Journal watch 12/11/2025

Welcome to our regular round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview of papers including effectiveness of SG and OAGB on CVD risk, liraglutide plus MBS, global variations in MBS (the PARTNER Study), safety of robotic vs. laparoscopic MBS and preexisting GERD with thirty-day intervention following SG, and more (please note, log-in maybe required to access the full paper).

Comparative effectiveness of sleeve gastrectomy and one-anastomosis gastric bypass on cardiovascular disease risk

Metabolic-bariatric surgery (MBS) significantly reduced the predicted ten-year year atherosclerotic cardiovascular disease (ASCVD) risk, with comparable outcomes between sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB), researchers from the University of Shahid Beheshti University, Tajrish, Iran, have reported.

Writing in the European Heart Journal, they compared the effectiveness of the two procedures on the predicted ten-year ASCVD risk. Longitudinal changes in ASCVD risk were analysed, and regression models were applied to evaluate the impact of individual and combined factors on risk changes over the maximum follow-up period.

The study included 1,397 participants (952 undergoing SG and 445 undergoing OAGB). Participants who underwent OAGB had a higher baseline body mass index (BMI) and more severe diabetes status. After adjusting for potential confounders, the ten-year ASCVD risk significantly reduced post-operatively, with no observed differences between the surgical groups over the four-year follow-up period.

The key determinants influencing the changes in ASCVD risk included baseline risk score, age, TC, T2DM, TyG index, triglycerides, HbA1c, SBP, sex, FPG, smoking, HDL-C, and eGFR.

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Liraglutide and Weight Loss Among Suboptimal Responders to Metabolic Bariatric Surgery - A Randomized Clinical Trial

Researchers from Monash University, Melbourne, Victoria, Australia reporting the outcomes from a  randomised clinical trial, have concluded that liraglutide provided greater weight loss at 12 months than placebo in a cohort of patients with a suboptimal response to MBS.

Reporting in JAMA Network Open, the study included 24 participants in each arm (liraglutide arm: mean [SD] age, 48.7 [10.5] years; 22 [92%] female; placebo arm: mean [SD] age, 43.6 [11.4] years; 20 [83%] female). At 12 months, mean (SE) weight loss in the liraglutide group was 5.7 (1.1) kg with a mean (SD) weight gain of 1.4 (1.2) kg in the placebo group (between-group difference, 7.1 kg [95% CI, 3.9-10.3 kg]; p<0.001). There were no adverse effects on health or quality of life.

“These results suggest that combining obesity management medications with MBS affords the opportunity to increase weight loss for those with a suboptimal initial response or weight regain, potentially avoiding conversion surgery,” they concluded.

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Global Variations in Practices after Bariatric and Metabolic Surgery; the PARTNER Study

An international team of researchers reporting the findings from the PARTNER study have revealed a significant international variation in postoperative management practices following MBS.

Writing in Obesity Surgery, the PARTNER study aimed to evaluate global clinical practices in the postoperative management following MBS by surveying multidisciplinary healthcare professionals. The survey assessed five domains: follow-up care, postoperative treatment, dietary management, patient support, and measurement of surgical outcomes.

A total of 262 responses were received from 62 countries. Most respondents were bariatric surgeons (72.1%) working in public healthcare systems (73.3%). While 78.7% reported conducting three-month postoperative reviews, only 23.7% offered indefinite follow-up. Hybrid models of care (virtual and in-person) were common (56.9%). VTE prophylaxis and postoperative PPI use were recommended by 64.1% and 84.3% respectively. Nearly all respondents (98.1%) provided dietary advice, with protein and micronutrient supplementation widely endorsed. Only 56.1% routinely referred patients for psychological follow-up. Definitions of surgical success and failure varied widely, with inconsistent objective outcome measures.

“These findings underscore the need for more standardised, evidence-based guidelines to improve long-term outcomes and equity of care worldwide,” they concluded.

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Comparative Safety of Robotic Versus Laparoscopic Bariatric Surgery

The use of robotic-assisted bariatric surgery in the US more than tripled over the last decade, and short- and long-term outcomes of robotic versus laparoscopic bariatric surgery were largely equivalent, investigators from the University of Michigan, Ann Arbor, have reported.

Writing in the Annals of Surgery, they wanted to determine the uptake of robotic-assisted bariatric surgery and evaluate its safety compared to the laparoscopic approach. Using data from the Medicare claims database, instrumental variables analysis was used to assess risk-adjusted outcomes at 90 days, and 1, 3, 5 and 7 years after surgery.

In total, 121,521 patients underwent bariatric surgery during the study period, of whom 74,993 (61.7%) underwent sleeve gastrectomy and 46,528 (38.3%) underwent gastric bypass. Use of robotic-assisted sleeve gastrectomy increased by 250%, from 5.1% to 17.9%, and use of robotic-assisted gastric bypass increased by 361%, from 4.2% to 19.3%.

They found no significant differences in 90-day outcomes between the two approaches. At 7 years, there were no significant differences in the adjusted hazard ratio (aHR) of complications, hospitalization, emergency department use, reintervention, or revision between the two approaches. However, compared to the laparoscopic approach, the robotic-assisted approach was associated with a higher 7-year aHR of reoperation for both procedures (sleeve gastrectomy aHR 1.51 [95% CI 1.06–1.97]; gastric bypass aHR 1.58 [95% CI 1.12–2.03]).

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The association of preexisting gastroesophageal reflux disease with thirty-day intervention following sleeve gastrectomy using the ACS-MBSAQIP database

A preoperative diagnosis of gastroesophageal reflux disease (GERD) is associated with more 30-day re-interventions following sleeve gastrectomy (SG), according to researchers from the University of Nebraska Medical Center, Omaha, NE.

Published in Surgical Endoscopy, they sought to determine if there is an association between a preoperative diagnosis of GERD and 30-day interventions following SG.

Using data from the American College of Surgeons Metabolic and Bariatric Surgery Quality Improvement Program Database (ACS-MBSAQIP), 502,995 patients met inclusion criteria; 137,518 (27.3%) had a preoperative diagnosis of GERD. After 1:1 matching, patients with a preoperative diagnosis of GERD were more likely to be evaluated in the emergency department, undergo outpatient treatment of dehydration, and to be admitted to the hospital for treatment of dehydration within 30 days of SG.

“The sequela of these interventions with respect to the long-term success of SG requires further investigation,” the researchers concluded.

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