الأبحاث والإسهامات الأكاديمية

A single-center controlled study of 86 adults undergoing metabolic and bariatric surgery, comparing usual care with a nurse-led education program supported by an illustrated Arabic booklet. At six months the education group had better eating-behavior scores, and at one month much higher knowledge; weight loss also favored education, but patients were allocated by time period rather than randomly, so randomized trials are needed.

A decade-long analysis of the MBSAQIP registry (2015–2024; 411,155 patients) comparing robotic and laparoscopic Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. Robotic use rose sharply, from 8.6% to 44.0% of bypasses, but it was linked to longer operations and more readmissions for both procedures, without a clear overall 30-day safety advantage. The duodenal switch results were less precise and are considered exploratory.

A PROSPERO-registered systematic review, meta-analysis and network meta-analysis of 17 studies (343,531 surgical patients and about 1.6 million controls) on breast cancer incidence after metabolic and bariatric surgery. Surgery was associated with about a 25% lower breast cancer incidence (HR 0.75), with a clearer effect before menopause. Sleeve gastrectomy and Roux-en-Y gastric bypass both performed better than no surgery, but neither was superior, and the certainty of evidence ranged from very low to moderate.

A retrospective case series of 13 patients (0.9% of 1,450 bypass patients) who underwent laparoscopic reversal to normal anatomy for refractory complications of gastric bypass: severe malnutrition after one-anastomosis gastric bypass, or intractable marginal ulcers or severe dumping after Roux-en-Y gastric bypass. Reversal was safe and resolved every primary complication, with marked recovery of albumin and hemoglobin, but 84.6% of patients returned to a BMI above 30 within a year, underlining the need for careful selection and counseling.

The first longitudinal synthesis of all nine IFSO Global Registry reports (2014–2024). Reported activity grew from about 100,000 operations in 18 countries to nearly 600,000 in 36 countries, and sleeve gastrectomy rose from 22% to 60% of primary procedures while Roux-en-Y gastric bypass fell from 66% to 30%. A FAIR-informed appraisal found modest gains in transparency but limited data interoperability and reuse, and the authors call for harmonized definitions and more complete follow-up.

A worldwide survey of 245 IFSO surgeons in 47 countries mapping how Roux-en-Y gastric bypass is performed in practice. Technique varied widely: only about half routinely measure pouch length, bougie sizes ranged from 28 to 46 Fr, about one in five use ring augmentation, and closure of mesenteric defects was common but not universal. Better reporting of these technical choices is proposed as a basis for future consensus.

A systematic review of 26 reports (34 patients), with a video-illustrated case, on perforation of the excluded stomach or duodenum after Roux-en-Y or one-anastomosis gastric bypass. These events occurred on average about 10 years after surgery, and CT more often showed free fluid than free air. Laparoscopic repair achieved source control in most cases, and early diagnostic laparoscopy is recommended for septic bypass patients with unexplained free fluid.

A case report of a 36-year-old woman whose planned sleeve gastrectomy was aborted because of an incidental gastric lesion that CT and repeated endoscopy could not diagnose. After multidisciplinary review she underwent one-anastomosis gastric bypass with resection of the remnant stomach containing the lesion, which proved to be benign heterotopic pancreas. The case shows how resectional bariatric procedures can provide both weight-loss surgery and a definitive diagnosis.

A systematic review and meta-analysis of 21 studies (848 men) on sexual function, testosterone and semen quality after Roux-en-Y gastric bypass and sleeve gastrectomy. Both operations improved testosterone and sex hormone–binding globulin; erectile function and sperm concentration improved significantly after sleeve gastrectomy but not after bypass. Because the procedures were not compared head to head, the authors call for direct comparative studies.

A comparative cohort study of 94 patients undergoing revisional one-anastomosis gastric bypass after sleeve gastrectomy, with or without a ring. At one year, ring-augmented OAGB achieved greater weight loss (81.7% vs. 61.3% excess weight loss) with similar operative time, hospital stay and early complications. Ring-related problems were uncommon, and one ring was removed for persistent vomiting.

A blinded study in which 93 metabolic and bariatric surgery experts rated answers from ChatGPT-4o, Gemini 2.0 Flash and DeepSeek-V3 to 30 guideline-based clinical questions. DeepSeek-V3 scored highest (2.44 of 3), ahead of ChatGPT-4o (1.79) and Gemini (1.63), with excellent agreement between raters. The findings underline the need for specialty-specific validation before these models are used in clinical care.

A conference abstract, published in Sleep Medicine, on changes in upper airway function and sleep-disordered breathing after laparoscopic sleeve gastrectomy in patients with obesity. The team's full study of upper airway remodeling after sleeve gastrectomy is published in Obesity Surgery.

Three-year results of a randomized controlled trial comparing ring-augmented with standard sleeve gastrectomy in patients with a BMI above 50. The ring produced greater weight loss (48.8% vs. 45.5% total weight loss), less significant weight regain and smaller pouch volumes, with similar complications and reflux, but food tolerance was consistently worse. Two patients needed ring removal.

A commentary on aligning the Lancet Commission's definition of clinical obesity with eligibility for surgery. It argues that BMI alone is not enough and proposes combining biological risk markers, such as the Visceral Adiposity Index, with validated lifestyle-capability measures, so that escalation to surgery reflects both disease burden and the realistic chance that conservative treatment will succeed.

A prospective study of 40 patients with obesity and obstructive sleep apnea assessed with upper-airway MRI and polysomnography before and 12 months after laparoscopic sleeve gastrectomy. Alongside an average weight loss of 43.8 kg, apnea severity and oxygen desaturation fell significantly, the airway widened and tongue volume decreased, and CPAP use dropped from 90% to 22.5%.

An editorial on the ethics of metabolic and bariatric surgery. It argues that "first, do no harm" must be weighed against the harm of withholding effective treatment, and proposes a framework built around primum succurrere ("first, help") alongside traditional ethical principles, with safeguards, careful patient selection and respect for patient autonomy.

A letter on a meta-analysis of long-term randomized trials comparing sleeve gastrectomy with Roux-en-Y gastric bypass. It points out that two included trials used non-standard operations (greater curvature plication and ring-augmented bypass), which adds clinical heterogeneity, and asks the authors to exclude them or run sensitivity analyses.

A letter on a multimedia article proposing routine anterior fixation of the esophagus to the hiatus during hiatal hernia repair at bariatric surgery. It notes that the step is presented as routine without outcome data or objective assessment, such as endoscopy, reflux scores or imaging, and that these are needed before any benefit can be judged.

A preliminary observational series of eight patients without heart disease who developed early sinus bradycardia after laparoscopic sleeve gastrectomy. Heart rate rose briefly after surgery, fell to about 50 beats per minute within 24 hours and took around two weeks to normalize, with no abnormalities on ECG or echocardiography. The authors call for studies of its mechanism and clinical significance.

A multimedia case of a 56-year-old woman with weight regain and vomiting 10 years after open vertical banded gastroplasty, complicated by staple-line dehiscence, a gastro-gastric fistula and mesh. The operation was converted laparoscopically to one-anastomosis gastric bypass below the mesh, guided by a calibration tube. She went home on day 3 and, at 18 months, had a BMI of 25.4 with full symptom resolution.

Proposes the Unified Ergonomic Checklist for Minimally Invasive Surgeries in Obesity (UEC-MISO), which combines posture (RULA), mental workload (NASA-TLX), trocar configuration (PSPOSO) and body-part discomfort into a single ergonomic risk score for the operating surgeon. It responds to high rates of musculoskeletal strain and burnout among bariatric surgeons and calls for validation and adoption by societies such as IFSO and SAGES.

An editorial on the terms "mini", "midi" and "super" sleeve, which appear in the IFSO Atlas but have no formal definition in the literature or guidelines. It argues that these labels describe different calibrations of the same operation, are largely promotional and cause confusion, and calls for standardized reporting of bougie size and antral resection.

A conference abstract, published in the British Journal of Surgery, presenting a meta-analysis of 34 studies (7,173 sleeve gastrectomies) on trocar placement. Port configurations varied widely; operative time was not related to port number or angles, while excess weight loss varied between configurations, suggesting that standardized port placement deserves further study. The full analysis was published as the PSPOSO checklist.

An international survey of 273 Young-IFSO members (surgeons aged 45 or younger) from 49 countries on endoscopy training and practice. Half had endoscopy in their surgical training, yet a third do not perform endoscopy, nearly half lack confidence managing bariatric complications endoscopically, and only about a quarter perform endoscopic bariatric therapies. Dr. Zidan contributed as a collaborative author.

A national survey of 80 Egyptian bariatric surgeons on practice trends and the use of upper endoscopy (EGD). Procedure volumes, especially sleeve gastrectomy and SASI, rose between 2021 and 2023, but only 12.5% performed routine preoperative EGD and 3.8% routine EGD at one year, well below IFSO recommendations, with cost and institutional factors shaping practice.

An editorial asking whether new technologies in metabolic and bariatric surgery, from laparoscopy to robotic platforms and endoscopic therapies, are adopted for patients' benefit or because they fascinate surgeons. It traces how laparoscopy earned its place through better outcomes and argues that newer technologies should be judged by the same patient-centered evidence.

An editorial on routine ultrasound before metabolic and bariatric surgery. Because obesity itself causes gallstones, gallbladder disease found after surgery may have been present beforehand; the authors argue that inconsistent preoperative imaging leads to surgery being blamed for disease it did not cause and drives wide variation in concomitant cholecystectomy.

A letter on a study of liver retraction with long surgical gauze in three-port sleeve gastrectomy. Drawing on their own experience, the authors found that in patients with grade 2 fatty liver the gastroesophageal junction and angle of His could not always be exposed adequately, and suggest standardized preoperative liver assessment before choosing this technique.

A poster abstract presented at IBC Oxford and published in the British Journal of Surgery, reviewing 147 patients after single anastomosis sleeve ileal bipartition (SASI) with two-year follow-up. Lipids fell significantly while iron, ferritin and calcium did not; vitamin D and B12 declined despite supplementation. The authors conclude that a standardized SASI technique with correct supplementation and regular follow-up avoids malnutrition.

A critical letter on a systematic review of incidental GISTs found during bariatric surgery. It highlights methodological flaws, including no PROSPERO registration, a PubMed-only search with an arbitrary date cut-off, and the omission of earlier reviews and existing management frameworks, which the authors argue undermine its conclusions.

An editorial on the lack of consensus about gastric pouch length in Roux-en-Y gastric bypass. Pouch size affects weight loss, marginal ulcers and reflux, yet it is usually described loosely, for example by the number of stapler cartridges used. The authors call for standardized measurement and reporting to support a consensus.

A letter on a meta-analysis comparing SADI and one-anastomosis gastric bypass as revisions after sleeve gastrectomy. It points out that nutritional outcomes, a key concern with both malabsorptive procedures, were not analyzed in detail, and stresses how common-channel and limb lengths influence the risk of deficiencies.

A systematic review and meta-analysis of 34 studies (7,173 sleeve gastrectomies) on trocar number and placement. Port configurations varied widely, with no significant link between port number or manipulation angles and operative time or weight loss. Based on these findings, the authors propose the PSPOSO checklist to standardize how port placement is reported.

An editorial applying Bloom's taxonomy, particularly its psychomotor domain, to bariatric surgery training. It describes a structured progression from observation and closely supervised practice to independent, expert performance, and suggests the framework can guide curriculum design and assessment.

A letter on a report of Guillain-Barré syndrome after sleeve gastrectomy. Noting normal cerebrospinal fluid in one case and a presumptive diagnosis in the other, the authors argue that neuropathy from vitamin B deficiency was not adequately excluded and call for full nutritional assessment in such patients.

A cross-sectional study of 411 patients after bariatric surgery in Egypt, assessing body image, self-esteem, quality of life and satisfaction with validated questionnaires. Most had sleeve gastrectomy; scores were generally average, weight loss did not differ significantly between procedures, and body image scores fell after the second postoperative year while self-esteem rose with time since surgery.

An editorial on preserving the experience of pioneering bariatric surgeons as the field adopts new technology and artificial intelligence. Drawing on Newton's "shoulders of giants", it argues that senior surgeons' practical skills and judgment should be documented and passed on while they are still active, rather than recognized only in memorials.

An editorial proposing a new parametric classification of metabolic and bariatric procedures to replace the traditional restrictive, malabsorptive and hybrid categories. Building on the authors' earlier anatomical classification, it divides operations into resectional and non-resectional procedures and describes them by anatomical variables to allow more systematic comparison.

An editorial on medical malpractice stress syndrome among bariatric surgeons, who can become "second victims" of complications and legal claims. It discusses the psychological toll, the difficulty of distinguishing errors from recognized complications, and the importance of legal and mental-health support.

A letter on a systematic review of magnetic sphincter augmentation for reflux after sleeve gastrectomy. It highlights the small, retrospective and mainly US-based studies, a median two-year follow-up too short to detect erosion or migration, the lack of objective reflux testing, and the exclusion of patients with a BMI above 35.

A letter supporting a discharge planning safety checklist for patients who travel abroad for bariatric surgery. The authors endorse the checklist and suggest additions, including structured follow-up at 3, 6 and 12 months and yearly afterwards, documentation of allergies, chronic conditions and medications, and nutrition tracking.

An editorial asking whether a Meckel's diverticulum found incidentally during bariatric surgery should be removed. Drawing on complications reported after bariatric procedures and an illustrative case, it raises the question as a hypothesis for future research and consensus within IFSO.

A letter on a study of a single-fire stapler (Titan) in sleeve gastrectomy. While acknowledging the reported shorter operations and fewer readmissions, it notes that comparing different time periods and mixing laparoscopic with robotic cases may bias the results through surgeons' learning curves.

A letter on a study of intrathoracic sleeve migration after sleeve gastrectomy with gastropexy. It acknowledges the study's size and analysis but questions its retrospective design, incomplete baseline reflux data and possible masking of symptoms by acid-suppressing drugs, and notes that "sleeve migration" has no standard definition.

A letter on a study comparing endoscopic and operative findings of hiatal hernia during sleeve gastrectomy. It discusses the role of preoperative endoscopy, citing IFSO recommendations and evidence that about a quarter of patients without symptoms have findings that can change surgical management.

A letter on a systematic review of remnant gastrectomy with gastric bypass. It links those findings to the authors' own work on incidental gastric GISTs and promotes their classification of bariatric operations into resectional and non-resectional procedures, particularly in the context of reducing gastrointestinal cancer risk.

A letter responding to a single-center report of high malnutrition rates after single anastomosis sleeve ileal (SASI) bypass. It reviews the evidence that SASI is effective for weight loss and metabolic disease, and argues that conflicting malnutrition findings reflect variation in how the operation is performed, calling for standardization and further research.

A single-team experience combined with a systematic review of incidental gastric GISTs found during bariatric surgery, which occur in about 0.7% of cases. The authors propose a treatment strategy and a new classification of bariatric procedures into resectional and non-resectional operations to guide decisions when a GIST is found.

A brief report of an iatrogenic chyle duct injury recognized during laparoscopic sleeve gastrectomy. The injury was identified and ligated during the operation, preventing postoperative chylous ascites.