Journal watch 26/11/2025

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 side-to-side compression anastomosis, surgery and mortality and kidney transplants, Indian surgeons’ perspectives on obesity, and obesity-associated vs overall deaths, and more (please note, log-in maybe required to access the full paper).

Creation of Side-to-Side Compression Anastomosis Using the GT Metabolic Solutions™ Magnet System, DI Biofragmentable (MagDI™ System) to Achieve Duodeno-Ileal Diversion in Patients with Obesity: Preliminary Italian Multi-Center Results

Preliminary data shows that side-to-side magnet compression duodeno-ileal anastomosis was feasible, safe and effective, according to researchers from Italy.

Reporting in Obesity Surgery, this Italian multi-centre clinical investigation evaluated the feasibility, safety and efficacy of the creation of a side-to-side compression anastomosis using the GT Metabolic Solutions Magnet System, DI Biofragmentable (MagDI System) to achieve duodeno-ileal diversion.

In total, 28 patients (19 female) underwent surgery in 4 centres. The mean age and BMI were 44 years and 36.7 ± 4.4 kg/m2. Mean operative time and hospital stay were 73.2 min and 1.6 days. Paired magnets were expelled in all patients in a mean of 37.3 days.

There were three procedure-related serious adverse events (Clavien Dindo III, one ileal perforation, one liver insufficiency and one trocar site hernia. Mean BMI, %EWL and %TWL at 90 days (n=23) were 32.7 ± 0.8 kg/m2, 36.6 ± 4.6% and 10.4 ± 1.1%. Mean HbA1c decreased from 6% at baseline to 5.7% at 30 days and to 5.5% at 90 days.

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Outcomes After Bariatric Surgery in Older Adults With Obesity and End-Stage Kidney Disease

Roux-en-Y gastric bypass (RYGB) in older patients with end-stage kidney disease (ESKD) is associated with increased mortality and lower kidney transplant (KT) likelihood, whereas sleeve gastrectomy (SG) is associated with decreased mortality and higher KT likelihood compared to nonsurgical matched controls, according to researchers from New York University Langone Health, New York.

Published in World of Surgery, they identified 876 patients with RYGB and 1,508 patients with SG and compared 5-year mortality by age-group (18–29/30–39/40–49/50–59/60–69/≥ 70 years) to nonsurgical matched controls.

Among patients with RYGB versus controls, 5-year mortality was 11.4% versus 17.3% (aHR = 0.230.581.44), 31.5% versus 30.1% (aHR = 0.731.021.41), and 37.9% versus 47.3% (aHR = 0.690.771.00) for 18–29/30–39/40–49 years; however, 5-year mortality was 77.1% versus 68.3% (aHR = 1.241.561.95) for 60–69 years and 86.8% versus 78.7% (aHR = 1.802.393.16) for ≥ 70 years.

In patients with SG versus controls, 5-year mortality was 17.8% versus 30.2% (aHR = 0.260.470.83), 18.1% versus 36.3% (aHR = 0.280.390.53), 28.7% versus 48.9% (aHR = 0.350.430.53), 31.1% versus 61.6% (aHR = 0.270.350.44), 37.3% versus 65.7% (aHR = 0.350.480.66), and 51.5% versus 93.6% (aHR = 0.140.370.94) for 18–29/30–39/40–49/50–59/60–69/≥ 70 years. Among listed ≥ 65 years, KT incidence was 21.3% versus 25.4% (aHR = 0.191.015.26) for patients with RYGB versus controls and 66.7% versus 39.9% (aHR = 0.622.318.64) for patients with SG versus controls.

They concluded that choice of bariatric surgery type may play a role in improving survival for older patients with ESKD.

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Surgeons’ Perspectives on Insurance Coverage for Metabolic and Bariatric Surgery in India: An Obesity and Metabolic Surgery Society of India (OSSI) Survey

Indian researchers have reported that despite regulatory progress, insurance-related challenges like administrative delays, poor patient awareness, and inconsistent claim approvals continue to limit equitable access to MBS in India.

Published in Obesity Surgery, this cross-sectional survey was conducted among 109 members of the Obesity Surgery Society of India (OSSI) between November 2024 and March 2025. The questionnaire covered surgeon demographics, insurance experiences, patient patterns, and policy suggestions. Data were collected anonymously and analyzed using descriptive statistics.

The results showed that 87.2% of respondents observed more patient interest after IRDAI’s insurance mandate, only 9.2% reported that most of their patients used insurance. Low awareness, complex paperwork and high out-of-pocket costs were major problems. 95.4% of respondents said patients delay surgery while waiting for insurance approval. The approval process was rated as complex or very complex by 69.7%. High denial rates were reported, often due to obesity exclusions or incomplete documentation.

Nearly all respondents supported changes to improve the system, including faster approvals, fewer documentation requirements, and broader eligibility criteria such as lower BMI thresholds and inclusion of type 2 diabetes. They concluded that policymakers and insurers need to streamline processes and expand eligibility to ensure more people can benefit from this life-saving treatment.

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U.S. Mortality in Abdominal Surgical Emergencies: Comparative Analysis of Obesity-Associated vs Overall Deaths (1999-2020)

Researchers from Pakistan and the US have found that rising trends in obesity-related mortality in abdominal surgical emergencies with racial and regional disparities, and have called for targeted interventions.

Writing in The American Journal of Surgery, they study analysed US mortality trends (1999-2020) from the CDC WONDER database, assessing mortality both overall and in patients with obesity and acute abdominal surgical emergencies (ASE) using ICD-10 codes. Age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) were calculated.

Obesity-related ASE AAMR rose significantly from 2.05 to 5.5 per million, with a marked increase post-2018 (APC=23.42). Mortality was higher in women but increased faster in men in the obesity group in contrast to higher ASE related mortality in males overall. Significant racial disparities were noted, with obesity related ASE mortality highest among non-Hispanic American Indians. Regionally, the South exhibited the steepest mortality increase.

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