Journal watch 29/10/2025

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 bariatric surgery has become safer over time, higher hospital and surgeon MBS volumes were associated with lower short-term mortality, fewer complications and shorter hospital stays, pharmacologic management of post-bariatric hypoglycemia (PBH) shows promise but there is an urgent need for standardised PBH definitions, and more (please note, log-in maybe required to access the full paper).

Refining Bariatric Surgery: A Nationwide 15-year Study to Reduce Morbidity and Improve Recovery

Researchers from Lille University, Lille, France, have reported that although bariatric surgery has become safer over time, with declining mortality and complication rates, the stagnation of improvements in recent years highlights the need for further optimization strategies.

Writing in Annals of Surgery, they evaluated the evolution of postoperative mortality and morbidity associated with bariatric surgery over a 15-year period using a nationwide database.

Among 486,161 first-time bariatric procedures, sleeve gastrectomy and gastric bypass dominated. The overall 90-day mortality rate was 0.1%, varying significantly by procedure (p<0.001), with adjustable gastric banding exhibiting the lowest rate. Mortality decreased by 40% over time, but sleeve gastrectomy and gastric bypass showed a plateau effect since 2018. Reoperations declined (4.9%–4.5%), and intensive care unit admissions for severe complications fell by 58%. Medication analysis revealed reduced analgesic (-29.4%), antidepressant (-15.7%), and anxiolytic (-12.7%) use, while laxative consumption increased (+86.4%).

These findings support the continued integration of surgery within a multimodal obesity treatment paradigm, the researchers stated.

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Volume‒outcome relationships in bariatric surgery: a rapid review

Researchers form the Technische Universität Berlin, Berlin, Germany, have found that higher hospital and surgeon volumes were associated with lower short-term mortality, fewer complications and shorter hospital stays, after bariatric surgery.

The findings, published in the International Journal of Obesity, included 36 studies met the inclusion criteria. Of these, 12 studies examined the association between hospital volume and mortality, and five studies focused on surgeon volume. Eight of the hospital volume studies and four of the surgeon volume studies reported a positive association with reduced mortality; some showed mixed results. The association was more pronounced in higher-quality studies.

They concluded that future research should aim to standardise volume definitions to improve comparability and support policy efforts to centralize care and enhance patient outcomes.

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Ten‑Year Results of a Randomized Trial Comparing Banded Roux‑en‑Y Gastric Bypass to Sleeve Gastrectomy for Type 2 Diabetes and Weight Loss

Researchers from New Zealand have found that silastic-ring (SR) to LRYGB (SR-LRYGB) is superior to LSG for diabetes remission and weight loss at ten years following surgery.

Writing in Obesity Surgery, the ten-year analysis from this prospective, randomised, parallel, two-arm, clinical trial, was conducted on 114 patients with T2D who underwent SR-LRYGB or LSG. The primary outcome was diabetes remission assessed at ten years. Secondary outcomes included percentage total body weight loss (%TWL) and complications.

At ten years after surgery, diabetes remission was seen in 15/49 (30.6%) after SR-LRYGB and 7/40 (17.5%) after LSG (adjusted OR 3.3; 95% confidence interval (CI) 1.0, 10.6; p=0.042). Percentage total body weight loss was greater after SR-LRYGB than LSG (27.2% vs. 20.2%, absolute difference 7.0% 95% CI 2.2%, 11.8%; p=0.005). Late minor complication rates were 28.6% after SR-LRYGB and 19.0% after LSG (absolute difference 9.6%, p=0.226). Late major complication rates were 25.0% after SR-LRYGB and 31.0% after LSG (absolute difference 6.0%, p=0.535).

“This study confirms long-term enhanced patient outcomes in patients undergoing SR-LRYGB when compared directly with LSG. This study adds to the mounting body of evidence that demonstrates sustained diabetes remission and weight loss in patients undergoing SR-LRYGB,” they concluded.

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Managing post-bariatric hypoglycemia: a systematic review of pharmacological therapies

Pharmacologic management of post-bariatric hypoglycemia (PBH) shows promise, however, there is an urgent need for standardised PBH definitions, patient-centred outcome measures, longer follow-up, and adequately powered RCTs to establish evidence-based therapeutic guidelines, according to researchers from Bahrain.

This systematic review, published in Diabetology & Metabolic Syndrome, 13 comparative studies, five single-intervention studies and 15 case reports were included. Among comparative studies, 12 were RCTs and one was a retrospective study. Meta-analysis revealed that anakinra and empagliflozin significantly reduced the risk of hypoglycemia compared to placebo (RR: 0.29; 95% CI: 0.09–0.91 for both). Dasiglucagon showed efficacy as a rescue agent. In single-intervention studies, pasireotide and acarbose prevented hypoglycemia in all patients. Case reports suggested variable success with agents such as liraglutide, verapamil, and semaglutide.

However, the certainty of evidence was rated very low, with small sample sizes, heterogeneous definitions of PBH, and imprecise effect estimates limiting the robustness of conclusions.

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