Comparing perioperative outcomes of robotic-assisted (RAS) and laparoscopic (LAP) Roux-en-Y gastric bypass (RYGB). A retrospective cohort study was conducted using Premier Healthcare Database, from 2020 to 2023. The study included adult patients with Body Mass Index 30 or higher who underwent elective inpatient RYGB surgery via RAS or LAP. RAS and LAP cohorts were matched through propensity scoring. Regression models with standard errors clustered by matched pair were used to estimate associations between surgical approach and perioperative outcomes. After matching, RAS-RYGB was associated with lower odds of conversion to open surgery (OR, 0.48; 95% CI, 0.32-0.73), ICU admission (OR, 0.57; 95% CI, 0.45-0.73), blood transfusion (OR, 0.77; 95% CI, 0.63-0.95) compared with LAP-RYGB. RAS-RYGB was also associated with slightly lower odds of being in a higher length-of-stay category (OR, 0.85; 95% CI, 0.81-0.89) and have 30-day all-cause reencounters (OR, 0.87; 95% CI, 0.82-0.91). Operating room time was longer with RAS-RYGB (mean difference, 17.5 min; 95% CI, 16.1-18.9), and bowel obstruction was more frequent (OR, 1.25; 95% CI, 1.01-1.54). Other perioperative complications were similar between groups. RAS-RYGB was associated with lower conversion to open surgery, blood transfusion, ICU admissions, modest shift towards shorter length of stay and post-operative visits than LAP-RYGB, but with higher bowel obstruction and longer operating time.

Background/Objectives: Obesity is extremely common among patients with end stage renal disease (ESRD) due to shared metabolic risk factors. Renal transplantation is the gold standard treatment for ESRD, however obesity is a major barrier due to increased anaesthetic risks, surgical complications and poorer graft outcomes. The aim of this study was to assess ESRD patients referred for metabolic bariatric surgery (MBS) in Scotland. Methods: Data from all adult patients with ESRD who were referred for MBS in Scotland from January 2014 to August 2025 were obtained retrospectively. Categorical data are presented as number and percentage; non-parametric continuous data are presented as median and inter-quartile range. A focused review of comparable published cohorts was performed for context. Results: A total of 9 patients with ESRD were referred for MBS over the study period; of these, 5 patients went on to have MBS. Of the patients who underwent MBS, the median age at referral was 47 years, 3 of 5 were female and the median starting weight and body mass index (BMI) were 131 kg and 49 kg/m[2] respectively. Four patients underwent laparoscopic sleeve gastrectomy, and 1 patient underwent one-anastomosis gastric bypass. The median length of hospital stay was 2 days. The median total percentage weight loss was 33.5% (range 27.7% to 48.1%). Four of the five patients were able to be activated on the transplant waiting list after successfully achieving their target weight after a median of 8.4 months. Of the 4 listed patients, 3 were transplanted with no post-operative complications, and 1 remains active on the waiting list. Across seven comparable cohorts (19 to 198 operated patients), all single- or two-centre, ours had the only national coverage. Listing and transplantation outcomes (4 of 5 listed, 3 of 5 transplanted) were broadly consistent with the range reported in these cohorts, although the small sample precludes formal comparison. Conclusions: In this small case series and review, MBS appeared safe and feasible in a highly selected group of patients with obesity and ESRD. MBS facilitates access to renal transplant but is under-utilised in Scotland. We plan to formalise a national treatment pathway to streamline access to bariatric services for patients with ESRD and enable more patients to undergo renal transplantation.

The prevalence of obesity across the world, especially in the United States, remains at epidemic proportions, creating significant health complications in these patients and posing challenges for overcoming numerous related conditions. Over the years, the surgical approach to the management and treatment of obesity and associated morbidities has continued to increase in use and has been an effective treatment method. Various approaches to surgical management include Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), adjustable gastric banding, biliopancreatic diversion with duodenal switch (DS), and endoscopic intragastric balloons. Endoscopy has remained a mainstay approach to evaluating post-operative changes and complications following these procedures. In this scoping review, we discuss the indications and optimal timing for endoscopic evaluation post-bariatric surgical intervention, common endoscopic findings, endoscopic therapeutic techniques and challenges, as well as future directions in the field of post-operative endoscopy. We conclude that while some complications require immediate surgical or radiologic intervention prior to endoscopy, other complications may be evaluated with endoscopy.

Factors limiting fat cell expandability remain scarcely explored, and comprehensive functional comparisons of adipose depots in humans are limited. In the present study, we collected visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) paired-samples from 22 patients with obesity undergoing elective Roux-en-Y gastric bypass surgery. Whole tissue samples were used to determine adipocyte cell size using a coulter counter and gene expression levels using bulk mRNA sequencing. Isolated adipocytes from the same tissue samples were used to functionally assess glucose uptake using glucose tracer assay, and lipolysis by measuring glycerol release. Western blotting was used to determine Caveolin 1 levels in adipocytes. The relationship between COL3A1 expression and systemic health outcomes was assessed using data from the Adipose Tissue Knowledge Portal. We found that SAT adipocytes were larger in size, displayed higher basal lipolysis and higher lipolysis-related gene expression than VAT adipocytes. Isoprenaline-induced lipolytic responsiveness, as well as basal and insulin-stimulated glucose uptake were higher in VAT than in SAT adipocytes. SAT displayed higher levels of extracellular matrix components associated with cellular flexibility and higher cellular Caveolin 1 levels than VAT. Further, we identified subcutaneous adipose tissue COL3A1 as a potential contributor to insulin resistance in obesity, positively associated with BMI, HOMA-IR and adipocyte size. In summary, our findings underscore distinct metabolic properties of subcutaneous and visceral adipocytes in obesity, with SAT adipose tissue exhibiting characteristics that possibly promote greater cellular expandability.

Roux-en-Y gastric bypass (RYGB) is an important bariatric and metabolic surgical procedure, and the design of intestinal limb lengths is a key factor affecting weight loss outcomes, metabolic improvements, and postoperative nutritional status. Currently, there are no established international standards for the optimal lengths of the biliopancreatic limb, alimentary limb, and common channel. This article reviews the evolutionary history of RYGB and its common classification, with a focus on analyzing the impact of the lengths of the alimentary limb, biliopancreatic limb, common channel, and total alimentary limb on postoperative weight loss outcomes and complications. The length of the alimentary limb can be designed based on the patient's BMI stratification: for patients with BMI ≥ 50 kg/m[2], 130-150 cm is recommended; for those with BMI <50 kg/m[2], ≤ 100 cm is recommended. The length of the biliopancreatic limb ranges from 50-150 cm, and the sum of the lengths of the biliopancreatic limb and alimentary limb should be controlled at approximately 200 cm, as excessive length may increase the risk of adverse events. A common channel length exceeding 400 cm can reduce the risk of complications. The total length of the alimentary limb should be greater than 400 cm to balance weight loss and nutritional safety. However, the optimization of intestinal limb lengths still needs to consider the patient's baseline characteristics and the type of surgical procedure. This article aims to provide guidance for clinical decision-making regarding intestinal limb lengths in RYGB based on guidelines, emphasizing the importance of formulating individualized plans in conjunction with patient characteristics, with particular attention to ethnic-specific factors relevant to the Chinese population to optimize surgical outcomes.