Metabolic and bariatric surgery has continued to evolve under the dual imperatives of efficacy and safety. Sleeve gastrectomy (SG) with transit bipartition (SG-TB), derived from SG, reconstructs a “dual-channel” pathway that preserves the pylorus and proximal small-bowel function, while aiming to achieve metabolic effects comparable to biliopancreatic diversion with fewer severe nutritional complications. In 2025, the first Chinese expert consensus on SG-TB was released, and the inaugural international SG-TB consensus meeting was convened in Europe, reaching preliminary alignment on procedure classification, key technical parameters, and indications/contraindications. Emerging clinical evidence indicates that SG-TB confers advantages in weight reduction, remission of type 2 diabetes, and prevention of gastroesophageal reflux disease, and also demonstrates feasibility in revisional surgeries and complex cases. Nevertheless, current studies are predominantly observational, with limited evidence quality and considerable heterogeneity. Stratification of surgical parameters and establishment of reproducible training systems remain unmet needs. Building upon a synthesis of national and international consensus statements and recent clinical advances, this commentary further analyzes the challenges that SG-TB faces in procedural heterogeneity, evidence accumulation, individualized practice, and mechanistic research. This commentary seeks to offer practical reference and research directions for the bariatric community, ultimately supporting the advancement of SG-TB from a promising technique toward standardized and mainstream adoption.
ObjectiveTo systematically review the research progress in the selection of metabolic bariatric procedures, efficacy, safety, complication prevention, and long-term management for elderly patients, so as to provide references for surgical decision-making and perioperative management in future metabolic and bariatric surgery for elderly obese patients. MethodA review of recent domestic and international literature on metabolic and bariatric surgery in elderly patients was conducted. ResultsWith the intensification of societal aging, the incidence of obesity and related metabolic diseases among the elderly population has significantly increased. Metabolic and bariatric surgery has been proven to effectively reduce weight and improve obesity-related metabolic diseases in elderly patients. Current guidelines no longer consider age an absolute contraindication for surgery. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly used procedures internationally. SG is superior to RYGB in terms of surgical safety, while RYGB has greater advantages in improving metabolic diseases. Although the postoperative mortality and complications risks in elderly obese patients are higher than those in younger obese patients, strict preoperative assessment and individualized procedure selection can significantly reduce these risks. ConclusionsMetabolic and bariatric surgery can serve as an effective treatment for elderly obese patients, offering comprehensive benefits in weight loss and metabolic improvement. Procedure selection requires individualized assessment, balancing the patient’s baseline condition and metabolic needs. Postoperative success hinges on systematic long-term follow-up and management to ensure sustained benefits and safety. Future efforts should focus on clarifying the definitions or standards of “elderly” and “obesity,” followed by more large-sample, long-term follow-up randomized controlled studies to validate the safety and efficacy of metabolic and bariatric surgery.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) was recommended as the gold standard procedure for metabolic and bariatric surgery by the National Institutes of Health in the 1990s and then had been adopted till now, which could effectively control excess weight and treat metabolic diseases relevant to obesity in a long term. The current LRYGB procedure had been performed more than half a century of development and update, and is still constantly evolving. Standardized and precise surgical procedures are of great significance in ensuring treatment effect and reducing the incidence of complications. Thus, the author reviewed the development process of LRYGB, further understanding and emphasizing the importance of standardized and precise surgical procedures.
ObjectiveTo explore the trajectories of health-related quality of life (HRQoL) among adolescents after metabolic bariatric surgery and to identify influencing factors. MethodsThis retrospective cohort study included 208 adolescents who underwent metabolic bariatric surgery at the First Affiliated Hospital of Nanjing Medical University from June 2023 to December 2024. Data on quality of life were collected at baseline, 3 months, and 6 months postoperatively, along with related scale assessments at 6 months. Latent class growth modeling was applied to identify trajectory categories of quality of life. Demographic characteristics and scale points were compared across groups, and unordered multinomial logistic regression was used to analyze influencing factors. ResultsThree distinct HRQoL trajectories were identified by latent class growth model: low-level improvement group (102 cases, 49.0%), moderate-level stable group (74 cases, 35.6%), and high-level decline group (32 cases, 15.4%). Significant differences were observed among groups in BMI, percentage of excess weight loss (EWL%), points of body image, self-esteem, objective support, support utilization and appearance anxiety index at 6 months after operation (P<0.05). At 6 months postoperatively, patients in the low-level improvement group had the lowest BMI and the highest EWL%, along with higher body image and support utilization points. Patients in the moderate-level stable group experienced less weight reduction than those in the low-level improvement group, with only limited improvement in quality of life. Although patients in the high-level decline group initially had better preoperative quality of life, they showed the least postoperative weight loss, the lowest body image and support utilization points, and higher appearance anxiety points, with a progressive decline in quality of life. Results of unordered multinomial logistic regression analysis indicated that postoperative BMI, EWL%, points of body image, and support utilization were influencing factors associated with HRQoL trajectories (P<0.05). ConclusionsMetabolic bariatric surgery improves quality of life in most adolescents, yet a subgroup experiences unfavorable trajectories. Postoperative weight loss, body image, and social support are critical determinants. Early identification and targeted interventions are needed to optimize long-term outcomes.
ObjectiveTo investigate the difference of DNA methylation before and after bariatric surgery.MethodThe relevant literatures of the research on the changes of DNA methylation level and gene expression regulation in blood and tissues before and after bariatric surgery were retrieved and reviewed.ResultsDNA methylation was an important method of epigenetic regulation in organisms and its role in bariatric surgery had been paid more and more attention in recent years. Existing studies had found that there were changes of DNA methylation in blood and tissues before and after bariatric surgery. The degree of methylation varies with different follow-up time after bariatric surgery and the same gene had different degrees of methylation in different tissues, and some even had the opposite results.ConclusionsDNA methylation levels before and after bariatric surgery are different in different tissues. And studies with larger sample size and longer follow-up time are needed, to further reveal relationship among DNA methylation, obesity, and bariatric surgery.
ObjectiveTo compare the safety of the incision along the upper umbilical margin (referred to as the “upper incision”) versus the transverse umbilical incision (referred to as the “transverse incision”) for single-port bariatric surgery, and to assess their effects on postoperative scar appearance and patient’s psychological adaptation. MethodsThis study was designed as a multi-center retrospective analysis. The patients who underwent bariatric surgery via the upper incision and transverse incision at the Third People’s Hospital of Chengdu, Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, and the First Affiliated Hospital of Jinan University from December 2024 to April 2025. The incidence of postoperative complications and the pionts of scar appearance (evaluated using the POSAS 3.0 scale) and psychological adaptation (measured with the BODY-Q scale) between the two incision methods were compared. Furthermore, multiple linear regression model was employed to evaluate the impact of different incision methods on points of scar appearance and psychological adaptation. ResultsA total of 194 patients who underwent single-port bariatric surgery were included, with 134 in the transverse incision group and 60 in the upper incision group. There was no statistically significant difference in the total incidence of incision complications between the transverse and upper incision groups [11.9% (16/134) vs. 18.3% (11/60), χ2=0.930, P=0.335]. The transverse incision group showed significantly better outcomes than the upper incision group in the overall points of BODY-Q scale [(39.86±1.02) points vs. (37.63±4.70) points, t=–6.090, P<0.001] and POSAS scale [(17.60±2.35) points vs. (21.25±6.00) points, t=5.239, P<0.001]. After adjusting for potential confounding factors such as history of diabetes mellitus, education level, smoking status, alcohol consumption status, keloid tendency, and use of scar improvement products in the multiple linear regression model, the advantage of the transverse incision remained significant [β(95%CI)=–1.81 (–2.84, –0.78), P<0.001]. Conclusions This study demonstrates that the transverse incision significantly improves the overall appearance of the postoperative scar and enhances patient’s psychological adaptation compared to the upper incision in single-port bariatric surgery. This advantage persists independently after adjusting for multiple confounding factors. Therefore, the transverse incision could be considered a more favorable approach in terms of cosmetic outcomes and patient’s psychological adaptation.
ObjectiveTo evaluate the safety, feasibility, and efficacy of single-incision plus one-port laparoscopic sleeve gastrectomy (SILS+1) for patients with obesity. MethodsA retrospective analysis was conducted on obese patients underwent laparoscopic sleeve gastrectomy (LSG) from January 2023 to November 2024 at West China Hospital of Sichuan University. Patients were stratified into two groups: SILS+1 group and conventional multi-port LSG (MPLSG) group. Comparative parameters included operative time, postoperative hospital stay, complications rate, weight loss outcomes, and improvement in metabolic indicators [including hemoglobin A1c (HbA1c), triglyceride (TG), total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C)]. ResultsA total of 95 patients with obesity were enrolled, including 40 in the SILS+1 group and 55 in the MPLSG group. The SILS+1 group had significantly lower preoperative body mass index (BMI), HbA1c, and TC level compared to the MPLSG group (P<0.05), and a significantly higher proportion of female patients (P<0.05). Other baseline characteristics, such as age, TG and HDL-C levels, showed no statistically significant differences (P>0.05). Operative time was significantly longer in the SILS+1 group than in the MPLSG group [(100.16±17.53) min vs. (93.82±20.83) min, P<0.001]. The proportion of patients requiring drainage tube placement was significantly lower in the SILS+1 group as compared with the MPLSG group [55.0% (22/40) vs. 76.4% (42/55), P=0.049]. There were no statistically significant differences between the two groups in the need for additional trocar sites, change in hemoglobin level from preoperative to postoperative day 1, postoperative hospital stay, or incidence of postoperative (Clavien-Dindo grade Ⅰ) complications (P>0.05). No 30-day readmissions occurred in either group. One patient in the SILS+1 group required an additional trocar site. Gastrointestinal patency was normal in all patients, with no signs of contrast agent leakage or stricture observed. Both SILS+1 and MPLSG procedures demonstrated equivalent efficacy in weight loss outcomes (P>0.05) and in their effects on HbA1c, TG, and TC levels (P>0.05). The SILS+1 procedure showed a significant advantage in improving HDL-C level (F=6.221, P=0.015), with significantly higher postoperative HDL-C level observed at 6 months postoperatively compared to the MPLSG group (F=2.500, P=0.027). ConclusionsFor selected obese populations, SILS+1 represents a feasible and safe alternative to MPLSG. This technique demonstrates equivalent efficacy to MPLSG in early-stage weight loss and metabolic improvement, serving as a transitional approach toward pure single-incision LSG.
Objective To investigate the clinical application value of unsymmetrical four-port laparoscopic sleeve gastrectomy (LSG). Methods The clinical data of 114 patients with obesity who were admitted to Mianyang Central Hospital from June 2021 to May 2022 were retrospective analyzed. All the 114 patients underwent unsymme-trical four-port LSG, and were observed their surgical and postoperative conditions, complications and follow-up the patient’s esthetic satisfaction of wounds at 3 months after surgery. Results All 114 patients underwent unsymmetrical four-port LSG successfully, without conversion to open surgery. The operative time was 68–160 min, average (104.2±26.1) minutes; volume of intraoperative blood loss was 2–50 mL, average (10.7±7.6) mL; the duration of postoperative hospital stay was 3–6 d, average (4.0±0.7) days. Of the 114 patients, 8 patients (7.0%) had fat liquefaction of wounds, 68 patients (59.6%) had postoperative nausea and vomiting in the 24 hours after operation, and all patients had no serious complications such as gastrointestinal bleeding, intraperitoneal hemorrhage, or gastric leakage. One hundred and fourteen patients were followed-up for 3–14 months, with a median follow-up of 6 months. Forty patients (35.1%) had hair loss, 3 patients (2.6%) had mild anemia. Of the 114 patients, 2 (1.8%) were dissatisfied with the cosmetic effects of wounds, 64 (56.1%) were satisfied, and 48 (42.1%) were very satisfied. The satisfaction rate was 98.2% (112/114). Conclusion The unsymmetrical four-port LSG is safe and feasible, it does not affect esthetic satisfaction of wounds.
ObjectiveTo systematically evaluate the effects of weight-loss interventions on hormone levels and sexual function in patients with obesity. MethodsThis review was conducted in accordance with PRISMA guidelines. A systematic search of PubMed, Embase, and other databases was performed for studies published within the past decade that investigated the effects of bariatric surgery, glucagon-like peptide 1 (GLP-1) receptor agonists, and lifestyle interventions on sex hormones and sexual function. ResultsBariatric surgery (e.g., sleeve gastrectomy, gastric bypass) demonstrated the most pronounced improvements in hormonal balance and sexual function. In males, total testosterone levels doubled postoperatively, with marked increase in erectile function score. In females with polycystic ovary syndrome, androgen levels were reduced by 50%, with significant amelioration in the female sexual function index. GLP-1 receptor agonists (e.g., semaglutide, liraglutide) partially improved sperm quality and testosterone levels, but were also associated with a higher risk of erectile dysfunction (with a hazard ratio of approximately 4.5). Lifestyle interventions (e.g., low-calorie diet, exercise) could increase sex hormone-binding globulin levels and improve sexual function score, although their efficacy remained inferior to that of surgery. ConclusionsWeight-loss interventions can alleviate hormonal imbalances and sexual dysfunction in obesity, with bariatric surgery demonstrating the most significant effects. Pharmacological and lifestyle interventions have shown variable efficacy. Future research should further investigate mechanisms underlying effects of different weight-loss modalities on sexual health.
ObjectiveTo observe the changes of body composition in patients with obesity after sleeve gastrectomy (SG) and know the factors affecting the effective weight loss. MethodsThe obese patients who received SG treatment at the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University from October 2019 to October 2022 were included according to the inclusion and exclusion criteria. The anthropometric parameters, lipid metabolism indexes, and body composition data were collected before surgery (1 d) and at 1-, 3-, 6-, and 12-month after surgery. The risk factors affecting the effective weight loss were analyzed. ResultsA total of 170 patients were included in the study. ① The anthropometric parameters such as body weight, body mass index, waist circumference, hip circumference, and waist-to-hip ratio at different time points after surgery as compared with the baseline (1 day before surgery) values were decreased (P<0.05) and showed continuous downward trends after surgery (P<0.05), meanwhile the percentage total weight loss and percentage excess weight loss (%EWL) indicators showed continuous upward trends (P<0.05). ② The lipid metabolic indexes such as triglyceride, total cholesterol, and uric acid, except for the total cholesterol indexes at the 6th and 12th month had no statistical differences as compared with the baseline value (P>0.05) and the uric acid was increased at the 1st month after surgery (P<0.05), the other indexes at different time points after surgery showed continuous downward trends as compared with the baseline values (P<0.05). ③ All the body composition parameters except percentage fat-free mass of the left and right lower limbs (P>0.05) at different time points after surgery as compared with the baseline values were decreased (P<0.05), and some body composition indicators, such as fat mass, percentage fat mass, visceral fat area, and obesity degree continued to decrease within 1 year after surgery (P<0.05). ④ There were 93 patients with reaching the standard of effective weight loss (%EWL was 50% or more). The multivariate logistic regression analysis showed that the lower fat mass of right lower limb, the higher probability of effective weight loss [OR (95%CI)=0.452 (0.290, 0.703), P<0.001]. The area under the receiver operating characteristic curve of the fat mass of the right lower limb was 0.782 [95%CI=(0.672, 0.893), P<0.001], its sensitivity and specificity were 0.679 and 0.792, respectively, and the cut-off value was 7.35 kg. ConclusionsThe results of this study suggest that SG can markedly improve the anthropometric and lipid metabolism indicators of patients with obesity, and achieve effective weight loss in a short-time. The body composition from the whole body to limbs and trunk might be changed. The fat mass of the right lower limb is closely related to the short-term effective weight loss after surgery and it has a moderate ability to distinguish achieving effective weight loss.