Bariatric Surgical Practice and Patient Care

Obesity is a global epidemic, associated with metabolic disorders and significant health risks. It is often treated with bariatric and metabolic surgery (BMS), such as Roux-en-Y gastric bypass and sleeve gastrectomy. These interventions impact not only weight loss but also taste perception and food preferences, possibly influencing dietary habits. This study investigates taste and nutritional outcomes during the post-BMS weaning phase, evaluating an alternative semiliquid diet with “Foods for Special Medical Purposes” (FSMPs) for improved taste acceptance and nutrient intake.

Thirty-two patients undergoing BMS were divided into two groups 16 were placed on an FSMP-based diet (Group A) and 16 on traditional homogenized foods (Group B). Sensory evaluation included taste strips, sensory questionnaires, and weekly dietary questionnaires. Hematochemical analyses and bioimpedance measurements were conducted presurgery (T0) and 1-month postsurgery (T1) to assess nutrient status and body composition.

Patients in Group A showed improved protein intake and a trend toward better compliance with the FSMP diet. Significant changes in taste perception were noted, particularly for sour and salty tastes, with patients reporting altered taste intensity and preferences, especially for high-calorie foods. There were no significant differences in anthropometric or hematochemical outcomes between the groups, although FSMPs showed a marginal benefit in maintaining protein levels.

FSMPs may offer an effective alternative in the post-BMS weaning phase, supporting nutrient intake and adherence to dietary guidelines. The observed changes in taste perception highlight the importance of tailored dietary strategies to support long-term dietary adjustment and weight management.

Laparoscopic sleeve gastrectomy (LSG) is a widely performed procedure for obesity management, and effective postoperative pain control remains a significant challenge. Ultrasound-guided regional blocks, as part of a multimodal analgesia approach, have recently gained prominence in improving postoperative outcomes. This study evaluates the comparative efficacy of modified thoracoabdominal plane block with perichondrial approach (M-TAPA) and oblique subcostal transversus abdominis plane (OSTAP) blocks, specifically addressing the role of ultrasound guidance in enhancing postoperative pain management in patients undergoing LSG.

This prospective, single-center randomized study included 60 patients (M-TAPA [n = 30] and OSTAP [n = 30]) scheduled for LSG. The primary outcome was tramadol consumption via patient-controlled analgesia. Secondary outcomes included the Numeric Rating Scale for pain, postoperative nausea and vomiting, additional analgesic requirements, and block execution time.

At the 6-h postoperative mark, tramadol consumption in the M-TAPA group was significantly lower than in the OSTAP group (p = 0.009). Total tramadol consumption over 24 h was found to be lower in the M-TAPA group (280 ± 89.08 mg) than in the OSTAP group (325.5 ± 100.21 mg). The difference was close to the statistical significance limit (p = 0.058).

These findings support the growing role of ultrasound-guided regional techniques in enhancing multimodal analgesia in bariatric surgery, particularly in obese patients.

Early postoperative total weight loss percentage (TWL%) shows heterogeneous predictive value for subsequent outcomes, yet targeted management strategies remain challenging. Identifying distinct early weight loss trajectories could characterize high-risk populations for weight regain, enabling proactive interventions to optimize long-term outcomes.

This prospective observational study was conducted from April 2023 to December 2024. Dynamic weight data were recorded at 1, 3, 6, and 18 months postoperatively; TWL% was calculated. Latent Growth Curve Modeling (LGCM) was used to construct early weight loss trajectory models. Logistic regression analyzed associations between early weight loss trajectories and weight regain risk.

A total of 215 patients were included in the study. Weight regain incidence was 23.26%. LGCM identified two TWL% trajectory groups: rapid weight loss group and slow weight loss group. Taking the slow weight loss group as reference, rapid weight loss group had significant lower risk in the incidences of weight regain [Odds ratio (OR) = 0.441, p = 0.044].

Two distinct early postoperative weight loss trajectories were identified, with the rapid weight loss group demonstrating significantly lower weight regain at 18 months. Early weight loss patterns are correlated with medium-term outcomes through more effective resetting of body weight set points.

Despite surging interest in glucagon-like peptide-1 receptor agonist (GLP1RA), there are few data regarding how preoperative GLP1RA impacts postoperative outcomes after bariatric surgery.

This is a retrospective cohort study comparing early and long-term total weight loss (TWL%) between adult patients with and without preoperative GLP1RA before bariatric surgery.

A total of 902 patients were included, with 561 (62.2%) patients having gastric bypass and the rest having sleeve gastrectomy. Among these, 19 patients had liraglutide and 10 had semaglutide before surgery. Patients who received GLP1RA experienced slightly greater preoperative weight loss (6.7 ± 7.0% vs. 4.8 ± 9.9%, p = 0.30). A trend toward higher 1- to 2-month weight loss with preop GLP1RA, which was only significant among sleeve gastrectomy patients, was observed, with TWL% being 17.6 ± 7.4% vs. 11.4 ± 6.4% (p < 0.01) and 21.9 ± 7.6% vs. 17.1 ± 7.0% (p = 0.03) at 1 and 2 months, respectively. This difference gradually diminished at 6 months (27.5 ± 6.7% vs. 24.3 ± 7.6%, p = 0.15), 1 year (31.8 ± 7.7% vs. 28.3 ± 9.5%, p = 0.23), and 2 years (30.2 ± 8.2% vs. 28.2 ± 10.3%, p = 0.23).

Greater early weight loss after sleeve gastrectomy was observed among patients who had preoperative GLP1RA. It is worth considering continuing GLP1RA after sleeve gastrectomy for patients who are at high risk for insufficient weight loss.

Several international guidelines recommend venous thromboembolism (VTE) chemoprophylaxis post bariatric surgery, as these patients are at moderate to high risk of developing thrombosis. Nonetheless, there is no consensus on the agent to be used for these cases. Fondaparinux, an inhibitor of factor Xa, has been used for preventing VTE generally in postoperative patients, but no clear data about its role in bariatric patients.

To study the efficacy and safety of Fondaparinux in prophylaxis against VTE in patients undergoing bariatric surgery.

We reviewed the medical records of patients who underwent bariatric surgery in a main bariatric center between January 2015 and May 2019 and who received Fondaparinux for VTE prophylaxis. In our hospital protocol, we use pneumatic compression devices intraoperatively and Fondaparinux 2.5 mg subcutaneously once daily for 5 days starting 6 h postsurgery regardless of body mass index (BMI). Intraoperatively, we neither use hemostatic agents nor suture the staple line. We use abdominal drains in some, but not all cases.

We reviewed the files of 546 patients who received Fondaparinux postsurgery. 167 patients (30.5%) were males, while 379 patients were females (69.5%). The mean age was 34 years, and the mean BMI was 44.2. 206 had sleeve gastrectomy (37.7%), 286 one-anastomosis gastric bypass surgery (52.3%), 27 had Roux-En-Y (5%), and the remaining 27 patients (5%) had revisional surgery. 234 had patients had no drain placed (42.8%), while 296 had a drain for 1 day (54.2%), 13 had the drain for 2 days (2.3%), and three patients had a drain for 7 days (0.6%). Mean preoperative and postoperative hemoglobin was 12.56 and 12.28, respectively. Four patients (0.86%) had an increase in bloody drainage in the drain that stopped spontaneously without any need for blood transfusion or surgical intervention. No cases of VTE, bleeding requiring intervention, or mortality were reported during the 6-month follow-up.

Fondaparinux, as a single daily dose for 5 days, seems to be safe and effective in patients with different BMIs after bariatric surgery. Further prospective studies are needed to determine its exact role and help establish clear guidelines.

Weight and height data were collected for body mass index (BMI) calculation, using the night feeding questionnaires, the Pittsburgh Sleep Quality Index (PSQI), and an adapted questionnaire about the practice of physical activity (PA). The data were analyzed in Statistical Package for the Social Sciences, v. 24.0 (statistical significance p < 0.05). The research was approved by the Research Ethics Committee (No. 5.180.990).

A total of 125 adults were evaluated in the preoperative stage of bariatric surgery, with an average BMI 46.2 kg/m² (±7.4), 51.2% were physically active, with an average practice of PA of 219 (±128.8) min. It was observed that 14.4% of participants met criteria for suggestive night eating syndrome (NES) behavior and 72% of participants had poor sleep quality. The PSQI score was a predictor of NES symptoms, regardless of BMI and practice of PA (B = 0.788, 95% confidence interval = 0.548–1.028, p < 0.001).

Level III, well-designed cohort or case–control analytic studies.

Sleep quality was found to be a predictor of NES suggestive behavior.

This study evaluated the effects of omentopexy on postoperative nausea and vomiting (PONV) in the first 24 h after patients underwent laparoscopic sleeve gastrectomy (LSG).

In this prospectively designed retrospective data analysis study, 200 patients who underwent LSG consecutively in our clinic between August 2023 and December 2023 were assigned to one of two groups: 100 patients with omentopexy and 100 patients without omentopexy. The patients’ demographic data, Apfel scores, and PONV scales were collected prospectively by the service nurses and analyzed retrospectively. LSG was performed using the five-trocar technique with imbrications in all patients.

Among the 200 patients (100 with omentopexy, 100 without), the mean age was 38.9 ± 10.1 years, the mean body mass index was 41.9 ± 6.4 kg/m², and 86.5% were female gender. The LSG with omentopexy group had a statistically significantly lower nausea score and less vomiting than the LSG without omentopexy group (p < 0.05), even though the LSG with omentopexy group’s Apfel score was statistically higher than that of the other group. Furthermore, the duration of nausea was statistically significantly higher in the LSG without omentopexy group (p < 0.05).

Omentopexy is commonly preferred by surgeons for diverse purposes, including reinforcement of the stapler line, reducing gastrointestinal symptoms after LSG, and preventing torsion or reflux. In our study, the nausea score, duration of nausea, and vomiting were statistically significantly lower in patients who underwent LSG with omentopexy, indicating that surgeons may use omentopexy to control early PONV after LSG.

This study aimed to assess the prevalence of depression, anxiety, perceived discrimination, and weight stigma among bariatric surgery candidates.

This cross-sectional study was conducted from April to November 2024 at a tertiary care obesity treatment center using convenience sampling. Participants (N = 210) completed validated tools, including the Beck Anxiety Inventory, Beck Depression Inventory, Weight Self-Stigma Questionnaire, and a discrimination scale. Data were analyzed using descriptive statistics, independent group comparisons, correlation tests, and multivariate adjusted models.

The median age of participants was 39 years. Based on body mass index (BMI), patients were categorized into Group A (35–40, n = 75) and Group B (>40, n = 135). BMI was significantly associated with marital status (p = 0.049) and education level (p = 0.031). While 43.8% had no or minimal depression, 81.4% reported grade 2 anxiety. Group A showed significantly higher depression scores (p = 0.012), whereas severe anxiety was more frequent in Group B. Moderate discrimination and mild stigma were commonly reported. Adjusted analyses revealed positive correlations between BMI and both discrimination (rs = 0.33, p < 0.001) and stigma (rs = 0.23, p = 0.007).

Psychological distress and perceived stigma are prevalent in candidates for bariatric surgery. It is recommended to implement psychosocial screening and provide targeted psychological interventions to improve mental health and postoperative outcomes among them.

Patients with severe neurological obesity are at a significantly higher risk of difficult airway due to anatomical and physiological alterations, presenting critical challenges in clinical airway management. Guided by Benner’s from Novice to Expert framework and Kolcaba’s Comfort Theory, this review examines nursing strategies that enhance both technical competency and patient-centered care in difficult airway management.

Using Benner’s competency domains as an analytical lens, this review examines the impact of obesity on airway physiology, identifies challenges in current nursing practices, and explores the potential of emerging technologies in difficult airway management. Key aspects include airway assessment limitations, nursing intervention gaps, and advancements in technology-driven solutions.

Current nursing approaches often lack standardized protocols for assessing and managing difficult airways in this population. The integration of novel techniques, such as artificial intelligence-assisted airway assessment, advanced imaging, and individualized airway management strategies, shows promise in enhancing patient outcomes.

Improving difficult airway nursing in neurological obesity requires the development of evidence-based nursing protocols, adoption of emerging technologies, and enhanced training for clinical nurses. Addressing these gaps can significantly improve airway safety and optimize patient care.

Psychosocial assessments by behavioral health (BH) professionals before metabolic and bariatric surgery (MBS) are recommended by national guidelines. Accordingly, insurance companies often require patients to undergo psychosocial assessments before MBS. This paper reviews the historical evolution of the MBS psychosocial assessment, clarifies the role of BH professionals within the team before and after MBS, and describes strategies to effectively utilize psychosocial assessments to optimize patient outcomes.

Authors conducted a manual search of the available literature and completed a narrative review.

The original intent of the psychosocial assessment for MBS was to correlate psychiatric profiles to weight loss outcomes or identify which patients were predicted to succeed or “fail” after MBS. Historically, these evaluations were gatekeeping mechanisms, which invalidates the myriad ways that psychosocial assessments can identify and support patients. Controversy exists about the necessity of these evaluations, leading some MBS team members and patients to see it as an unavoidable “checkbox” with little clinical utility outcomes.

Viewing the psychosocial assessment as a checkbox minimizes the potential benefits to patients and MBS team members. Additionally, it diminishes the expertise of BH professionals who are uniquely trained to support this patient population toward an optimal surgical outcome.