Objective To review the changes of gut microbiota after bariatric surgery and the related mechanisms of improving metabolism. Method Domestic and international literatures in recent ten years on the changes of gut microbiota in bariatric surgery and the mechanisms of improving metabolism were collated and summarized. Result The common bariatric procedures performed to date were vertical sleeve gastrectomy (VSG) and laparoscopic Roux-en-Y gastric bypass (RYGB). The changes of gut microbiota vary in different surgical procedures, which were related to the changes of diet habits, gastrointestinal anatomy, gastrointestinal hormone levels and metabolic complications. The gut microbiota might improve the body metabolism by regulating the levels of short chain fatty acids, branched chain amino acids and bacterial endotoxin in the intestinal lumen. Conclusions Significant changes are found in gut microbiota after bariatric surgery, which may be involved in the improvement of body metabolism by regulating the level of bacterial endotoxin and microbial metabolite. However, more in-depth mechanisms need to be further clarified.
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.
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.
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 summarize the progress of research on the interaction between bariatric surgery and intestinal flora at home and abroad in recent years, in order to provide new ideas for promoting recovery after bariatric surgery. MethodThe domestic and international literature of intestinal flora changes after bariatric surgery was searched and reviewed. ResultsThe main changes of the intestinal flora after bariatric surgery showed that the abundance of thick-walled bacteria was decreased and the numbers of Bacteroides and Aspergillus were increased. Some common complications after bariatric surgery such as anastomotic fistula, nutritional deficiencies, and inflammation were related to the intestinal flora imbalance. Supplementation with probiotics, prebiotics, dietary interventions, or fecal microbial transplantation were expected to reduce the incidence of complications after bariatric surgery. ConclusionsBariatric surgery is a durable and effective method for treating obesity and its comorbidities. Changes in individual intestinal flora after bariatric surgery have an impact on both weight loss outcomes and postoperative complications, and it is important to find ways to reduce postoperative complications after bariatric surgery by improving intestinal flora.
This review systematically traces the two-decade evolution of bariatric and metabolic surgery. The high recidivism rate associated with conventional obesity treatments have driven rapid innovation in therapeutic strategies and simultaneously accelerated progress in the surgical management of metabolic diseases. The application of laparoscopic and robotic technologies has not only improved cosmetic outcomes through smaller incisions but also significantly enhanced operational precision, further promoting the adoption and dissemination of surgical interventions. Over time, sleeve gastrectomy and gastric bypass have become the mainstream procedures. Recent research has demonstrated that metabolic surgery mediates its benefits through reprogramming of the neuroendocrine axis, restructuring of the gut microbiota ecosystem, and activation of bile acid signaling pathways. Future efforts should focus on refining long-term complication management protocols and developing individualized prediction models. By utilizing precise phenotyping to optimize procedure selection and implement stratified technical approaches, the field aims to achieve sustained metabolic health.
Sleeve gastrectomy with transit bipartition (SG-TB) was a novel bariatric and metabolic surgery that had received preliminary approval for its effectiveness and safety in reducing weight, improving diabetes, and other metabolic diseases. It showed promising prospects in clinical applications. However, SG-TB also faced some challenges including a small number of cases, insufficient clinical evidence, issues with anastomotic stoma and common channel design, bile reflux, gastroesophageal reflux disease, and malnutrition. Further research is needed to enhance the standardization of SG-TB procedures and provides reference for its wider implementation.
Obesity and osteoarthritis (OA) are two major global public health challenges, and their comorbidity has been steadily increasing in China, presenting new challenges in clinical diagnosis and treatment. Obesity combined with OA differs from other OA subtypes in terms of diagnosis, assessment, and treatment, requiring an integrated approach to weight management and joint protection. In response, the Obesity Research Branch of the Biophysical Society of China, in collaboration with multidisciplinary experts, developed this expert consensus based on a systematic review of recent evidence from evidence-based medicine, employing the Delphi method. This consensus introduces the innovative “obesity-OA” dual-axis assessment concept and proposes a tiered treatment protocol for different obesity grades and OA stages, which includes conservative treatment, weight-loss medications, metabolic and bariatric surgery, and joint replacement surgery. The consensus also covers multidisciplinary evaluation, perioperative management, and postoperative follow-up, resulting in 6 core themes with 17 recommendations. The goal is to provide a scientific and systematic clinical practice guide for the standardized diagnosis and treatment of obesity combined with OA in China.
Obesity is a disease state characterized by the accumulation of abnormal or excessive fat that threatens human health. With the rapid development of the economy and society and the change in lifestyle, obesity is highly prevalent in our country and has become an important disease that threatens the health of the population. Different from traditional non-surgical treatments, metabolic and bariatric surgery has a definite curative effect, is not easy to rebound, has good safety, and has sufficient evidence of clinical benefit, which can make many obese patients, especially those with moderate to severe obesity, fully recover. The treatment of obesity has become an important means in the comprehensive treatment of obesity. This article intends to describe the application of bariatric metabolic surgery in the comprehensive treatment of obesity from three aspects: bariatric surgery indications, surgical method selection, and perioperative multidisciplinary intervention.
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.