Journal watch 5/11/2025

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 MBS is independently associated with improved survival in individuals aged 69 years and older, re-sleeve gastrectomy associated with significantly higher rates of serious perioperative complications, conversion to open in bariatric surgery associated with significant increased risk of postoperative complications and treatment for obesity in the UK could become a two-tier system where the most vulnerable patients miss out altogether, and more (please note, log-in maybe required to access the full paper).

Metabolic and bariatric surgery in adults aged 69 years and older in England: a matched survival retrospective cohort study

MBS is independently associated with improved survival in individuals aged 69 years and older with acceptable perioperative risk, according to researchers from the UK.

Reporting in The Lancet, they conducted a retrospective cohort study of 186 patients aged 69 years and older managed in a UK tertiary bariatric centre between January 2015 and December 2024. Of the 186 patients, after matching, 44 MBS patients were compared with 34 control participants. Matched Kaplan–Meier analysis showed superior survival among MBS patients compared with control patients (log-rank p=0.010).

MBS was associated with a 68% reduction in all-cause mortality on univariate analysis (hazard ratio 0.32 [95% CI 0·11–0.92]; p=0.036) and a 75% reduction in all-cause mortality on multivariate analysis (0.25 [0.08–0.77]; p=0.015). In MBS patients, the postoperative 30-day morbidity rate was 9%: Dindo-Clavien grade III-IV complications occurred in three (7%) of 44 patients and one person (2%) died.

The investigators concluded that chronological age alone should not preclude consideration for MBS and their findings support further evaluation of surgical options in well selected older adults with obesity.

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Outcomes of Re-Sleeve Gastrectomy after Primary Sleeve Gastrectomy: A MBSAQIP analysis of perioperative risk

Re-sleeve gastrectomy (ReSG) is associated with significantly higher rates of serious perioperative complications compared to primary sleeve gastrectomy (P-SG), despite similar short-term mortality, according to a study led by researchers from the Cleveland Clinic, Ohio, US.

Published in SOARD, they evaluate 30-day perioperative outcomes between ReSG (n=3,218) and P-SG (n=493,187) using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from accredited bariatric surgical centres.

The reported ReSG patients were older, more likely female, and had a higher prevalence of gastroesophageal reflux disease (GERD) but lower BMI and comorbidity burden. ReSG was associated with significantly higher rates of serious complications (5.13% vs. 2.03%, p<0.0001), including anastomotic leak, deep surgical site infection and the need for reintervention.

Multivariable analysis identified ReSG as the strongest independent predictor of serious complications (OR 2.26), followed by anticoagulant use, history of VTE, insulin-dependent diabetes, hypertension, GERD and Black race. Mortality was low and comparable between groups (p=0.360).

“These findings underscore the importance of revisional strategy selection and alternative procedures may offer superior safety, more durable weight loss, and improved metabolic outcomes for revision after SG,” they concluded.

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Conversion To Open Approach in Primary Bariatric Surgery: A MBSAQIP Cohort Analysis of 524 224 Patients Evaluating Complications of and Risk Factors for Conversion

Conversion to open in bariatric surgery is rare but associated with significant increased risk of postoperative complications, according to researchers from the University of Alberta, Edmonton, Canada.

Published in Obesity Surgery, using data from the MBSAQIP database from 2020 to 2022 to identify two cohorts; those who underwent a minimally invasive approach and those who required conversion to open. Patients undergoing primary sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS) and single anastomosis duodenal-ileal bypass (SADI) were included.

A total of 524,224 patients were identified of which 181 (0.03%) required conversion to open. Factors associated with increased risk of conversion to open included age, BMI, lower albumin, sleep apnoea, undergoing RYBG or BPD-DS (vs. SG) and previous foregut surgery. Patients converted were more likely to have 30-day reoperation, reintervention, or readmission on bivariate analysis. Conversion to open was also an independent predictor of serious complications on multivariate analysis.

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Tirzepatide and the NHS: are we creating a two-tier obesity treatment system?

Treatment for obesity in the UK could become a two-tier system where the most vulnerable patients miss out altogether, obesity experts from King's College London and the Obesity Management Collaborative (OMC-UK) have warned. They stated that strict eligibility criteria means that only a small number of people will have access to the weight loss drug tirzepatide (Mounjaro) on the NHS, with those able to afford it paying privately for treatment.

The researchers argue, in an editorial published in the British Journal of General Practice (BJGP), that this gap creates a two-tier treatment system, where the ability to self-fund determines who receives care.

The opinion piece calls for changes to improve fairness and equity. These include changing who qualifies for support, setting up clearer routes to accessing care that take ethnicity and underdiagnosis into account, accelerating the national rollout, and expanding digital health services to reach patients in areas where specialist services are limited.

The authors also stress that access to medication must go hand-in-hand with broader public health measures, including policies to improve diets, address food insecurity and ensure healthier urban environments.

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