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 investigate the effect of stomach intestinal pylorus sparing surgery in metabolic surgery for weight loss.MethodThe literatures about stomach intestinal pylorus sparing surgery were reviewed by searching domestic and foreign literatures.ResultsIn recent years, stomach intestinal pylorus sparing surgery had been gradually applied in clinical practice. Compared with other weight-loss surgeries, it had better clinical effects in weight reduction and blood glucose control. It not only provided a new surgical treatment for patients with severe obesity, but also promoted the development of weight-loss metabolic surgery.ConclusionAs a new metabolic surgery, stomach intestinal pylorus sparing surgery is safe and feasible for weight loss.
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.
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 observe the changes of body composition in patients with obesity after sleeve gastrectomy (SG) and know the factors affecting the effective weight loss. MethodsThe obese patients who received SG treatment at the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University from October 2019 to October 2022 were included according to the inclusion and exclusion criteria. The anthropometric parameters, lipid metabolism indexes, and body composition data were collected before surgery (1 d) and at 1-, 3-, 6-, and 12-month after surgery. The risk factors affecting the effective weight loss were analyzed. ResultsA total of 170 patients were included in the study. ① The anthropometric parameters such as body weight, body mass index, waist circumference, hip circumference, and waist-to-hip ratio at different time points after surgery as compared with the baseline (1 day before surgery) values were decreased (P<0.05) and showed continuous downward trends after surgery (P<0.05), meanwhile the percentage total weight loss and percentage excess weight loss (%EWL) indicators showed continuous upward trends (P<0.05). ② The lipid metabolic indexes such as triglyceride, total cholesterol, and uric acid, except for the total cholesterol indexes at the 6th and 12th month had no statistical differences as compared with the baseline value (P>0.05) and the uric acid was increased at the 1st month after surgery (P<0.05), the other indexes at different time points after surgery showed continuous downward trends as compared with the baseline values (P<0.05). ③ All the body composition parameters except percentage fat-free mass of the left and right lower limbs (P>0.05) at different time points after surgery as compared with the baseline values were decreased (P<0.05), and some body composition indicators, such as fat mass, percentage fat mass, visceral fat area, and obesity degree continued to decrease within 1 year after surgery (P<0.05). ④ There were 93 patients with reaching the standard of effective weight loss (%EWL was 50% or more). The multivariate logistic regression analysis showed that the lower fat mass of right lower limb, the higher probability of effective weight loss [OR (95%CI)=0.452 (0.290, 0.703), P<0.001]. The area under the receiver operating characteristic curve of the fat mass of the right lower limb was 0.782 [95%CI=(0.672, 0.893), P<0.001], its sensitivity and specificity were 0.679 and 0.792, respectively, and the cut-off value was 7.35 kg. ConclusionsThe results of this study suggest that SG can markedly improve the anthropometric and lipid metabolism indicators of patients with obesity, and achieve effective weight loss in a short-time. The body composition from the whole body to limbs and trunk might be changed. The fat mass of the right lower limb is closely related to the short-term effective weight loss after surgery and it has a moderate ability to distinguish achieving effective weight loss.
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.
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.
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.
ObjectiveTo explore the trajectories of health-related quality of life (HRQoL) among adolescents after metabolic bariatric surgery and to identify influencing factors. MethodsThis retrospective cohort study included 208 adolescents who underwent metabolic bariatric surgery at the First Affiliated Hospital of Nanjing Medical University from June 2023 to December 2024. Data on quality of life were collected at baseline, 3 months, and 6 months postoperatively, along with related scale assessments at 6 months. Latent class growth modeling was applied to identify trajectory categories of quality of life. Demographic characteristics and scale points were compared across groups, and unordered multinomial logistic regression was used to analyze influencing factors. ResultsThree distinct HRQoL trajectories were identified by latent class growth model: low-level improvement group (102 cases, 49.0%), moderate-level stable group (74 cases, 35.6%), and high-level decline group (32 cases, 15.4%). Significant differences were observed among groups in BMI, percentage of excess weight loss (EWL%), points of body image, self-esteem, objective support, support utilization and appearance anxiety index at 6 months after operation (P<0.05). At 6 months postoperatively, patients in the low-level improvement group had the lowest BMI and the highest EWL%, along with higher body image and support utilization points. Patients in the moderate-level stable group experienced less weight reduction than those in the low-level improvement group, with only limited improvement in quality of life. Although patients in the high-level decline group initially had better preoperative quality of life, they showed the least postoperative weight loss, the lowest body image and support utilization points, and higher appearance anxiety points, with a progressive decline in quality of life. Results of unordered multinomial logistic regression analysis indicated that postoperative BMI, EWL%, points of body image, and support utilization were influencing factors associated with HRQoL trajectories (P<0.05). ConclusionsMetabolic bariatric surgery improves quality of life in most adolescents, yet a subgroup experiences unfavorable trajectories. Postoperative weight loss, body image, and social support are critical determinants. Early identification and targeted interventions are needed to optimize long-term outcomes.
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.