Childhood and adolescent obesity has become a global epidemic. The interventions mainly include lifestyle intervention, medication treatment and bariatric surgery. Among them, lifestyle intervention, especially intensive lifestyle intervention with participation of family members, is the first-line treatment for obesity in children and adolescents. Both medication and bariatric surgery are adjuvant treatments for severely obese children and adolescents. Currently, metformin is the most widely used drug for the treatment of obesity in children and adolescents in both China and other countries; orlistat and liraglutide are also the drugs that are safe and often used in other countries; other drugs are not recommended. As a tertiary prevention and treatment strategy for obesity, bariatric surgery should be carried out on the basis of good compliance from both the children and their family members, with the cooperation of multiple disciplines. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most common types of procedure performed. Meanwhile, as a new treatment method, intra-gastric balloon procedure needs to be paid more attention to its efficacy and safety.
Adolescent ; Humans ; Child ; Pediatric Obesity/prevention & control* ; Obesity, Morbid/surgery* ; Gastric Bypass/methods* ; Metformin ; Gastrectomy/methods* ; Treatment Outcome ; Retrospective Studies

Objective: To investigate the safety and feasibility of using an endoscopic suturing instrument in laparoscopic gastrojejunostomy. Methods: A descriptive case series study was conducted to retrospectively analyze the clinical data of 5 patients with gastric cancer who underwent laparoscopic distal gastrectomy (Billroth II + Braun anastomosis) at Tangdu Hospital, Air Force Medical University from October 2022 to January 2023. The common opening was closed using an endoscopic suturing instrument. The indications were as follows: (1) patients aged between 18 and 80 years; (2) patients with gastric adenocarcinoma; (3) cTNM between I-III; (4) lower-third gastric cancer and radical gastrectomy is recommended; (5) no history of upper abdominal surgery (except for laparoscopic cholecystectomy). The surgery was performed as follows: A side-to-side gastrojejunostomy was performed with endoscopic linear cutter stapler. Then the common opening was closed with endoscopic suturing instrument. During suturing and closing the common opening, a vertical mattress suture was used to completely invert and close the mucosa-to-mucosa and serosa-to-serosa of the gastric and jejunum walls. After the first layer of suture was completed, the seromuscular layer was sutured from top to bottom to embed the common opening of stomach and jejunum. Results: Laparoscopic closure of the common gastrojejunal opening with endoscopic suturing instrument was successfully completed in all 5 patients. The operative time was (308.6±22.6) minutes, while the time of gastrojejunostomy was (15.4±3.1) minutes. The operative blood loss was (34.0±10.8) ml. No intraoperative or postoperative complications occurred in any of the patients. The first passage of gas occurred at (2.6±0.9) days, and the postoperative hospital stay was (7.0±1.9) days. Conclusion: The application of endoscopic suturing instrument in laparoscopic gastrojejunostomy is safe and feasible.
Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Gastric Bypass ; Stomach Neoplasms/pathology* ; Retrospective Studies ; Gastroenterostomy ; Laparoscopy ; Gastrectomy

With the increasing number of obese patients worldwide, metabolic and bariatric surgery (MBS) has quickly become an effective way to treat obesity and related metabolic diseases such as type 2 diabetes, hypertension, lipid abnormalities, etc. Although MBS has become an important part of general surgery, there is still controversy regarding the indications for MBS. In 1991, the National Institutes of Health (NIH) issued a statement on the surgical treatment of severe obesity and other related issues, which continues to be the standard for insurance companies, health care systems, and hospital selection of patients. The standard no longer reflects the best practice data and lacks relevance to today's modern surgeries and patient populations. After 31 years, in October 2022, the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), the world's leading authorities on weight loss and metabolic surgery, jointly released new guidelines for MBS indications, based on increasing awareness of obesity and its comorbidities and the accumulation of evidence of obesity metabolic diseases. In a series of recommendations, the eligibility of patients for bariatric surgery has been expanded. Specific key updates include the following: (1) MBS is recommended for individuals with BMI≥35 kg/m², regardless of the presence, absence, or severity of co-morbidities; (2) MBS should be considered for individuals with metabolic diseases and BMI 30.0-34.9 kg/m²; (3) the BMI threshold should be adjusted for the Asian population:: BMI≥25 kg/m² suggest clinical obesity, and BMI ≥ 27.5 kg/m² population should consider MBS; (4) Appropriately selected children and adolescents should be considered for MBS.
Adolescent ; Child ; Humans ; Diabetes Mellitus, Type 2/surgery* ; Bariatric Surgery ; Obesity/surgery* ; Obesity, Morbid/surgery* ; Weight Loss

Objective: Obesity is known to be associated with left ventricular diastolic dysfunction due to its effect on blood pressure and glucose tolerance. We aimed to investigate whether weight loss after bariatric surgery might improve diastolic dysfunction through in-depth echocardiographic examination. Methodology: We recruited twenty-eight patients who were about to undergo bariatric surgery by purposive sampling. They underwent echocardiography at baseline and 6 months after surgery with a focus on diastolic function measurements and global longitudinal strain (GLS). They also had fasting serum lipid and glucose measurements pre- and post-surgery. Results: The mean weight loss after surgery was 24.1 kg. Out of the 28 subjects, fifteen (54%) initially had diastolic dysfunction before surgery. Only two had persistent diastolic dysfunction 6 months after surgery. The mean indexed left atrial volume 6 months post-surgery was 27.1 from 32 ml/m2 prior to surgery. The average E/e’ is 11.78 post-surgery from 13.43 pre-surgery. The left ventricular GLS became (-)25.7% after surgery from (-)21.2% prior to surgery. Their post-surgery fasting serum lipid and glucose levels also showed significant improvement. Conclusion Our study reinforced the existing evidence that bariatric surgery significantly improved echocardiographic parameters of diastolic function and left ventricular global longitudinal strain, along with various metabolic profiles.
Bariatric Surgery ; Obesity

The rising prevalence of obesity in Singapore is a harbinger for a corresponding increase in obesity-related complications such as type 2 diabetes mellitus (T2DM) and coronary heart disease. Obesity is a complex disease driven by multiple factors, and hence, treatment cannot follow a 'one-size-fits-all' approach. Lifestyle modifications involving dietary interventions, physical activity and behavioural changes remain the cornerstone of obesity management. However, similar to other chronic diseases such as T2DM and hypertension, lifestyle modifications are often insufficient on their own, hence the importance of other treatment modalities including pharmacotherapy, endoscopic bariatric therapy and metabolic-bariatric surgery. Weight loss medications currently approved in Singapore include phentermine, orlistat, liraglutide and naltrexone-bupropion. In recent years, endoscopic bariatric therapies have evolved as an effective, minimally invasive and durable therapeutic option for obesity. Metabolic-bariatric surgery remains the most effective and durable treatment for patients with severe obesity, with an average weight loss of 25%-30% after one year.
Humans ; Singapore ; Diabetes Mellitus, Type 2 ; Obesity ; Obesity, Morbid ; Bariatric Surgery

Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy characterized by simple operation and few postoperative complications have gradually become the two most commonly used surgical methods in clinical practice.A series of complications often occur after bariatric surgery,including gallstone disease,anemia,malnutrition,gastroesophageal reflux disease,kidney stones,and birth defects in offspring of women of childbearing age.There are controversies regarding the causes and countermeasures of these complications.This article mainly reviews the risk factors and countermeasures for the complications after bariatric surgery.
Humans ; Female ; Bariatric Surgery/methods* ; Gastric Bypass/methods* ; Gastroesophageal Reflux/surgery* ; Postoperative Complications/prevention & control* ; Risk Factors ; Gastrectomy/methods* ; Laparoscopy/methods* ; Obesity, Morbid/surgery* ; Retrospective Studies

Humans ; Diabetes Mellitus, Type 2/surgery* ; Gastrectomy ; Gastric Bypass ; Obesity/surgery* ; Obesity, Morbid/surgery* ; Treatment Outcome ; Laparoscopy ; Retrospective Studies

With the increasing prevalence of obesity and the popularity of bariatric surgery, more and more patients with obesity are undergoing bariatric surgery. "Precision Medicine" is a new generation of medical concepts. We introduce the concept of "precision medicine" into precision bariatric and metabolic surgery, in order to optimize and integrate modern surgical theory and technology with traditional surgical methods under the requirements of high precision and high efficiency standards, so as to achieve minimal trauma and invasion, maximal organ protection, minimal medical cost and best weight loss effect. Chinese Society for Metabolic and Bariatric Surgery (CSMBS) organized some domestic bariatric surgery experts to conduct four relevant problem-oriented and 36 clinically practical problems, including precise preoperative assessment, precise perioperative management, precise surgical operation, and precise postoperative management. Based on domestic and foreign literature evidence and combined with Chinese conditions and clinical experience, CSMBS has formulated a Chinese expert consensus on precision obesity metabolic surgery, aiming to provide guidance for the clinical practice of precision obesity metabolic surgery in our country.
Bariatric Surgery ; China ; Consensus ; Humans ; Obesity/surgery* ; Weight Loss

The quantity of cases of metabolic and obesity-related diseases including obesity and type 2 diabetes in China are increasing each year. The total numbers of both existing patients and new patients each year are rated as the highest in the world. A large amount of evidence-based medical reports have shown that bariatric surgery can effectively reduce excessive body weight in patients with morbid obesity, and alleviate the effects of a series of obesity-related metabolic comorbidities, including type 2 diabetes. Laparoscopic one anastomosis gastric bypass (OAGB) is currently one of the most widely practiced bariatric surgeries procedures in the world. Although this procedure has been carried out on patients in China for more than 15 years, the standard surgical operation for OAGB has not been subject to relevant guidelines or consensus. In light of this, Chinese Society for Metabolic & Bariatric Surgery (CSMBS) recently initiated the compilation of the first edition of the "Procedural guideline for laparoscopic one anastomosis gastric bypass (2022 Edition)", aiming to provide a unified specifications for this procedure. It will provide a reference for surgical operating standards for clinicians in the field of obesity-related metabolic surgery to reduce or avoid complications caused by irregular surgery, and will ultimately benefit more patients.
Bariatric Surgery ; Diabetes Mellitus, Type 2/surgery* ; Gastric Bypass/adverse effects* ; Humans ; Laparoscopy ; Obesity, Morbid/surgery* ; Retrospective Studies

Laparoscopic Roux-en-Y gastric bypass (RYGB) is an important obesity surgery. The risk of remnant gastric cancer after RYGB for obesity is gaining growing attention from bariatric surgeons and patients with obesity. This systematic review included articles from major databases internationally and domestically that specifically described the remnant gastric cancer after RYGB intervention, a total of 21 cases was subsequently analyzed. The average median time from post-operative RYGB to diagnosis of gastric cancer was 11 years (1-28 years), the duration of gastric cancer symptoms lasted 7 days to 6 years, abdominal pain is the most common (71.4%), especially in the upper abdomen (33.3%), followed by nausea and vomiting (33.3%), over-weight loss (33.3%), and abdominal bloating (28.6%), etc. Neoplasm location was reported to occur in the antrum or the pre-pyloric region (71.4%), with adenocarcinoma being the most common tumor histology observed (71.4%), tumor stage III-IV as the most diagnosed, 38.1% of tumor were deemed to be unresectable, 52.4% of the patients performed subtotal gastrectomy and lymphadenectomy. In addition, a global article investigating the occurrence of esophageal gastric cancer after RYGB in 64 cases revealed the common preoperative medical history include smoking habits (37.5%), alcohol issues (14.0%), GERD (86.0%), presence with Barret esophagus (10.9%), patients that has other malignant tumor medical history (6.3%), first-degree relatives (6.3%), or other family members with gastric esophagus cancer family history. Although the incidence of gastric cancer after RYGB is rare, the increasing prevalence of gastric cancer development is one of great concern. A rise in clinical cases of patients treated with RYGB presents a target for future studies. Risk of gastric cancer after RYGB should be evaluated and considered in high-risk cases.
Esophageal Neoplasms/surgery* ; Gastric Bypass/adverse effects* ; Humans ; Laparoscopy ; Obesity/surgery* ; Obesity, Morbid/surgery* ; Stomach Neoplasms/surgery*