gastrectomy for gastric cancer, yet head-to-head real-world data exclusively in stage III disease remain scarce. Using Taiwan’s National Health Insurance Research Database linked to the Taiwan Cancer Registry–Long Form, we identified stage III gastric cancer patients who underwent D2 gastrectomy (2010–2019) and received adjuvant XELOX or TS-1 for ≥3 months. Propensity score matching balanced chemotherapy and non-chemotherapy cohorts (1706/group). Overall survival (OS) was the primary endpoint; disease progression was defined as initiation of FOLFOX salvage chemotherapy (used as a pragmatic proxy for disease recurrence). A second propensity score matching was performed directly between XELOX (n = 533) and TS-1 (n = 893) groups, yielding 490 matched pairs with well-balanced baseline characteristics. Multivariable Cox regression was adjusted for sex, age, comorbidities, and Charlson Comorbidity Index. TS-1 was associated with significantly better OS (adjusted HR 0.73, 95% CI 0.61–0.86; p < 0.001) and lower progression (adjusted HR 0.38, 95% CI 0.23–0.62; p < 0.001) versus XELOX; the corresponding 3-year OS was approximately 65.4% for TS-1 versus 56.8% for XELOX, and extrapolated 5-year OS approximately 50.2% versus 41.7%, respectively (note: these 5-year estimates are Kaplan–Meier projections beyond the mean follow-up of ~2.6 years and carry substantial uncertainty; they should be interpreted with caution). Benefits were confined to stage IIIA (OS HR 0.64, 95% CI 0.45–0.89; p = 0.009; interaction p = 0.006; progression HR 0.29, 95% CI 0.11–0.76; p = 0.011), with comparable outcomes in IIIB and IIIC. Adjuvant TS-1 monotherapy was associated with superior OS and lower disease progression versus XELOX in stage III gastric cancer, particularly in stage IIIA; these findings are hypothesis-generating and warrant confirmation in prospective randomized trials, whereas in stage IIIB/IIIC outcomes were comparable between the two regimens. Full article

Background/Objectives: textbook outcome (TO) is an established surgical quality measure, but failure is recognized only after postoperative events. We evaluated whether intraoperative stress burden (blood loss, fluid administration, and transfusion) is associated with adapted TO attainment and overall survival (OS) after curative-intent gastrectomy. Methods: in 2352 patients with gastric adenocarcinoma (2010–2020), an intraoperative stress burden score summed three binary components (blood loss > 200 mL, fluid > 68 mL/kg, and any transfusion) and was categorized as low, intermediate, or high. Adapted TO required R0 resection, ≥15 retrieved nodes, no Clavien–Dindo ≥ III complication, no unplanned reoperation, no 30-day mortality, and length of stay ≤ 12 days. Multivariable logistic and Cox models, overlap weighting, and sensitivity analyses were applied. Results: the median age was 60 years; 66.9% were male, 67.7% had pT3–4 and 42.0% pN2–3 disease, and 30.1% underwent minimally invasive surgery. TO attainment declined with increasing burden (78.0%, 70.5%, and 65.2%; p < 0.001). Intermediate and high burden were associated with TO failure (adjusted odds ratios 1.50 and 1.68), though the high-burden association was attenuated after adjusting for operative time. High burden was associated with worse OS (adjusted hazard ratio 1.36; 95% CI 1.15–1.62; 1.44 after overlap weighting). Risk was time-varying—strongest in the first postoperative year (HR 2.03), persisting at 12–60 months (HR 1.54), and absent beyond 60 months. Conclusions: higher intraoperative stress burden identified patients with lower adapted TO attainment and increased early mortality after gastrectomy. External validation is needed. Full article

Background: Obesity is an independent and major risk factor for cardiovascular diseases. However, the presence of common comorbidities such as diabetes and hypertension makes it difficult to understand the direct impact of obesity on the myocardium. The aim of this study is to evaluate the isolated effects of weight loss achieved after bariatric surgery on left ventricular (LV) geometry and diastolic functions in individuals with the “Metabolically Healthy Obese” (MHO) phenotype. Materials and Methods: The study included 28 patients (Surgical Group) who underwent Laparoscopic Sleeve Gastrectomy (LSG) between January 2022 and December 2025, had a preoperative Body Mass Index (BMI) > 40 kg/m², and had no known cardiovascular or metabolic diseases. The control group consisted of 25 age- and gender-matched metabolically healthy morbidly obese patients who had not undergone surgery. Demographic and echocardiographic data of all participants were analyzed at baseline and at 6 months. Results: Weight Loss: In the surgical group, BMI decreased from 46.21 kg/m² to 37.11 kg/m² at the 6th month, while no significant change was observed in the control group. Cardiac Structure: In the surgical group, Left Ventricular Mass Index was significantly decreased from 51.11 g/m² to 44.57 g/m². Cardiac Function: The E/A ratio, an indicator of diastolic function, increased significantly from 1.19 to 1.34 in the surgical group, indicating notable improvement. No clinically meaningful change in systolic function was detected. Metabolic Parameters: The surgical group exhibited marked improvements in glucose and lipid profiles (decrease in Total Cholesterol, increase in HDL). Conclusions: The study demonstrates that bariatric surgery, independent of metabolic comorbidities, directly provides “reverse remodeling” of cardiac structure and improves function through reduction of adipose tissue and alleviation of hemodynamic load. These results support the effectiveness of surgery in reducing cardiovascular risk and preserving cardiac structure even in morbidly obese patients without comorbidities. Full article

Background: In the US, obesity is still a serious public health issue. Bariatric surgery utilization has recently been influenced by the COVID-19 pandemic and the 2022 American Society for Metabolic and Bariatric Surgery (ASMBS)/International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) guideline expansion. The combined effects of these events on national utilization trends remain unclear. Methods: We conducted a retrospective longitudinal study using electronic medical record data from the TriNetX network, including adults aged ≥18 years from 2018 through 2024. Primary bariatric procedures were identified using validated CPT and ICD codes. Quarterly surgery rates per 100,000 adults were calculated using the number of unique adults with at least one healthcare encounter per quarter as the denominator. Level and slope changes related to the start of COVID-19 (Q2 2020) and the application of the 2022 ASMBS guidelines (Q1 2022) were evaluated using interrupted time series models. Procedure-type distributions were also evaluated. Results: A total of 215,072 procedures were identified. Utilization was stable before Q2 2020, when a significant decline occurred following the onset of COVID-19. Rates recovered through 2021. After Q1 2022, a modest immediate increase was observed, followed by a sustained downward trend through 2024. Sleeve gastrectomy accounted for approximately two-thirds of procedures throughout the study period. Conclusions: Bariatric surgery utilization was markedly disrupted by COVID-19 and showed limited sustained growth after guideline expansion. These patterns might be a reflection of more general changes in the management of obesity, such as the growing accessibility of medication. Full article

Background/Objectives: Bariatric surgery is an effective intervention for severe obesity; however, long-term outcomes may be influenced by postoperative dietary behaviors, nutritional status, and complications. In Saudi Arabia, longitudinal evidence on weight trajectories and postoperative diet quality remains limited. The present study aimed at evaluating three-year weight status trends; assessing sociodemographic factors, baseline BMI, and postoperative diet quality; and examining nutrition-related complications following bariatric surgery. Methods: This retrospective longitudinal study included 189 adults who underwent sleeve gastrectomy at two tertiary hospitals in Jeddah, Saudi Arabia. Anthropometric data were obtained from medical records at six time points: preoperative, two weeks, six months, one year, two years, and three years postoperatively. Diet quality and postoperative complications were assessed via structured telephone interviews. Weight outcomes were expressed as percentage of total body weight loss (%TBWL), excess body weight loss (%EWL), excess body mass index loss (%EBMIL), and weight regain. Statistical analyses included Friedman’s test, Mann–Whitney U test, and multiple linear regression. Results: Significant improvements in all weight loss indicators were observed over three years (p < 0.001). Diet quality score was the only significant variable associated with weight loss at three years, with higher scores associated with greater %EWL and %EBMIL. Baseline BMI and DQS were significantly associated with %EWL (Beta = −0.17, 95% CI: −1.72 to −0.13 and Beta = 0.21, 95% CI: 1.37 to 7.12, respectively) and %EBMIL (Beta = −0.15, 95% CI: −1.68 to −0.07 and Beta = 0.24, 95% CI: 1.90 to 7.66, respectively). Age was significantly associated with weight regain (Beta = 0.20, 95% CI: 0.02 to 1.08). Conclusions: Bariatric surgery resulted in sustained weight reduction over three years. Postoperative baseline BMI and diet quality were significantly associated with %EWL and %EBMIL, underscoring the importance of structured nutritional follow-up and counseling. Full article

Background: Gastrectomy for gastric cancer is associated with substantial metabolic, nutritional, and immunological disturbances that may significantly influence postoperative recovery. Increasing evidence suggests that perioperative immunonutritional status, particularly when assessed by the Controlling Nutritional Status (CONUT) score, represents an important predictor of surgical outcomes. However, prospective data evaluating sex-related differences in postoperative nutritional recovery after gastrectomy remain limited. The aim of this study was to evaluate sex-related differences in perioperative immunonutritional status and functional recovery after gastrectomy for gastric cancer using serial CONUT score assessment. Methods: This prospective observational cohort study included 150 consecutive patients undergoing curative-intent gastrectomy for gastric adenocarcinoma at a tertiary referral center between 2021 and 2024. Nutritional and immune status were longitudinally assessed using the CONUT score at predefined perioperative timepoints: preoperatively (T0), early postoperatively (T1), and at 3-month follow-up (T3). Functional recovery outcomes, postoperative complications, and mid-term functional parameters were compared between male and female patients. Multivariable logistic regression analysis was performed to identify independent predictors of delayed postoperative recovery. Results: The study population included 91 male patients (60.7%) and 59 female patients (39.3%). Significant postoperative deterioration in albumin levels, lymphocyte counts, total cholesterol, and CONUT scores were observed in the entire cohort (p-time < 0.001 for all comparisons), followed by partial recovery during follow-up. No significant sex-related differences were identified regarding longitudinal immunonutritional evolution, postoperative complications, gastrointestinal recovery, or functional outcomes (p > 0.05). Overall postoperative complications occurred in 31.3% of patients, while 90-day mortality was 2.7%. An elevated baseline CONUT score ≥ 5 (OR 2.74, 95% CI 1.48–5.09, p = 0.001), postoperative CONUT score T1 ≥ 5 (OR 3.36, 95% CI 1.82–6.19, p < 0.001), ASA class III (OR 2.08, 95% CI 1.19–3.63, p = 0.010), and anastomotic leakage (OR 4.91, 95% CI 1.74–13.88, p = 0.003) independently predicted delayed functional recovery. Male sex was not independently associated with adverse postoperative recovery (OR 1.18, 95% CI 0.74–1.89, p = 0.44). Conclusions: Gastrectomy induces significant postoperative immunonutritional deterioration irrespective of sex. Although biological sex did not independently influence postoperative recovery trajectories, impaired perioperative immunonutritional status—particularly elevated postoperative CONUT score—was strongly associated with delayed functional recovery. Serial perioperative CONUT assessment may represent a valuable tool for individualized postoperative risk stratification and nutritional management in gastric cancer patients undergoing gastrectomy. Full article

Background/Objectives: Robotic gastrectomy (RG) for gastric cancer requires structured implementation to ensure oncological safety, particularly in Western centers with lower case volumes. Indocyanine green (ICG)-guided near-infrared lymphography may facilitate adequate lymphadenectomy and reliable tumor localization. We report our stepwise institutional introduction of RG and evaluate the perioperative outcomes and diagnostic accuracy of ICG-guided lymphography. Methods: All consecutive patients who underwent curative-intent RG at the University Medical Center Ljubljana between June 2022 and September 2025 were retrospectively analyzed. The implementation followed a structured stepwise approach, beginning with subtotal gastrectomy and progressing to total gastrectomy after formal training at Severance Hospital, Yonsei University Health System, under the mentorship of Prof. Woo Jin Hyung. ICG was administered endoscopically the day before surgery for tumor localization and intraoperative lymphatic mapping. The operative learning curve was assessed by CUSUM analysis, segmented regression, and bootstrapped plateau estimation. Results: Thirty-eight patients underwent RG (17 subtotal and 21 total). R0 resection was achieved in 100% of cases. The conversion rate was 2.6%. Major complications (Clavien–Dindo ≥ IIIb) occurred in six patients (15.8%). The 30-day mortality rate was 0%, and the 90-day mortality rate was 2.6%. Bootstrapped plateau operative times were 321.2 min (95% Bias-corrected and accelerated confidence interval (BCa CI): 278.4–344.1) for subtotal and 413.5 min (95% BCa CI: 378.1–476.1) for total gastrectomy, with the steepest learning phase confined to the first 2–4 cases. ICG was used in 23 patients. In a validation subset of five patients (259 lymph node stations), the sensitivity and negative predictive value were both 100%, with zero false negatives in 57 ICG-negative stations. Conclusions: RG can be safely introduced using a structured, stepwise strategy supported by training at a high-volume expert center. ICG-guided lymphography demonstrated 100% sensitivity for tumor-draining nodal basins in a small validation cohort (n = 5), supporting the feasibility of the technique during program introduction and warranting prospective evaluation in larger series. Full article

Small intestinal bacterial overgrowth (SIBO) refers to an abnormal increase in the number of bacteria in the small intestine and is observed in various diseases. SIBO can also develop after long-term use of proton pump inhibitors (drug-induced SIBO), bariatric surgery, gastrectomy, and other surgeries (postoperative SIBO). The aim of this narrative review is to summarize all of the published information on the treatment of SIBO in as much detail as possible and present it separately for each specific disease and intervention associated with SIBO. The most extensively studied drug for the treatment of SIBO is rifaximin. It eliminates SIBO in 63% of cases; however, most studies lack a control group. Small RCTs assessing the effects of this antibiotic on SIBO have reported conflicting results, and a meta-analysis showed no effect. A large RCT is required to verify the results of uncontrolled studies. Neomycin and norfloxacin showed efficacy in the treatment of SIBO in single RCTs, with elimination rates of 20 and 100%, respectively. Ciprofloxacin, rifamycin, metronidazole, and other antibiotics, as well as ursodeoxycholic acid, showed positive effects for the treatment of SIBO, but only in uncontrolled studies or in comparison with rifaximin or other drugs. The reported elimination rates were 54%, 67%, 79%, and 75%, respectively. Eradication therapy for Helicobacter pylori infection eliminated SIBO at a rate of approximately 70%. Probiotics have been tested for treatment of SIBO in various diseases. VSL#3 and Saccharomyces boulardii CNCM I-745 were effective in RCTs, with elimination rates of 58% and 80%, respectively. In conclusion, when selecting SIBO treatment regimens, those that have demonstrated the greatest efficacy for a specific concomitant disease should be preferred, despite the generally low level of evidence supporting these approaches in most cases. Full article

Background/Objectives: Standard gastrectomy with lymph node dissection up to D1+ achieves good oncologic control for early gastric cancer not amenable to endoscopic submucosal dissection, yet it frequently leads to post-gastrectomy syndromes and long-term nutritional impairment. Local resection of the stomach reduces post-gastrectomy syndrome; however, the extent of lymph node dissection should be limited beyond D1+ in such cases. This review evaluates the safety of local resection for early gastric cancer reported in East Asia. Methods: We reviewed current concepts and clinical evidence regarding (i) the limitations of preoperative nodal staging, (ii) sentinel node biopsy and function-preserving gastrectomy, and (iii) functional outcomes and procedure-specific complications following local resection, with a focus on delayed gastric emptying. Results: Conventional imaging and biomarkers are inadequate for reliable preoperative identification of node-negative disease. Conversely, sentinel node biopsies demonstrate high intraoperative diagnostic accuracy. Large prospective studies have revealed that, when indications are strictly adhered to, sentinel node biopsy-guided function-preserving gastrectomy can yield survival outcomes comparable to those of standard gastrectomy. The indications for local resection include solitary submucosal tumors below 4 cm in size, diagnosed as node-negative by sentinel node biopsy. Although the available quality-of-life data are generally favorable, there is risk of delayed gastric emptying in local resection with limited lymph node dissection in cases of early gastric cancer. Postoperative gastric deformity following closure was identified as the primary cause. Conclusions: Local resection for submucosal gastric cancer guided by sentinel node biopsy may be oncologically acceptable and function-preserving; however, the prevention of gastric deformity is crucial for its safe implementation. Full article

Minimally invasive gastrectomy has become an established surgical approach for gastric cancer, supported by randomized trials demonstrating oncologic outcomes comparable to open surgery. Initially applied mainly to early-stage disease, laparoscopic gastrectomy has gradually expanded to selected patients with advanced gastric cancer and to more complex procedures, including total gastrectomy. In parallel, robotic surgery and reduced-port techniques have further broadened the technical spectrum of minimally invasive gastric cancer surgery. This review summarizes current evidence on laparoscopic, robotic, and reduced-port gastrectomy, with emphasis on randomized trials, large-scale clinical studies, and recent guideline recommendations. Laparoscopic distal gastrectomy has shown robust oncologic equivalence in early and selected advanced gastric cancer, while evidence for laparoscopic total gastrectomy continues to grow, particularly in experienced centers. Robotic and reduced-port approaches appear feasible and safe in selected settings, although clear superiority over standard laparoscopy has not been established. As minimally invasive techniques are adopted more widely, careful consideration is needed during program development and expansion. Patient selection, surgeon experience, learning curve, institutional volume, standardized operative procedures, quality control, and multidisciplinary support are important factors for safe implementation. Future studies should focus not only on comparing surgical approaches, but also on defining how minimally invasive gastrectomy can be applied safely and consistently across diverse clinical settings. Full article

Background and Objectives: Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed metabolic bariatric surgery procedures worldwide. However, conventional LSG generally requires liver retraction for adequate visualization of the operative field. This study aimed to evaluate the feasibility, perioperative safety, and metabolic outcomes of a modified three-port LSG technique performed without the use of a liver retractor. Materials and Methods: This retrospective single-center cohort study included 2000 consecutive individuals with obesity who underwent three-port laparoscopic sleeve gastrectomy between January 2020 and December 2023. All procedures were performed without mechanical liver retraction by two experienced bariatric surgeons. Operative outcomes, postoperative complications, weight loss parameters, metabolic variables, and histopathological findings were evaluated during a 12-month follow-up period. All included patients completed the predefined follow-up schedule. Postoperative complications were classified according to the Clavien–Dindo classification system. Results: The mean operative time, defined as skin-to-skin duration, was 30 ± 15 min, and the median hospital stay was 2.3 days. No conversion to open surgery, additional trocar placement, or rescue liver retractor use was required. The overall complication rate was 9.4%, with most complications classified as Clavien–Dindo grade I–II. Reoperation was required in three patients (0.15%), and no mortality was observed. Significant metabolic improvements were detected following surgery. Mean HbA1c levels decreased from 7.23% preoperatively to 5.67% at 12 months (p < 0.001), while BMI decreased from 42.6 kg/m² to 28.7 kg/m² (p < 0.001). Excess weight loss and total weight loss at 12 months reached 82.4% and 34.2%, respectively. Diabetes remission was achieved in 65.4% of patients with baseline type 2 diabetes mellitus. Continuous glucose monitoring findings demonstrated reduced postoperative glycemic variability. Conclusions: Three-port laparoscopic sleeve gastrectomy performed without a liver retractor appears to be a feasible and effective surgical approach when performed by experienced bariatric surgeons. The technique was associated with acceptable perioperative safety and favorable metabolic outcomes. However, because of the retrospective single-center design and absence of a conventional comparison group, definitive conclusions regarding superiority or equivalence to standard techniques cannot be established. Prospective multicenter comparative studies are required to validate these findings. Full article

Adipose tissue-derived extracellular vesicles (adiposomes) carry a protein cargo that we previously showed differs between obese and lean individuals. In this study, we investigate how adiposomal protein cargo changes in response to sleeve gastrectomy and examine whether these changes are associated with clinical improvements. Twenty-three obese adults underwent pre- and post-bariatric surgery adipose sampling for adiposome isolation and clinical assessments that included vascular and metabolic profiles and inflammatory markers. The adiposomal protein cargo was analyzed via non-targeted proteomics. Differential protein abundance, pathway enrichment, and correlation analyses were assessed. Twelve weeks after bariatric surgery, BMI and fat mass decreased, accompanied by improved glucose and lipid profiles. Inflammatory markers (leptin, IL-6, CRP) also declined, while adiponectin and nitric oxide increased. Adiposomal proteomics identified 287 proteins, with 138 significantly altered. Downregulated proteins included PRDX2, FN1, SERPIND1, and inflammatory mediators; upregulated proteins included talin-1, fibrinogens, and adiponectin. Correlation analysis linked these changes to improvements in lipid profiles, vascular function, and circulating inflammatory markers. Pathway analysis revealed inhibition of lipid-regulatory pathways alongside enrichment of immune, metabolic, and vascular pathways, including lipoprotein metabolism and endothelial signaling. Bariatric surgery-induced cardiometabolic improvements were accompanied by adiposome proteomic remodeling, characterized by reduced inflammation and metabolic reprogramming. Full article

Background: Palliative surgery is often considered for advanced stages of gastric cancer to reduce symptoms and improve quality of life; however, it is associated with considerable risks of postoperative complications and mortality. The aim of this study is to analyze the differences in severe complication rates and mortality between palliative and curative gastric cancer surgeries using data from a nationwide survey conducted by the Korean Gastric Cancer Association. Materials and Methods: Data from 12,420 patients who underwent gastric cancer surgery in 2019 were analyzed. Surgical procedures were categorized as total gastrectomies (TGs), distal gastrectomies (DGs), or bypass operations. Patients were divided into curative gastrectomy (CG, n = 12,114) and palliative surgery (PS, n = 306) groups. Postoperative complications were classified using the Clavien–Dindo (C-D) classification. Severe complications were defined as C-D grade IIIa or higher. Results: Compared with the CG group, the PS group had significantly higher rates of severe complications (10.2% vs. 4.8%, p < 0.001) and mortality (1.6% vs. 0.2%, p = 0.001). Leakage (3.9% vs. 1.3%, p = 0.001) and pancreatic fistula (1% vs. 0.2%, p = 0.036) were significantly more common in the PS group. When compared by resection extent, the PS group had higher severe complication rates than the CG group for DGs (13% vs. 3.8%, p < 0.001) and a higher mortality rate for TGs (3.3% vs. 0.3%, p = 0.006). Conclusions: Palliative gastric cancer surgeries are associated with significantly higher rates of severe complications and mortality than are curative surgeries. These findings emphasize the need for careful patient selection and thorough preoperative counseling when considering palliative gastric cancer surgery. Full article

Background. This study aimed to evaluate the efficacy and safety of low-dose neoadjuvant chemotherapy with an oral fluoropyrimidine containing tegafur, gimeracil, and oteracil (S-1) and oxaliplatin (NAC-SOX) in improving resectability and long-term outcomes in patients with advanced gastric cancer. Methods. This was a single-center, retrospective study analyzing patients with advanced gastric cancer or esophagogastric junction cancer who received NAC-SOX. (S-1: 80–120 mg/m², oxaliplatin: 100 mg/m²) followed by gastrectomy with D2 lymphadenectomy. Clinical background, chemotherapy-related adverse effects, surgical outcomes, pathological response, and survival were assessed. Results. A total of 34 patients underwent NAC-SOX, with a median age of 74 years. The most common surgical procedure was total gastrectomy (n = 16). Peripheral neuropathy was the most frequent adverse effect, but no grade 4 toxicities were observed. Postoperative complications (≥CD grade 3a) occurred in 8.8% of cases, with no treatment-related deaths. R0 resection was achieved in 85.3% of cases, and the pathological complete response rate was 20.6%. The 3-year recurrence-free and overall survival rates were 71.3% and 83.2%, respectively. Conclusions. Low-dose NAC-SOX demonstrated favorable efficacy and safety, achieving high R0 resection and pathological response rates. Further prospective studies are needed to optimize treatment strategies. Full article

Background/Objectives: While bariatric surgery is known to improve plantar pressure distribution and reduce foot-related symptoms, its impact on radiographic forefoot alignment parameters, such as the intermetatarsal angle (IMA) and hallux valgus angle (HVA), remains unclear, highlighting the need for further investigation. The aim of this study was to quantitatively evaluate changes of HVA and IMA in patients undergoing bariatric surgery and to determine whether weight loss-induced reductions in mechanical load are associated with differential changes of the forefoot. Methods: Weight-bearing anteroposterior foot radiographs of 102 patients who underwent laparoscopic sleeve gastrectomy were obtained preoperatively and at 6 months postoperatively. HVA and IMA were measured using standardized digital techniques. Changes in angular parameters were analyzed in relation to body mass index reduction. Results: Intra-observer reliability was excellent for all angular measurements (ICC: 0.987–0.999, p < 0.001). Radiographic evaluation demonstrated no significant change in HVA (p = 0.147), whereas IMA showed a significant decrease postoperatively (p < 0.001). No significant change was observed in HVA distribution (p = 0.341), and although the proportion of patients within the normal IMA range increased, this did not reach statistical significance (p = 0.091). Correlation analysis revealed significant associations of postoperative angles with age and body weight parameters (p < 0.05), while no significant relationship was found between changes in body weight or BMI and angular measurements (p > 0.05). Conclusions: Sleeve gastrectomy significantly improves biomechanically driven aspects of forefoot alignment (decrease in IMA), while structural deformities (HVA) remain unchanged in the short-term. These findings highlight that obesity-related forefoot pathology is predominantly linked to altered load distribution rather than fixed structural deformity, suggesting that radiographic parameters reflecting biomechanical loading are more sensitive to weight loss. Full article