Journal Watch 16/7/2025

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 predicting postoperative leaks, psychological determinants of exercise adherence in bariatric patients, supervised exercised training before surgery on body composition, earlier bariatric surgery has better outcomes, closure of mesenteric defects fails to reduce internal herniation, and more (please note, log-in maybe required to access the full paper).

Predicting Postoperative Leaks: A Preoperative Risk Index for Bariatric Surgery

Hypoalbuminemia, smoking, therapeutic anticoagulation and history of foregut surgery are the most significant risk factors of postoperative leaks, according to a study by investigators from the US and Mexico.

Reporting in Obesity Surgery and using data from the MBSAQIP database, they  carried out a multivariate analysis and identified the most common risk factors for a leak after a primary bariatric surgery.

Data from 193,847 patients was analysed, 140,605 had a SG (72.5%), and 53,242 had a RYGB (27.5%). A leak was present in 190 patients (0.1%) after SG and in 113 (0.2%) after RYGB. Statistically significant risk factors included: albumin < 3 g/dL (OR 3.196), previous foregut surgery (OR 2.827), preoperative therapeutic anticoagulation (OR 1.874), smoking (OR 1.776), hypertension (OR 1.404), sleep apnoea (OR 1.322), and bypass surgery (OR 1.487). The risk of leak according to the number of points: 1 (OR 1.469), 2 (OR 2.066), 3 (OR 3.655), 4 (OR 3.609), 5 (OR 3.772), 6 (OR 4.075), 7 (OR 22.278).

“This score allows us to estimate more precisely the risk of a leak,” the researchers noted.

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Psychological determinants of exercise adherence in individuals with severe obesity awaiting bariatric surgery: what strategies can physical therapists adopt in prehabilitation programs? A scoping review

Brazilian investigators report that bariatric rehabilitation programmes should embrace physical activity counselling with a multi-theoretical approach, tailored to the unique needs and perspectives of surgical candidates.

Writing in the International Journal of Obesity, this scoping review identified seven relevant studies. They reported that key psychological constructs associated with exercise adherence included quality of life, pleasure, motivation, self-efficacy, self-monitoring, goal setting, and information seeking. Interventions employed cognitive behavioural therapy, group or individual physical activity counselling, and digital technologies to optimize exercise adherence.

They stated that integration of remote digital technologies preoperatively could serve as an effective strategy to provide support and guidance for behavioural changes.

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Impact of Supervised Exercised Training Before Bariatric Surgery on Body Composition

The implementation of a rehabilitation protocol before bariatric surgery is difficult in patients with obesity however, it probably allows the patients to establish regular and lasting physical activity, according to French researchers.

Writing in Clinical Obesity, the study offered patients the chance to join the metabolic rehabilitation protocol before surgery. A total of 178 patients were included in the study: 63 (35.4%) in the exercise group and 115 (64.6%) in the control group.

There were no significant differences between the two groups, but the increase in muscle mass seemed higher in exercise group versus control group: 6.3% ± 5.2% versus 5.2% ± 4.4% (p=0.14). HDLc and delta LDLc seemed higher in the exercise group versus control group: 0.57 ± 0.13 versus 0.55 ± 0.12 g/L and − 0.29 ± 0.27 versus − 0.22 ± 0.26 g/L, and CRP tends to be lower in the exercise group 1.1 ± 1.2 versus 1.8 ± 3.4 mg/L, but these results were not significant.

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The earlier metabolic bariatric surgery is performed, the better expected clinical benefit beyond weight loss: a short-term follow-up study

Patients who undergoing early metabolic bariatric surgery (persons with a duration of obesity prior to surgery of less than 5 years) exhibited better improvement in obesity-related medical conditions and related metabolic indices post-operation, according to Chinese investigators.

Reporting in the European Journal of Medical Research, they examined 143 patients with obesity who underwent laparoscopic sleeve gastrectomy (LSG) from Feb 2015 to Feb 2022. The median time from meeting the criteria for metabolic bariatric surgery to finally undergoing metabolic bariatric surgery for all participants was 5.75 years. Based on this, the participants were divided into two groups: the early operation group (persons with a duration of obesity prior to surgery of less than 5 years) and the late operation group (those with the duration of longer than 5 years).

At one year, there was no significant variation in weight loss, TWL% (p ≥0.05) between the early operation and late operation groups. However, patients in the early operation group had better improvements in obesity-related medical conditions one year after surgery (p<0.05). This group showed a more pronounced decrease in related metabolic indices, such as fasting blood glucose and triglyceride (p<0.01).

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Closure of Mesenteric Defects during Roux-en-Y Gastric Bypass Fails to Reduce Internal Herniation

Routine closure of mesenteric defects (MD) during Roux-en-Y gastric bypass (LRYGB). does not reduce internal herniation (IH) incidence but introduces the new complication of jejunojejunostomy (JJ) kinking, according to researchers from The Netherlands.

Published in Obesity Surgery, this retrospective cohort study included 6,896 and 1,903 LRYGB procedures before and after implementing routine MD closure respectively. The researchers analysed incidence of IH, kinking at the JJ, ICU admissions, hospital stay, postoperative pain relief and the diagnostic value of CT scans.

The incidence of IH in the closure group (2.84%) was not significantly different from the non-closure group (2.80%). Postoperative pain relief rates were similar between the groups. However, routine MD closure led to the occurrence of JJ kinking (0.84%), which was not present in the non-closure group, resulting in prolonged hospital stays and ICU admissions. CT scans were predictive for IH but had limitations.

“Our findings highlight the need for further research on alternative closure methods and improved diagnostic strategies to optimise surgical outcomes,” the authors concluded.

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