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Introduction Bariatric surgery is the only treatment option that achieves sustained weight loss in obese patients and that also has positive effects on obesity-related comorbidities. Laparoscopic sleeve gastrectomy (LSG) seems to achieve equal weight loss as laparoscopic Roux-en-Y gastric bypass (LRYGB), but there is still much debate about the quality of life (QOL) after LSG, mainly concerning the association with gastroesophageal reflux. Our hypothesis is that QOL after LSG is comparable with QOL after LRYGB. Materials and Methods Between February 2013 and February 2014, 150 patients were randomized to undergo either LSG or LRYGB in our clinic. Differences in QOL were compared between groups by using multiple QOL questionnaires at follow-up moments preoperatively and 2 and 12 months after surgery. Results After 12 months of follow-up, 128 patients had returned the questionnaires. Most QOL questionnaires showed significant improvement in scores between the preoperative moment and after 12 months of follow-up. The Gastroesophageal Reflux Disease Questionnaire (GerdQ) score deteriorated in the LSG group after 2 months, but recovered again after 12 months. After 2 months of follow-up, the mean GerdQ score was 6.95 ± 2.14 in the LSG group versus 5.50 ± 1.49 in the LRYGB group ( p  < 0.001). After 1 year, the mean GerdQ score was 6.63 ± 2.26 in the LSG group and 5.60 ± 1.07 in the LRYGB group ( p  = 0.001). Conclusion This randomized controlled trial shows that patients who underwent LSG have significantly higher GerdQ scores at both 2 and 12 months postoperatively than patients who underwent LRYGB, whereas overall QOL did not differ significantly.

Introduction Laparoscopic sleeve gastrectomy is one of the most common techniques in bariatric surgery, but there is no consensus on the optimal distance from the pylorus to start the gastric transection. The aim of this study is to determine the differences in gastric emptying, gastric distension and metabolic response between two starting distances. Material and Methods This is a prospective randomised study of 60 patients (30 patients with the section at 3 cm and 30 patients at 8 cm from the pylorus). We calculate at 6 and 12 months from surgery gastric emptying by scintigraphy (T1/2 min), gastric volume by CT scan (cc) and metabolic response by blood sample analysis (glucose, HbA1c, insulin, HOMA-IR, GLP-1, GIP and C-peptide). Results Gastric emptying increases the speed significantly in both groups but is greater in the 3-cm group ( p  < 0.05). Dividing groups into type 2 diabetic patients and non-diabetic patients, the speed in non-diabetic patients is significantly higher for the 3-cm group. Residual volume increases significantly in both groups, and there are no differences between them. One year after surgery, there are significant improvements in the hyperinsulinaemia in the patients of the 3-cm group with respect to the 8-cm group, but only in diabetic patients. No differences between groups are found regarding changes in GLP-1 or GIP. Conclusions Gastric emptying is faster in patients with antrum resection. The distance does not influence the gastric emptying of diabetic patients. Other mechanisms may explain metabolic response besides GLP-1 and its association with improvements in diabetes via gastric emptying.

Background Data on adherence to postoperative lifestyle recommendations by bariatric patients are scarce. Thus, the aim of this study was to evaluate adherence to selected recommendations during the first year following laparoscopic sleeve gastrectomy (LSG) surgery. Methods A prospective cohort study with 12 months of follow-up on 100 LSG patients was conducted. Data were collected at baseline and at 3 (M3), 6 (M6), and 12 (M12) months post-surgery and included anthropometrics, biochemical tests, food intake, food tolerance, common surgery-related side effects, physical activity (PA), supplementation, and number of follow-up meetings with a dietitian. Results Data were available for 77 patients (57.1% women, mean age 43.1 ± 9.3 years and preoperative BMI 42.1 ± 4.8 kg/m 2 ). Only a minority of the patients adhered to the recommended protein intake ≥60 g/day at all time points (≤40.3%) and ≥6 meetings with a dietitian at M12 (41.6%). Half of the patients performed ≥150 min/week of PA at all time points (≤50.6%) as recommended. PA of ≥150 min/week was associated with better lipid and glucose changes at M6 and M12 ( P  ≤ 0.044). Most of the patients adhered to the recommended supplementation at all time points (≥57.1%). Adherence to supplementation at M12 was significantly associated with higher serum levels of folic acid, iron, hemoglobin, and vitamins D and B12 ( P  ≤ 0.056 for all). Adherence to all recommendations was not significantly associated with excess weight loss ≥60% at M12 ( P  ≥ 0.195 for all). Conclusion Bariatric patients have medium to high adherence to the major lifestyle recommendations during the first year following LSG; however, adherence to those recommendations was not related to better weight loss at short-term follow-up. Adherence to recommended supplementation was associated with better micronutrient status 1 year postoperatively.

Background Laparoscopy-assisted distal gastrectomy (LADG) is generally considered superior to open distal gastrectomy (ODG) with regard to postoperative quality-of-life. Differences in postoperative pain may exist due to recent pain control techniques including epidural anesthesia. There is little evidence for this difference. In this article we report the results of our randomized single-blind study in LADG versus ODG. The aim of the present study was to evaluate differences in postoperative physical activity between LADG and ODG. Methods Forty patients with early gastric cancer (stage IA and IB) were registered in this randomized study. For strict evaluation, patients were not told about the type of operation until postoperative day 7. Postoperative physical activity was evaluated objectively by Active Tracer, which records the cumulative acceleration over a 24 h period to investigate differences in postoperative recovery. Questionnaire and visual analog scale score related to postoperative pain were also investigated. Results Significant differences were observed with a more favorable outcome noted in the LADG group with respect to intraoperative blood loss ( P  < 0.001), total amount of pain rescue ( P  < 0.001), wound size ( P  < 0.001), postoperative hospital stay ( P  < 0.001), and inflammatory parameters (C-reactive protein, SaO 2 , and duration of febrile period) ( P  < 0.001). Cumulative physical recovery to 70 % of the preoperative level was significantly shorter (by 3 days, P  < 0.001) in the LADG group. Conclusions Comparison of LADG and ODG for patients with early gastric cancer showed favorable outcome and earlier recovery of physical activity in the LADG group.

Background The RCT study on the efficacy of continuous active warming (CAW) in patients undergoing laparoscopic gastrectomy is scarce. The purpose of this research was to determine if a significant difference between continuous active warming (CAW) and active warming when body temperature is below 36 °C (BAW) in terms of incidence of intraoperative hypothermia and clinical rehabilitation in patients undergoing laparoscopic gastrectomy surgery. Methods A prospective, randomized and controlled trial with a sample of 62 patients who underwent elective total laparoscopic radical gastrectomy was conducted. Patients assigned to CAW group were warmed immediately since the surgical incision procedure, the others were warmed while the body bladder temperature dropped to 36 °C. The bladder temperature of the patient was recorded every 30 min during the operation. One-way ANOVA and ANOVA with repeated measures were used for comparisons between multiple groups, independent samples t -test for pair-wise comparisons. Results This study included a total of 62 patients, with 31 in each group. Among them, there were 52 males and 10 females, with an age range of 39 to 83 years. The mean age in the CAW group was (62.52 ± 8.15) years, and in the BAW group, it was (62.74 ± 9.20) years. The overall incidence of hypothermia was 16.13% in 62 patients who underwent elective total laparoscopic radical gastrectomy. The incidence of shivering and agitation after operation was both 3.23% in CAW group, and it was 32.26% and 29.03% in BAW group. Time from end of surgery to tracheal extubation in CAW group was significantly lower than BAW group. In addition, continuous active warming could shorten time to first postoperative flatus of patients and relieve postoperative pain. Conclusion Our study showed that continuous active warming in patients undergoing laparoscopic gastrectomy decreased the incidence of intraoperative hypothermia and contributed to postoperative rehabilitation. Trial Registration It was permitted by the Ethics Committee of Xijing Hospital, Air Force Military Medical University, China. No. KY20212024-C-1 25/01/2021 and was registered with the Chinese Clinical Trial Registration Center (11/02/2025) ( www.chictr.org.cn ; registration number: ChiCTR2500097060).

Background and AimsLongitudinal assessment of body composition following bariatric surgery allows monitoring of health status. Our aim was to elucidate trends of anthropometric and clinical outcomes 3 years following sleeve gastrectomy (SG).MethodsA prospective cohort study of 60 patients who underwent SG. Anthropometrics including body composition analysis measured by multi-frequency bioelectrical impedance analysis, blood tests, liver fat content measured by abdominal ultrasound and habitual physical activity were evaluated at baseline and at 6 (M6), 12 (M12), and 36 (M36) months post-surgery.ResultsSixty patients (55% women, age 44.7 ± 8.7 years) who completed the entire follow-up were included. Fat mass (FM) was reduced significantly 1 year post-surgery (55.8 ± 11.3 to 26.7 ± 8.3 kg; P < 0.001) and then increased between 1 and 3 years post-operatively, but remained below baseline level (26.7 ± 8.3 to 33.1 ± 11.1 kg; P < 0.001). Fat free mass (FFM) decreased significantly during the first 6 months (64.7 ± 14.3 to 56.9 ± 11.8 kg; P < 0.001), slightly decreased between M6 and M12 and then reached a plateau through M36. Weight loss “failure” (< 50% excess weight loss) was noticed in 5.0% and 28.3% of patients at M12 and M36, respectively. Markers of lipid and glucose metabolism changed thereafter in parallel to the changes observed in FM, with the exception of HDL-C, which increased continuingly from M6 throughout the whole period analyzed (45.0 ± 10.2 to 59.5 ± 15.4 mg/dl; P < 0.001) and HbA1c which continued to decrease between M12 and M36 (5.5 ± 0.4 to 5.3 ± 0.4%; P < 0.001). There were marked within-person variations in trends of anthropometric and clinical parameters during the 3-year follow-up.ConclusionsWeight regain primarily attributed to FM with no further decrease in FFM occurs between 1 and 3 years post-SG. FM increase at mid-term may underlie the recurrence of metabolic risk factors and can govern clinical interventions.

Objective The aim of this study was to evaluate the safety and effectiveness of fast-track surgery combined with laparoscopy-assisted radical distal gastrectomy for gastric cancer. Methods Eighty-eight eligible patients were randomly assigned into four groups: (1) fast-track surgery (FTS) + laparoscopy-assisted radical distal gastrectomy (LADG), treated with LADG and FTS treatment; (2) LADG, treated with LADG and traditional treatment; (3) FTS + open distal grastectomy (ODG), treated with ODG and FTS treatment; and (4) ODG, treated with ODG and traditional treatment. The clinical parameters and serum indicators were compared. Results Compared with the ODG group, the other three groups had earlier first flatus and shorter postoperative hospital stay (all P  <0.01; all P  <0.05), especially in the FTS + LADG group. The level of ALB was higher in the FTS + LADG group than in the LADG group at 4 and 7 days after surgery ( P  <0.05, P  <0.01). The level of CRP in the FTS + LADG group was lower than in the FTS+ODG group at 4 and 7 days after surgery ( P  <0.05, P  <0.05). The FTS + ODG group had lowest medical costs. Conclusion Combination of FTS and LADG in gastric cancer is safe, feasible, and efficient and can improve nutritional status, lessen postoperative stress, and accelerate postoperative rehabilitation. Compared with FTS + ODG and LADG, its advantages were limited in short-term follow-up.

Background Fast-track surgery has been shown to enhance postoperative recovery in several surgical fields. This study aimed to evaluate the safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy. Methods The present study was designed as a single-center, randomized, unblinded, parallel-group trial. Patients were eligible if they had gastric cancer for which laparoscopic distal gastrectomy was indicated. The fast-track surgery protocol included intensive preoperative education, a short duration of fasting, a preoperative carbohydrate load, early postoperative ambulation, early feeding, and sufficient pain control using local anesthetics perfused via a local anesthesia pump device, with limited use of opioids. The primary endpoint was the duration of possible and actual postoperative hospital stay. Results We randomized 47 patients into a fast-track group ( n  = 22) and a conventional pathway group ( n  = 22), with three patients withdrawn. The possible and actual postoperative hospital stays were shorter in the fast-track group than in the conventional group (4.68 ± 0.65 vs. 7.05 ± 0.65; P  < 0.001 and 5.36 ± 1.46 vs. 7.95 ± 1.98; P  < 0.001). The time to first flatus and pain intensity were not different between groups; however, a greater frequency of additional pain control was needed in the conventional group (3.64 ± 3.66 vs. 1.64 ± 1.33; P  = 0.023). The fast-track group was superior to the conventional group in several factors of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, including: fatigue, appetite loss, financial problems, and anxiety. The complication and readmission rates were similar between groups. Conclusions Fast-track surgery could enhance postoperative recovery, improve immediate postoperative quality of life, and be safely applied in laparoscopic distal gastrectomy.

Objective This study aims to explore the effects of prehabilitation strategies on the psychological state and glucose metabolism markers in patients undergoing laparoscopic sleeve gastrectomy (LSG). Methods A total of 120 eligible patients undergoing elective LSG between January 2024 and December 2024 were enrolled in the study. They were randomly assigned to either the control group or the observation group, with 60 patients in each group. The control group received routine care interventions, while the observation group received prehabilitation strategies. The outcomes were compared between the two groups, including body mass index (BMI), body fat percentage (PBF), visceral fat area (VFA), waist-to-hip ratio (WHR), basal metabolic rate (BMR), glucose metabolism markers, psychological state, and incidence of postoperative complications, measured both one day before and six months after the intervention. Results One day before the intervention, there were no significant differences between the two groups in BMI, PBF, VFA, WHR, and BMR ( P  > 0.05). However, six months after the intervention, the observation group showed significantly lower BMI, PBF, VFA, WHR, and BMR compared to the control group ( P  < 0.05). Furthermore, at six months post-surgery, the observation group had significantly lower HbA1c levels compared to the control group ( P  < 0.05), while the difference in fasting blood glucose (FBG) was not statistically significant ( P  > 0.05). Regarding psychological state, the observation group showed significantly lower scores on the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) six months after the intervention ( P  < 0.05). Additionally, the incidence of postoperative minor complications was significantly lower in the observation group compared to the control group ( P  < 0.05). Conclusion Prehabilitation strategies can effectively improve the psychological state, reduce glycated hemoglobin levels, promote weight loss, and reduce the incidence of minor postoperative minor complications in patients undergoing laparoscopic sleeve gastrectomy. These strategies appear to be safe and effective, and could be considered for wider clinical adoption. Clinical registration number Not applicable.

Background Poor nutrition in the first months after oesophago-gastric resection is a contributing factor to the reduced quality of life seen in these patients. The aim of this pilot and feasibility study was to ascertain the feasibility of conducting a multi-centre randomised controlled trial to evaluate routine home enteral nutrition in these patients. Methods Patients undergoing oesophagectomy or total gastrectomy were randomised to either six weeks of home feeding through a jejunostomy (intervention), or treatment as usual (control). Intervention comprised overnight feeding, providing 50 % of energy and protein requirements, in addition to usual oral intake. Primary outcome measures were recruitment and retention rates at six weeks and six months. Nutritional intake, nutritional parameters, quality of life and healthcare costs were also collected. Interviews were conducted with a sample of participants, to ascertain patient and carer experiences. Results Fifty-four of 112 (48 %) eligible patients participated in the study over the 20 months. Study retention at six weeks was 41/54 patients (76 %) and at six months was 36/54 (67 %). At six weeks, participants in the control group had lost on average 3.9 kg more than participants in the intervention group (95 % confidence interval [CI] 1.6 to 6.2). These differences remained evident at three months (mean difference 2.5 kg, 95 % CI −0.5 to 5.6) and at six months (mean difference 2.5 kg, 95 % CI −1.2 to 6.1). The mean values observed in the intervention group for mid arm circumference, mid arm muscle circumference, triceps skin fold thickness and right hand grip strength were greater than for the control group at all post hospital discharge time points. The economic evaluation suggested that it was feasible to collect resource use and EQ-5D data for a full cost-effectiveness analysis. Thematic analysis of 15 interviews identified three main themes related to the intervention and the trial: 1) a positive experience, 2) the reasons for taking part, and 3) uncertainty of the study process. Conclusions This study demonstrated that home enteral feeding by jejunostomy was feasible, safe and acceptable to patients and their carers. Whether home enteral feeding as ’usual practice’ is a cost-effective therapy would require confirmation in an appropriately powered, multi-centre study. Trial registration UK Clinical Research Network ID 12447 (main trial, first registered 30 May 2012); UK Clinical Research Network ID 13361 (qualitative substudy, first registered 30 May 2012); ClinicalTrials.gov NCT01870817 (first registered 28 May 2013)