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The world is experiencing an obesity epidemic. In both industrialized and emerging countries, the percentage of adults and children with obesity is increasing annually. It is no longer unusual to encounter a patient with extreme or morbid obesity in the operating room; these patients are routinely scheduled for every type of surgical procedure. Everyone involved in the peri-operative management of the surgical patient with morbid obesity – surgeons, anesthesiologists, internists, psychologists, nurses, nutritionists, respiratory therapists – must be aware of the special needs of these patients. Morbid Obesity: Peri-operative Management, 2nd edition considers the perioperative care of the morbidly obese patient, from preoperative preparation to intraoperative management and through to their postoperative course. Edited by leading experts in the management of the morbidly obese surgical patient, Morbid Obesity: Peri-operative Management, second edition, provides clear, practical clinical guidance on the management of the extremely obese surgical patient.

Background One-anastomosis gastric bypass (OAGB) has gradually gained in popularity. Evidence of the validity of the technique and the quality of life in the longer term is scarce. The aim of this study was to retrospectively evaluate the longitudinal (≥ 5 years) safety, weight-loss efficacy, comorbid disease improvement, and quality of life of patients following OAGB. Methods Data from patients who underwent OAGB from January 2009 to December 2011 were retrospectively reviewed. Preoperative clinical characteristics and data through 8 years were analyzed. Results A total of 163 patients completed 5 to 8 years of follow-up with a mean age of 41 ± 11.4 years (22–65). Ninety-four patients (57.6%) had undergone prior bariatric surgery (gastric band). Mean body mass index (BMI, kg/m 2 ) at the time of OAGB was 41.2 ± 6.5 (range 30.1–50.6). Twenty-one patients (13.0%) suffered from type 2 diabetes mellitus (T2DM), 59 (36.2%) hypertension, 31 osteoarthritis (19.0%), and 24 had obstructive sleep apnea (14.7%). At 5, 6, 7, and 8 years of follow-up, respective mean BMI reduction was 12.6 ( n = 163), 11.8 ( n = 100), 10.7 ( n = 82), and 8.8 ( n = 40). Respective mean excess weight loss was 81.8 ± 23.6%, 75.9 ± 20.8%, 69.1 ± 20.4%, and 62.3 ± 23.4%. All obesity-related comorbidities decreased significantly at follow-up time points. Five patients (3%) underwent laparoscopic reoperation within 90 days after surgery. Incidence of recurrent reflux was 14.0%. At a mean follow-up of 92 months (76–111), improved or greatly improved quality of life was reported by 86.0% of patients. Conclusion OAGB provided very good weight loss, comorbidity improvement, and quality of life at follow-up of ≥ 5 years.

Over the last two decades, obesity has reached epidemic proportions in the world, resulting in suffering and premature death. Morbid obesity is a chronic medical illness that has long-reaching consequences and is caused by multiple factors. Bariatric surgery and other non-invasive procedures in carefully selected patients are effective treatments for obesity. It is the only tool for sustained and effective long-term weight loss.The field of surgery is developing rapidly — offering innovative options for patients who have failed to lose weight by diet, exercise and pharmacological methods. The editors review problems that the patients face in the perioperative period and in the long term, as well as their adjustments in lifestyle and healthcare management.The text is authored by authorities who participate in the multidisciplinary care of bariatric patients. It will address the assessment and selection of patients' treatment before surgery, options for surgical intervention and postoperative medical management.

Background The use of one anastomosis gastric bypass (OAGB) has increased in recent years. However, the efficacy and safety outcomes of this procedure remain under debate. Here, we compare our early outcome and mid-term safety of OAGB with primary Roux-en-Y gastric bypass (RYGB). Methods This was a retrospective study using computerized electronic medical records data of patients who underwent RYGB or OAGB as a primary procedure from February 2012 to February 2019 in our bariatric center. Data collected included demographics, weight-outcomes, adverse events, hospital readmission, reoperation rates, and mortality following both procedures. Results A total of 314 patients were included (132 RYGB and 182 OAGB). Operative time and costs were significantly lower for OAGB (80 vs. 125 min, p<0.01 and 2018.8 vs. 2912.3 USD, p < 0.01, respectively), but length of hospital stay was longer (4.06 ± 0.67 days vs. 3.58 ± 0.79, p < 0.0001). At 12 months post-surgery, the percentage of excess body mass index loss was comparable between the two groups, but the change in body mass index (BMI) was significantly higher in the OAGB group. Early (< 30 days) and late (> 30 days) surgical adverse events were also similar between the two groups. Conclusion Comparable short- and mid-term outcomes and adverse events are found for primary OAGB and RYGB. OAGB is not inferior to RYGB as a primary bariatric procedure for the treatment of obesity. Graphical abstract

As part of a bariatric enhanced recovery after surgery (ERAS) program, at-home follow-up using a novel Internet application was used to detect early complications. The study aimed to evaluate the safety and effectiveness of this “connected surveillance” protocol over a 10-day follow-up. Patients were monitored 24/7 by a trained nursing team with daily surgeon review of patient self-reports. Morbidly obese patients ( n  = 281) underwent OAGB (126, 47.70%) or sleeve gastrectomy (138, 52.3%). Of 264 who completed the study (mean age 40 years [20–66]), 3 (1.1%) underwent revision for early complications; there were 6 (2.1%) readmissions and 22 (8.3%) consultations. In a bariatric surgery ERAS program, “Internet-connected surveillance” proved safe and effective in detecting 100% of early complications, and most patients were satisfied with their care.

Lipid metabolism dysregulation is a critical factor contributing to obesity. To counteract obesity-associated disorders, bariatric surgery is implemented as a very effective method. However, surgery such as Roux-en-Y gastric bypass (RYGB) is irreversible, resulting in life-long changes to the digestive tract. The aim of the present study was to elucidate changes in the fecal microbiota before and after RYGB in relation to blood lipid profiles and proinflammatory IL-6. Here, we studied the long-term effects, up to six years after the RYGB procedure, on 15 patients' gut microbiomes and their post-surgery well-being, emphasizing the biological sex of the patients. The results showed improved health among the patients after surgery, which coincided with weight loss and improved lipid metabolism. Health changes were associated with decreased inflammation and significant alterations in the gut microbiome after surgery that differed between females and males. The Actinobacteriota phylum decreased in females and increased in males. Overall increases in the genera , , , , and , and decreases in , , , , , , and were observed. In conclusion, our findings indicate that there were long-term changes in the gut microbiota after RYGB, and shifts in the microbial taxa appeared to differ depending on sex, which should be investigated further in a larger cohort.

Background Significant weight regain after Roux-en-Y gastric bypass (RYGB) occurs in around 20 % of patients in the long term. Anatomical reasons include dilatation of the gastric pouch and/or the pouch-jejunal anastomosis, leading to loss of restriction. Pouch reshaping (PR) aims at reestablishing restriction with a subsequent feeling of satiety. This study reports the outcome of PR embedded in a multidisciplinary treatment pathway. Methods Twenty-six patients after PR for weight regain >30 % following RYGB in a university hospital between October 2010 and March 2016 were analyzed. Excluded were patients with PR for gastro-gastric fistulae, hypoglycemia, candy cane syndrome, and concomitant alteration of limb lengths. PR consisted in laparoscopic lateral resection of the gastric pouch, the anastomosis and the proximal 5 cm of the alimentary limb over a 32F bougie. Results Median follow-up after PR was 48 months (range 24–60). Median BMI at PR was 39.1 kg/m 2 (32.7–59.1). Median operation time was 85 min (25–190), and median length of stay was 3 days (1–35). Minor complications (grade ≤ 2) occurred in seven (27 %) patients and major complications (grade ≥ 3) in four patients (15 %). Nadir BMI and %EBMIL after PR were 32.9 kg/m 2 and 43.3 %, reached after a median of 12 months (3–48). Comorbidities were resolved in 81 %. After 48 months, median BMI was 33.8 kg/m 2 (20.4–49.2) and %EBMIL was 61.4 (39.1–121.2). Conclusions Used selectively in a multidisciplinary treatment pathway, PR leads to prolonged weight stabilization around the previous nadir. However, its associated perioperative morbidity must not be disregarded.

Pregnancies occurring after bariatric surgery are associated with various perinatal complications. However, there may be differences in the type of perinatal complications occurring after different methods of bariatric surgery. The aim of the current study was to compare adverse perinatal outcomes in pregnant women following Roux-en-Y Gastric Bypass (RYGB) vs. Sleeve Gastrectomy (SG). A systematic database search was performed in PubMed, Embase, Scopus and CINAHL. Observational studies comparing perinatal outcomes post-bariatric (RYGB and SG) surgery to pregnancies without prior surgery were selected. Outcomes of interest were: maternal body mass index (BMI) at the time of conception, mode of delivery, time from surgery to conception, birth weight, gestational age and intrauterine fetal death. Article selection, risk of bias assessment and data extraction, were performed by two authors. The study protocol was published in its revised form in PROSPERO, registration number: CRD42021234480. A total of 3201 records were extracted. After duplicates were removed, 3143 records were screened for inclusion. Six studies fitted the selection criteria, of which four studies were RYGB and two SG (1100 post-RYGB vs. 209 post-SG). For the included studies, higher incidence of both SGA (22.9%, 11.9%, 14.2%) and LGA (4.2%, 4.8%, 1.7%) in SG compared to Roux-en-Y (SGA: 8.8%, 7.7%, 11.5%, 8.3% and LGA: 3.4%, 0.7%) were observed. SG had a shorter surgery to conception interval as compared to RYGB. Risk of bias assessment was moderate to serious for the studies included in the review, with bias in selection of participants being the major reason. Our systematic review demonstrated no major differences in BMI, mode of delivery, birthweight, gestational age, or rates of intrauterine death between women having undergone RYGB vs. SG. The rate of SGA and LGA births were higher in the SG group, but this group also had a shorter surgery to conception interval. Future studies are indicated to counsel women of reproductive age on the most appropriate type of bariatric surgery that is associated with the best perinatal outcomes.

Background Metabolic/bariatric procedures for the treatment of morbid obesity, as well as for type 2 diabetes, are among the most commonly performed gastrointestinal operations today, justifying periodic assessment of the numerical status of metabolic/bariatric surgery and its relative distribution of procedures. Methods An email questionnaire was sent to the leadership of the 50 nations or national groupings in the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Outcome measurements were numbers of metabolic/bariatric operations and surgeons, types of procedures performed, and trends from 2003 to 2008 to 2011 worldwide and in the regional groupings of Europe, USA/Canada, Latin/South America, and Asia/Pacific. Results Response rate was 84 %. The global total number of procedures in 2011 was 340,768; the global total number of metabolic/bariatric surgeons was 6,705. The most commonly performed procedures were Roux-en-Y gastric bypass (RYGB) 46.6 %; sleeve gastrectomy (SG) 27.8 %; adjustable gastric banding (AGB) 17.8 %; and biliopancreatic diversion/duodenal switch (BPD/DS) 2.2 %. The global trends from 2003 to 2008 to 2011 showed a decrease in RYGB: 65.1 to 49.0 to 46.6 %; an increase, followed by a steep decline, in AGB: 24.4 to 42.3 to 17.8 %; and a marked increase in SG: 0.0 to 5.3 to 27.89 %. BPD/DS declined: 6.1 to 4.9 to 2.1 %. The trends from the four IFSO regions differed, except for the universal increase in SG. Conclusions Periodic metabolic/bariatric surgery surveys add to the knowledge and understanding of all physicians caring for morbidly obese patients. The salient message of the 2011 assessment is that SG (0.0 % in 2008) has markedly increased in prevalence.

In this study of bariatric surgery, adolescents and adults showed marked weight loss that was similar in magnitude in the two groups 5 years after surgery. However, adolescents had remission of diabetes and hypertension more often than adults.