Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery最新文献

{"title":"Comment on: Anastomotic marginal ulceration after conversion of sleeve gastrectomy to Roux-en-Y gastric bypass.","authors":"Abdelrahman Nimeri","doi":"10.1016/j.soard.2026.08.023","DOIUrl":"https://doi.org/10.1016/j.soard.2026.08.023","url":null,"abstract":"","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of gastro-gastric fistula after Roux-en-Y gastric bypass: a systematic review and meta-analysis of endoscopic versus surgical outcomes.","authors":"Maryam Hassanesfahani, Dominique Popescu, Mrinalini Alla, Nageswara Mandava, Noman Khan, Darshak Shah","doi":"10.1016/j.soard.2026.08.016","DOIUrl":"https://doi.org/10.1016/j.soard.2026.08.016","url":null,"abstract":"<p><p>Gastro-gastric fistula is an uncommon but clinically significant complication after Roux-en-Y gastric bypass, presenting with weight regain, epigastric pain, bile reflux, or recurrent marginal ulceration. Although multiple endoscopic and surgical techniques have been described, comparative outcome data remain limited. We conducted a systematic review and meta-analysis of studies published between 1990 and 2025 evaluating endoscopic and surgical management of gastro-gastric fistula. Seventy-six studies underwent full-text assessment for eligibility, and 9 studies were eligible for quantitative analysis (5 endoscopic series, n = 127; 4 surgical series, n = 65). Endoscopic therapy achieved durable fistula closure in 29.9% of patients, with a low major adverse event rate (1.6%). Surgical revision demonstrated 100% clinical success, with a 26.2% postoperative complication rate and no procedure-related mortality. Random-effects modeling yielded consistent pooled estimates with low statistical heterogeneity. These findings suggest that endoscopic management offers an excellent safety profile but limited long-term durability, whereas surgical revision was associated with higher rates of durable fistula closure at the cost of higher perioperative morbidity. Given the observational nature of the available evidence, these findings should be interpreted cautiously and should not be considered evidence of definitive treatment superiority. Treatment selection should, therefore, be guided by fistula characteristics, chronicity, and patient risk profile. Standardized reporting and prospective evaluation of emerging endoscopic and hybrid techniques are needed to optimize management strategies.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to \"Robotic primary Roux-en-Y gastric bypass is independently associated with increased 30-day mortality: a 2023 MBSAQIP analysis of 50,365 patients\".","authors":"Salvador Navarrete","doi":"10.1016/j.soard.2026.08.022","DOIUrl":"https://doi.org/10.1016/j.soard.2026.08.022","url":null,"abstract":"","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term renal, cardiovascular, and survival outcomes in patients with obesity and chronic kidney disease following metabolic and bariatric surgery: a propensity score-matched TriNetX real-world cohort study.","authors":"Pattharasai Kachornvitaya, Xinlei Zhu, Sergio Bardaro, Valentin Mocanu, Mélissa V Wills, Juan S Barajas-Gamboa, Yung Lee, Ricard Corcelles, Andrew Strong, Salvador Navarrete, Thunyatorn Wuttiputhanun, Suthep Udomsawaengsup, Matthew Kroh, Jerry Dang","doi":"10.1016/j.soard.2026.08.015","DOIUrl":"https://doi.org/10.1016/j.soard.2026.08.015","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Obesity accelerates the progression of chronic kidney disease (CKD) and often limits access to kidney transplantation. Although metabolic and bariatric surgery (MBS) has been associated with improvements in kidney function and cardiometabolic outcomes, evidence regarding long-term kidney failure, dialysis, transplantation, cardiovascular, and survival outcomes among patients with established CKD remains heterogeneous.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the association between MBS and long-term renal, cardiovascular, and transplant outcomes, and all-cause mortality, in patients with obesity and CKD using a large, propensity score-matched real-world cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Settings: &lt;/strong&gt;Analysis of TriNetX Global Collaborative Network, a de-identified real-world database from over 140 health care organizations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Adults (≥18 years) with severe obesity and CKD who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 2010 and 2020. Patients were propensity score-matched 1:1 to those without MBS based on demographics, comorbidities, baseline kidney function, and medication use. Outcomes were assessed over 5years. Primary endpoints included incidence of end-stage renal disease (ESRD), dialysis initiation, kidney transplantation, cardiovascular events, and all-cause mortality. A subgroup analysis comparing SG and RYGB was performed using propensity score matching.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 4481 MBS patients were matched to 4481 non-MBS patients, with well-balanced baseline characteristics. Compared to the non-MBS group, MBS was associated with significantly lower risks of ESRD (5.9% versus 11.9%; odds ratio [OR] .47, 95% confidence interval [CI] .40-.55), dialysis dependence (4.1% versus 9.0%; OR .43, 95% CI .36-.52), and composite cardiovascular events (15.5% versus 27.7%; OR .48, 95% CI .42-.54). Interestingly, kidney transplant rates were more than twice as high in the MBS group (4.6% versus 2.2%; OR 2.13, 95% CI 1.67-2.72), and all-cause mortality was markedly lower (5.0% versus 16.3%; OR .27, 95% CI .23-.32). In subgroup analyses, outcomes were comparable between SG and RYGB, although SG was associated with higher kidney transplantation rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this large TriNetX cohort of patients with obesity and CKD, MBS was associated with lower observed rates of ESRD, dialysis dependence, cardiovascular events, and all-cause mortality and with a higher rate of kidney transplantation. Similar renal, cardiovascular, and survival outcomes were observed after SG and RYGB. Because of residual differences in baseline kidney function, unmeasured treatment-selection factors, and limitations in the geographic and institutional characterization of the TriNetX network, these findings should be interpreted as associations within the study cohort rather than causal effects or population-level estimates. Further prospect","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Roux-en-Y gastric bypass: the impact of tobacco nicotine, nontobacco nicotine, and marijuana use on postoperative outcomes.","authors":"Pooja Enagala, Joshua Wang, Zeyanna Dhalla, Chris Hsu, Sarah Samreen, Lauren McTaggart","doi":"10.1016/j.soard.2026.08.011","DOIUrl":"https://doi.org/10.1016/j.soard.2026.08.011","url":null,"abstract":"<p><strong>Background: </strong>Nontobacco nicotine products and cannabis use are increasingly prevalent, yet their effects on outcomes following Roux-en-Y gastric bypass (RYGB) remain poorly understood.</p><p><strong>Objectives: </strong>This study evaluates postoperative complications among patients undergoing RYGB using tobacco nicotine, nontobacco nicotine, or marijuana compared with nonusers.</p><p><strong>Setting: </strong>United States.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted using the TriNetX Research Network. Adults (>18 years) undergoing RYGB were stratified into 4 propensity-matched cohorts based on documented preoperative substance use within 90 days of surgery: tobacco nicotine, nontobacco nicotine, marijuana, and nonusers. One-year outcomes included infection, readmission, seroma, anastomotic leak, deep vein thrombosis, internal hernia, marginal ulcer, and nutritional deficiencies. Risk ratios (RRs), 95% confidence intervals, and P values (P < .05) were calculated.</p><p><strong>Results: </strong>Tobacco nicotine users showed increased readmission (RR 1.29), internal hernia (RR 1.29), marginal ulcer (RR 1.69), and nutritional deficiency (RR 1.04), with fewer anastomotic leaks (RR .65). Nontobacco nicotine users showed increases in readmission (RR 1.29), internal hernia (RR 1.30), and marginal ulcer (RR 1.57), with reduced leaks (RR .71). Marijuana users had increased marginal ulcers (RR 1.74), but no significant differences in readmission. No clinically meaningful differences were observed between nicotine groups or between marijuana and nicotine users.</p><p><strong>Conclusions: </strong>Tobacco nicotine, nontobacco nicotine, and marijuana use all increased morbidity across several markers, suggesting that various forms of substance use impact postoperative complications. These findings highlight the need for umbrella preoperative cessation recommendations and prospective studies on how nicotine and cannabis influence postoperative outcomes.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percentile-based weight loss benchmarks after sleeve gastrectomy, Roux-en-Y gastric bypass, and duodenal switch: a multi-site cohort study.","authors":"Ramsey M Dallal, Priscilla Lam, Aditya Das","doi":"10.1016/j.soard.2026.08.013","DOIUrl":"https://doi.org/10.1016/j.soard.2026.08.013","url":null,"abstract":"<p><strong>Background: </strong>Weight loss after bariatric surgery varies substantially among individuals, yet outcomes are usually reported as averages. Percentile benchmarks may better support patient counseling.</p><p><strong>Objectives: </strong>To develop percentile-based weight loss benchmarks after primary sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch/single-anastomosis duodeno-ileal bypass (DS/SADI).</p><p><strong>Setting: </strong>Five-campus academic health system, United States.</p><p><strong>Methods: </strong>Retrospective cohort study of 2730 primary bariatric patients (1796 SG, 663 RYGB, 271 DS/SADI; 2021 to 2026). Of 2928 eligible patients, 2730 (93.2%) had a postoperative follow-up weight; each contributed one most-recent weight (median follow-up 22.8 months; IQR, 9.7 to 36.1). Percent total body weight loss (%TBWL) benchmarks at the 10th through 90th percentiles were estimated using quantile regression adjusted for age, sex, initial body mass index (BMI), procedure, time, and procedure-by-time interaction, with 95% confidence intervals from bootstrap resampling.</p><p><strong>Results: </strong>Among 2730 primary bariatric patients (1796 SG, 663 RYGB, 271 DS/SADI), the three operations tracked closely through the first 6 months, where DS/SADI was not yet distinguishable from SG (P = .14), then pulled apart after the first year and stayed separated through 36 months. For a reference patient (woman, age 42, BMI 45), predicted median %TBWL at 12 months was 24.5% for SG, 30.0% for RYGB, and 33.4% for DS/SADI; by 24 months it was 23.7%, 30.7%, and 36.2%. In practical terms, RYGB ran about 5.5 percentage points ahead of SG at 1 year and 7.0 at 2 years, and DS/SADI led SG by 8.9 and 12.5. But the range matters as much as the average: at 24 months, %TBWL ran from 10.3% at the 10th percentile to 38.1% at the 90th for SG, 16.3% to 44.3% for RYGB, and 17.8% to 47.1% for DS/SADI, so one in ten SG patients lost about 10% or less while another one in ten lost nearly 40%, and a strong SG result matched a typical RYGB. Internal calibration was good (mean error 1.6 percentage points), and the ordering held across sensitivity analyses.</p><p><strong>Conclusions: </strong>Percentile benchmarks allow a surgeon to show patients what weight loss really looks like after each operation, side by side and out to 3 years, as a range rather than a single number. This is easier to use and more honest for counseling than the average, and it covers the window beyond the first year, when weight loss is still settling.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of single anastomosis duodeno-ileal bypass with sleeve gastrectomy adoption in a statewide collaborative using performance monitoring.","authors":"Oliver A Varban, Arthur M Carlin, Hassan Nasser, Michael Kia, Nabeel Obeid, Jonathan F Finks, Mouhammad Halabi, Matthew Bucala","doi":"10.1016/j.soard.2026.08.009","DOIUrl":"https://doi.org/10.1016/j.soard.2026.08.009","url":null,"abstract":"<p><strong>Background: </strong>Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is an emerging bariatric procedure with safety data often limited to single centers or single surgeons.</p><p><strong>Objective: </strong>To assess complication rates across a broad range of practices.</p><p><strong>Setting: </strong>Prospective, state-wide bariatric-specific clinical registry.</p><p><strong>Methods: </strong>We analyzed prospectively collected data from the Michigan Bariatric Surgery Collaborative (41-hospital consortium) for all primary SADI-S procedures between 2016 and 2025. Firth penalized logistic regression was performed to evaluate risk factors for serious complications. Time-series, funnel plot volume-outcome and risk-adjusted cumulative sum (CUSUM) analyses were performed to evaluate surgeon-specific performance and learning curve.</p><p><strong>Results: </strong>Among 330 SADI-S procedures (13 surgeons, 9 sites), serious complication rate, which included major cardiovascular/pulmonary events, anastomotic leak, renal failure, surgical site infection, venous thrombosis and reoperation was 2.7% and there were no deaths. Funnel plot volume-outcome relationship and CUSUM analysis for surgeons performing > 15 cases (6 surgeons), demonstrated no outliers. Serious complication rates trended at or below 2.7% despite an influx of cases in 2022. Learning curve analysis demonstrated that serious complications declined from 5.2% to 0.9% (P = .018) after 20 cases.</p><p><strong>Conclusion: </strong>Among experienced mid-career bariatric surgeons, SADI-S achieved acceptable safety with zero mortality and a low serious complication rate (2.7%) despite increased adoption at different hospitals. Surgeon-specific CUSUM monitoring did not demonstrate any outliers and serves as a framework for safe implementation of emerging procedures. Serious complication rates declined significantly after 20 cases among the study cohort.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thirty-day outcomes after bariatric conversion operations: a national analysis of 94,828 cases.","authors":"Ramsey M Dallal, Priscilla Lam, Aditya Das","doi":"10.1016/j.soard.2026.08.012","DOIUrl":"https://doi.org/10.1016/j.soard.2026.08.012","url":null,"abstract":"<p><strong>Background: </strong>Conversion bariatric operations are increasing and now comprise nearly 10% of procedures nationally, yet their 30-day risk compared with primary operations remains poorly characterized at the pathway level.</p><p><strong>Objectives: </strong>To estimate the adjusted excess 30-day serious adverse event (SAE) risk of conversion versus primary bariatric operations of the same final anatomy, and to identify which pathways carry the highest risk.</p><p><strong>Setting: </strong>National Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use File (PUF), 2020 to 2024.</p><p><strong>Methods: </strong>We performed anatomy-stratified logistic regression with marginal standardization on 949,507 bariatric operations (94,828 conversions). The primary outcome was a 17-component composite SAE. Adjusted risk differences (RDs) per 1000 were computed for sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch (DS)/single-anastomosis duodeno-ileal (SADI) strata, and a within-conversion model identified associated factors.</p><p><strong>Results: </strong>Conversion was associated with higher adjusted 30-day SAE risk across all anatomies: SG (RD 18.2 per 1000 [95% confidence interval, CI: 15.0-21.3], number needed to harm [NNH] 55), RYGB (22.1 [19.5-24.7], NNH 45), and DS/SADI (17.5 [9.4-25.7], NNH 57). The excess was concentrated in utilization events (reoperation, reintervention, and readmission) and selected technical complications, such as leak, organ-space infection, and bowel obstruction. Among conversions, a prior RYGB carried the highest risk (adjusted odds ratio [aOR]: 2.54 versus a prior sleeve). The excess showed no detectable change across study years.</p><p><strong>Conclusions: </strong>Conversion operations carry a clinically meaningful excess 30-day SAE risk that is greatest after a prior gastric bypass. Conversion status should be treated as a distinct risk category rather than benchmarked against primary procedures alone.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in preoperative weight loss modalities among patients receiving body contouring surgery.","authors":"Joey Liang, Justin L Anderson, Jackson M Cathey, Justin Zhang, Victoria N Yi, Ash Patel","doi":"10.1016/j.soard.2026.08.008","DOIUrl":"https://doi.org/10.1016/j.soard.2026.08.008","url":null,"abstract":"<p><strong>Background: </strong>While pharmacologic weight loss therapies like glucagon-like peptide-1 receptor agonists (GLP-1RAs) have increased in popularity, body contouring patients' utilization of other weight loss modalities remains unclear.</p><p><strong>Objectives: </strong>This retrospective cohort study examined the weight loss modalities used by body contouring patients and their impacts on procedure choice and surgical outcomes.</p><p><strong>Setting: </strong>University Hospital, United States.</p><p><strong>Methods: </strong>The TriNetX Research Network was queried for patients who received abdominoplasties, panniculectomies, thighplasties, and brachioplasties between 2012 and 2024. The incidence and prevalence of weight loss modalities were extracted. Trends in weight loss modality utilization were evaluated by Mann-Kendall test.</p><p><strong>Results: </strong>A total of 27,443 body contouring patients were included. Bariatric surgery (15.86%) was the most prevalent weight loss modality. Bariatric surgery (τ = .87, P < .001), naltrexone (τ = .87, P < .001), phentermine (τ = .82, P = .001), and liraglutide (τ = .78, P = .002) demonstrated the strongest increases in utilization overall. Subgroup analysis demonstrated increasing utilization of semaglutide among GLP-1RA users and increasing utilization of sleeve gastrectomy and gastric bypass among bariatric surgery recipients. Patients utilizing bariatric surgery (95.86% vs 92.62%, P < .001) and phentermine (94.29% vs 92.62%, P = .009) had significantly higher rates of abdominal contouring than non-medical weight loss controls. Bariatric surgery recipients also had lower rates of extremity contouring than controls (7.67% vs 9.31%, P = .003).</p><p><strong>Conclusions: </strong>Body contouring patients utilize a variety of surgical and pharmacologic weight loss modalities. Patients using potent weight loss modalities may more frequently undergo abdominal contouring compared to extremity contouring, potentially due to preferential abdominal skin laxity from massive weight loss.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anastomotic marginal ulceration after conversion of sleeve gastrectomy to Roux-en-Y gastric bypass.","authors":"Fadlullah Ba'th, Xiaoxi Feng, Jesse Gutnick, Toms Augustin, Rickesha Wilson, Jerry T Dang, Andrew T Strong, Walter Cha, Kalman Bencsath, Chao Tu, Alex Milinovich, Mary Ellen Satava, Salvador Navarrete, Ricard Corcelles, Matthew Kroh, Ali Aminian","doi":"10.1016/j.soard.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.soard.2026.08.007","url":null,"abstract":"<p><strong>Background: </strong>Patients who undergo Roux-en-Y gastric bypass (RYGB) can develop anastomotic marginal ulcers, which can lead to other complications such as stricture, bleeding, or perforation.</p><p><strong>Objectives: </strong>The study aimed to examine if patients undergoing conversion of sleeve gastrectomy to RYGB (SG-to-RYGB) were at a higher risk of marginal ulceration than a cohort of patients with primary RYGB.</p><p><strong>Setting: </strong>Cleveland Clinic Health System in the United States.</p><p><strong>Methods: </strong>This retrospective study included patients who underwent primary RYGB or SG-to-RYGB conversion at an academic health system between 2015 and 2023. Follow-up ended in March 2025. The Kaplan-Meier method was used to estimate the time to incident marginal ulcer.</p><p><strong>Results: </strong>The study included 1910 patients who underwent primary RYGB and 202 patients who underwent SG-to-RYGB conversion. During the follow-up time of 3.8 ± 2.9 years, 275 patients with primary RYGB and 40 patients who had SG-to-RYGB conversion developed a marginal ulcer. The cumulative incidence of marginal ulcer at 5 years was 16% (95% confidence interval [CI], 14%-18%) in the primary RYGB group and 27% (95% CI, 18%-35%) in the SG-to-RYGB group. The cumulative incidence of marginal ulcer at 8 years was 20% (95% CI, 17%-22%) in the primary RYGB group and 35% (95% CI, 20%-47%) in the SG-to-RYGB group (P = .01). In the SG-to-RYGB group, the cumulative incidence of marginal ulcer between patients who underwent RYGB primarily for gastroesophageal reflux disease and those who underwent RYGB for inadequate weight loss following SG was not statistically significant.</p><p><strong>Conclusions: </strong>The follow-up data up to 8 years indicate that approximately 20% of patients who undergo primary RYGB and 35% of those who undergo SG-to-RYGB conversion may develop marginal ulceration. Given the role of the antrum in acid secretion, future clinical trials could potentially test if antrectomy at the time of conversion of SG-to-RYGB has the potential to decrease the rate of marginal ulceration.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}