Laparoscopic Roux-en-Y gastric bypass (RYGB) is a classic operation in the field of obesity metabolic surgery. It not only obviously reduces body weight but also exhibits notable therapeutic efficacy in treating metabolic diseases such as type 2 diabetes. However, it can result in complications such as postoperative dumping syndrome and a lack of satiety after meals. So our team has further modified the RYGB, introducing a long and narrow pouch in RYGB (LN-RYGB), its core is reserving the length of the gastric pouch, then the long and narrow pouch could make maintaining a small gastric volume for a prolonged period, make food pass through slowly, and reduce reflux and decrease the incidences of dumping syndrome and intestinal bile acid reflux relevant to RYGB. The gastric contents could be thoroughly mixed, not only leading to a stronger satiety after meals but also reducing risk of postoperative bounce back. Furthermore, ulcer complications relevant to RYGB markedly declined, the therapeutic outcome is better especially in patients with type 2 diabetes. In future, more results and data relevant to LN-RYGB can be accumulated in clinic to further confirm its safety and effectiveness. Mearnwhile, it should still be paid attended to that LN-RYGB still faccs certain difficulties and has a clear indication. At present, the indications of RYGB are served as reference, and postoperative malnutrition and element deficiency need to be prevented and a long-term follow-up is also necessary.
ObjectiveTo explore the necessity of staple-line reinforcement (SLR) during laparoscopic sleeve gastrectomy (LSG) through evaluating its potential benefit and safety. MethodsA historical cohort study was conducted in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. The consecutive patients underwent LSG for morbid obesity by the same operative team from June 2022 to August 2023 were included, which were assigned into SLR group and un-SLR group according to the SLR or not. Both groups were assessed in terms of the operating time, postoperative hospital stay, total hospital stay, surgical costs, and complications. ResultsA total of 87 patients underwent the LSG from June 2022 to August 2023, all of whom were successfully completed without any conversion to open surgery. Among them, there were 34 cases in the SLR group and 53 cases in the un-SLR group. There were no statistical differences in the age, gender, body mass index, and so on between the two groups (P>0.05). There were no postoperative complications such as gastric leakage, bleeding, or gastrointestinal stenosis, and no perioperative death, as well as no case of reoperation within 30 d after surgery in all patients of the two groups. And there were no statistical differences in the postoperative hospital stay and total hospital stay between the two groups (P>0.05). However, it was found that the operative time was shorter (P<0.05), the surgical costs and total hospital stay costs were also less (P<0.05) in the un-SLR group as compared with the SLR group. ConclusionsBased on the analysis of cases data in this study, there is no added benefit in terms of reducing staple-line leak, bleeding, etc. in adopting SLR during LSG, and the operating time is prolonged and the cost is increased. So the necessity of the SLR or not during LSG needs to be further researched.
Single-incision laparoscopic sleeve gastrectomy (SILSG) was first described in 2008, which could effectively control excess body weight and treat metabolic diseases relevant to obesity in a long term. Over more than a decade of refinement and technical advancement, precise and standardized surgical techniques have become critical for ensuring treatment efficacy and reducing postoperative complication rates. Thus, this review summarized the evolution of SISLG, further understanding and emphasizing the importance of standardized and precise surgical procedures.
ObjectiveTo explore the effect of laparoscopic sleeve gastrectomy (LSG) on obesity and its comorbidities.MethodThe literatures about LSG in the treatment of obesity and its comorbidities were collected and summarized.ResultsLSG could not only effectively reduce the weight of patients with obesity, but also obviously alleviate comorbidities related to obesity, such as type 2 diabetes mellitus, obstructive sleep apnea syndrome, polycystic ovary syndrome, essential hypertension, hyperlipidemia, and so on.ConclusionsLSG has a definite and effective long-term weight loss effect, which is equal to other common weight loss methods. It has been recognized by more and more patients and clinicians because it has advantages of simple operation, safety, high efficiency and fewer complications. However, therapeutic effects of some comorbidities, such as gastroesophageal reflux disease, are still controversial and need further tobe studied.
A lot of evidence-based medical evidence has shown that laparoscopic Roux-en-Y gastric bypass (LRYGB) is a durable and effective method for obesity and diabetes, and can significantly improve a series of obesity-related metabolic complications. This guideline provides a detailed description of the main operating steps and technical points of the symmetric three-port LRYGB, including posture layout, trocar position selection, liver suspension, gauze exposure, production of small gastric sacs, gastrojejunal anastomosis and production of biliary pancreatic branches, entero-enteric side to side anastomosis, closure of gastrointestinal anastomosis and mesenteric hiatus, greater omentum coverage, and closure of incisions. The purpose is to standardize the operating process of the symmetrical three hole method of LRYGB, providing standardized surgical operation references for clinical doctors in the field of obesity metabolic surgery.
ObjectiveTo understand the present situation and effect of da Vinci robot in the treatment of obesity.MethodThe literatures about the application of da Vinci surgical robot in metabolic surgery for weight loss were reviewed.Resultsda Vinci surgical robot was a minimally invasive surgical system in recent years. Because of its unique structure, it broke through the limitations of traditional laparoscopic surgery, such as lack of field of vision, two-dimensional imaging, unstable lens, limited range of movement, and so on. It provided a solution way for metabolic surgery for weight loss with narrow operation space and high technical difficulty. At present, there were differences in operation time and postoperative complications between da Vinci surgical robot and laparoscopic weight loss.ConclusionsIn recent years, da Vinci surgical robot has been widely used in metabolic surgery for weight loss. It not only overcomes many limitations of laparoscopic assisted weight loss surgery, but also it is safe, feasible, and has a similar clinical effect. It provides a new choice for metabolic surgery for weight loss.
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 undergoing laparoscopic sleeve gastrectomy (LSG) from January 2023 to November 2024. Patients were stratified into two groups: SILS+1 and conventional multi-port LSG (MPLSG). Comparative parameters included operative time, postoperative hospital stay, complication rates, 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 BMI, HbA1c, and TC levels 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 [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 Hb level from preoperative to postoperative day 1, postoperative hospital stay, or incidence of postoperative complications (Clavien-Dindo grade I) (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 levels (F=6.221, P=0.015), with significantly higher postoperative HDL-C levels 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 laparoscopic sleeve gastrectomy.
ObjectiveTo systematically review the current prevalence, key determinants, and prevention strategies of childhood obesity in China. MethodA retrospective review of recent domestic and international literature and policy documents related to the epidemiological trends, health impacts, risk factors, and intervention strategies for childhood obesity was conducted, supplemented by national surveillance data and clinical practice updates. ResultsThe prevalence of childhood obesity in China had been rising continuously over the past four decades, with particularly high rates observed among primary school children and boys. Recent trends showed a “provincial reversal” and an “urban-rural reversal”. The complex interplay of factors at the family, school, and societal levels contributed to the high-risk environment for obesity. China had developed a relatively comprehensive policy framework for obesity prevention and control and was promoting a three-tier prevention strategy. Clinically, pharmacological and surgical interventions were being gradually adopted, and traditional Chinese medicine also showed potential. However, challenges remain, including limited health insurance coverage. ConclusionsChildhood obesity has become a significant public health issue in China, threatening national health and social development. Future efforts should focus on enhancing intersectoral governance, improving early intervention capabilities, expanding health insurance support, and standardizing clinical practices. A multi-level, multi-pathway integrated prevention and control system is essential for effectively curbing childhood obesity under the Healthy China strategy.
Both bariatric surgery and pharmacotherapy, particularly glucagon-like peptide-1 receptor agonist (GLP-1RA), are effective interventions for obesity, yet each has its own advantages and limitations. Drawing on the “bridging” concept from cancer therapy, this commentary explores an innovative obesity management strategy that involves the combined application of GLP-1RA and bariatric surgery during the perioperative period, with the aim of optimizing treatment outcomes. The present analysis focuses specifically on the potential value of this approach: preoperatively, GLP-1RAs serve as a “bridging therapy” to promote weight loss and reduce surgical risks in severely obese patients; postoperatively, they might be used to manage weight rebound or insufficient weight loss. This multimodal integrated strategy is designed to overcome the inherent limitations of single therapies and offer patients more comprehensive treatment options. Emphasizing that future research must urgently focus on optimizing treatment parameters (e.g., timing, dosage), evaluating long-term safety and efficacy, and establishing patient selection criteria for combination therapy. Integrating surgical and pharmacological treatments, this comprehensive strategy based on the oncological “bridging” concept represents a highly promising paradigm shift in obesity management.
The global prevalence of obesity continues to rise, while traditional therapies face challenges due to limited efficacy, invasiveness, and economic burdens. Endoscopic bariatric and metabolic therapies (EBMTs) have emerged as novel approaches to obesity management, characterized by their minimally invasive nature, reversibility, and targeted therapeutic mechanisms. This review systematically expounds the technical classifications and mechanisms of EBMTs, focusing on the clinical value of gastric and small intestinal intervention techniques. Gastric intervention techniques primarily comprise space-occupying devices and anatomical reconstruction: the former achieves short-term weight reduction through physical volume restriction but exhibits device-dependent efficacy, while the latter sustains long-term outcomes via endoscopic suturing or folding that induces durable morphological changes. Small intestinal intervention techniques improve metabolic regulation via gut-pancreas axis modulation, encompassing digestive diversion-driven alterations in chyme transit patterns and mucosal ablation-activated regeneration of endocrine microenvironments. Future studies should prioritize large-scale longitudinal studies to validate the efficacy and safety of EBMTs, thereby establishing evidence-based support for the precision management of obesity and related metabolic disorders.