Adrian T. Billeter

Background: Social media is an important source of health information for patients considering metabolic and bariatric surgery (MBS), but the quality of this information remains unclear. We assessed the quality of MBS-related videos on TikTok, Instagram, and Facebook. Methods: This cross-sectional study evaluated English-language videos identified between October and December 2025 using four MBS-related hashtags. Two MBS-experienced reviewers independently assessed video quality using the validated DISCERN and Principles for Health-related Information on Social Media (PRHISM) instruments. Video characteristics, creator type, and engagement metrics were recorded and compared across platforms and creator groups. Results: Of 116 included videos, 55 were from TikTok, 28 from Instagram and 33 from Facebook. Overall information quality was low to moderate. Instagram had the highest DISCERN and PRHISM scores, followed by Facebook, while TikTok had the lowest. In unadjusted analyses, DISCERN scores were significantly lower on TikTok than Instagram, while PRHISM scores were significantly lower on TikTok than both Instagram and Facebook. Healthcare professionals produced videos with significantly higher DISCERN scores than non-medical creators (34.05 ± 6.63 vs 25.66 ± 5.77; p < 0.001) and higher PRHISM scores (49.14 ± 9.16 vs 31.53 ± 7.83; p < 0.001). However, non-medical creators received significantly more likes and shares. Greater engagement was associated with lower information quality in unadjusted analyses, but these associations were attenuated after adjustment for platform and creator type. Conclusion: The quality of MBS-related information in the sampled social-media videos was low to moderate. Although TikTok showed lower information-quality scores than Instagram and Facebook in unadjusted analyses, the platform difference in DISCERN scores was attenuated after adjustment for creator type. Healthcare professionals provided higher-quality content but received less engagement, highlighting the need for accurate, accessible, and engaging evidence-based MBS information on social media.

Objective: To evaluate the institutional learning curve of robotic liver resection (RLR), its association with surgical complexity and outcomes in an international multicenter cohort. Summary of Background Data: RLR is increasingly adopted worldwide, but the dynamics of the learning process and its impact on surgical outcomes remain poorly defined. Methods: This international, multicenter, retrospective cohort study included consecutive patients who underwent RLR between 06/2013 and 12/2024 across 22 expert centers. Based on the first 150 cases at each center, three phases were used to define the learning curve: operative time for competency, major complications for proficiency, and textbook outcome for mastery. Risk-adjusted generalized additive models were used to assess the learning process. Benchmark performance was compared to international reference values. Results: Among 2,331 patients, the most common indications were hepatocellular carcinoma (36%), benign lesions (23%) and colorectal liver metastases (21%). Operative time decreased after achieving competency (case #62), from 240 to 220 minutes ( P P =0.144), while progression to mastery (cases #139–150) was associated with a higher rate of textbook outcome (76% vs. 87%, P =0.021). In contrast, conversion (5.1% vs. 4.9% vs. 2%), bile leak (4.0% vs. 5.3% vs. 3.8%), and 90-day mortality (0.7% vs. 0.9% vs. 0.9%) remained low and stable across all learning phases. Importantly, benchmark criteria for operative time, hospital stay, and textbook outcome were met across all complexity groups, including during the early learning phase. Conclusions: Robotic liver surgery shows progressive outcome improvement with early achievement of benchmark-level results and stable performance across increasing complexity. These findings indicate that, in experienced centers, RLR can be safely implemented and integrated into clinical practice, supporting its key role in modern hepatobiliary surgery.

Background: Roux-en-Y gastric bypass (RYGB) is an effective treatment for type 2 diabetes (T2D), but the physiological mechanisms underlying sustained improvements in glycemic control remain incompletely understood. Objective: To descriptively compare short- and long-term changes in glycemic control and insulin secretion dynamics following RYGB or best medical care (BMC) using an intravenous glucagon stimulation test (GST) in patients with non-severe obesity (BMI 2 ) and insulin-treated T2D. Methods: Thirty-five patients with long-standing insulin-dependent T2D were enrolled from two prospective studies and received either BMC or RYGB. GST was performed at baseline and repeated after 3, 6, 12 and 24 months. Changes in glucose, insulin, and C-peptide responses were analyzed. Exploratory indices derived from the GST were used to assess longitudinal within-subject changes. Results: Diabetes remission occurred in 10% of patients in the RYGB group versus 0% in the BMC group. Insulin therapy was discontinued in 73% versus 33%, while oral antidiabetic medication was discontinued in 33% vs. 0%. After 24 months HbA1c, BMI and use of antidiabetic medication were lower in the RYGB group. Insulin secretion rapidly decreased and remained lower over 24 months after RYGB, while C-peptide responses were largely stable and glycemic control improved. Exploratory GST-derived indices increased after RYGB but not after BMC. Conclusion: In this descriptive and exploratory analysis, RYGB was associated with changes consistent with improved metabolic efficiency, reflected by enhanced glycemic control and reduced insulin secretion requirements under intravenous stimulation testing conditions. These findings are hypothesis-generating and warrant confirmation in larger, methodologically controlled studies.

Introduction The influence of metabolic bariatric surgery (MBS) on renal damage remains poorly understood. Data on the impact of different types of MBS on renal markers is limited. This study analyzes the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on traditional (urinary albumin-creatinine ratio (uACR), estimated glomerular filtration rate (eGFR)) and new markers (serum uromodulin (sUMOD), serum kidney injury molecule-1 (sKIM-1)) of kidney function in a retrospective cohort of patients with nephropathy. Methods 50 patients (RYGB n = 25; SG n = 25) with renal involvement, defined as microalbuminuria (uACR > 3 mg/mmol) and/or reduced eGFR (< 60 ml/min) were included. Patients were matched for sex, age, body mass index (BMI) and glycemic control. Kidney function was assessed using creatinine, cystatin C, eGFR, uACR, sUMOD and sKIM-1. Results After a mean follow-up of 28.8 ± 6.1 months, renal involvement completely resolved in 48% after SG (p<.001) compared to 68% after RYGB (p<.001). UACR decreased after both procedures (SG -9.9 ± 23.2 mg/mmol, p=.002; RYGB − 14.4 ± 28.9 mg/mmol, p<.001) without a difference between procedures (p=.923). SUMOD and sKIM-1 improved significantly after SG (p=.025, p=.028). Conclusions In this study, MBS was associated with improved nephropathy outcomes, independent of the type of procedure performed. SUMOD emerges as a promising biomarker to predict renal recovery.

Aims: Type 2 diabetes (T2D) is characterized by its clinical heterogeneity. Newly described T2D subphenotypes, each with distinct metabolic and co‐morbidity risk profiles, may enable a more personalized care. This study examined whether these subphenotypes can predict outcomes in patients undergoing metabolic and bariatric surgery (MBS). Materials and Methods: A total of 233 people with T2D from four clinical centres undergoing MBS were retrospectively assigned to T2D subphenotypes based on the Ahlqvist methodology. The primary outcome was T2D remission at 2 years; secondary outcomes included changes in HOMA2‐%B, HOMA2‐IR, and total body weight loss (%TWL). Intraoperative liver biopsies were evaluated for metabolic dysfunction‐associated steatotic liver disease (MASLD) and steatohepatitis (MASH). Results: All participants were classified as mild obesity‐related diabetes (MOD) (62.2%), severe insulin‐resistant diabetes (SIRD) (19.7%), or SIDD (18.1%). At 2 years, diabetes remission was lower in severe insulin‐deficient diabetes (SIDD) (36.7%) than MOD (79.3%) and SIRD (97.2%; p < 0.001). SIDD had lower BMI (38.3 vs. 45.2 and 43.2 kg/m ² ; p < 0.001) and worse beta‐cell function (HOMA2‐%B, 92.4 vs. 131.5 vs. 164; p = 0.010), with highest HOMA2‐IR in SIRD (6.0 ± 3.4 vs. 4.4 ± 2.8 vs. 3.6 ± 1.9; p < 0.001). %TWL was similar across subphenotypes. SIDD showed higher baseline MASH prevalence (60.5% vs. 46.3% vs. 46.3%). Conclusion: T2D subphenotypes respond differently to T2D remission after MBS with SIDD showing a significantly lower remission rate than MOD and SIRD at 2 years. Considering metabolic status in treatment decisions may improve patient outcomes.

Background: Obesity, a chronic disease with serious associated medical problems, remains a global health challenge. While metabolic bariatric surgery (MBS) is the most effective treatment for weight loss, GLP-1 receptor agonists (RAs) are emerging as promising alternatives or adjuncts. This study evaluates the impact of preoperative GLP-1 therapy on weight loss and obesity-related complications over three years and explores reasons for transitioning to surgery. Methods: Patients who underwent RYGB or SG from 2015–2021 were retrospectively analyzed, excluding those with revision and conversion surgeries, postoperative GLP-1 use, or pregnancy during follow-up. Propensity score matching (1:1) was used to adjust for confounders. The primary outcome was a combined endpoint of the SF-Bari Score, incorporating weight loss, improvement of obesity-related conditions, and surgical complications until 36 months post-surgery. Results: A total of 215 patients were analyzed, including 54 who received GLP-1 RAs prior to surgery, with a preoperative total body weight loss (%TWL) of 3.7 ± 4.3%. %TWL did not differ significantly between groups: at 12 months, 29.8 ± 7.7% (non-GLP-1) vs. 28.1 ± 7.6% (GLP-1); at 24 months, 28.9 ± 8.2% vs. 27.2 ± 8.4%; and at 36 months, 26.9 ± 9.1% vs. 25.4 ± 9.1%. SF-Bari Scores were similar between groups at all timepoints: 96.0 ± 24.2 vs. 93.5 ± 26.3 at 12 months, 93.8 ± 24.4 vs. 91.0 ± 25.6 at 24 months, and 89.1 ± 24.7 vs. 85.5 ± 25.8 at 36 months (non-GLP-1 vs. GLP-1). Propensity score matching confirmed comparable outcomes between groups. Patients transitioned to surgery for definitive treatment, side effects, or medication unavailability. Conclusion: Among patients who proceeded to surgery after GLP-1 therapy, prior GLP-1 use was not associated with different surgical outcomes.

Background: Postoperative outcomes after metabolic and bariatric (MBS) can vary due to preoperative behaviors and psychological factors, with several eating patterns (EPs), including eating disorders (EDs), often associated with suboptimal weight loss. Some guidelines even consider EDs a contraindication for MBS. This study examined the impact of EPs on long-term outcomes after MBS. Methods: A retrospective analysis was conducted on prospectively collected data from 1550 patients who underwent primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2010 and 2018. Patients were categorized based on preoperative EPs, including binge eating disorder (BED), snacking behavior (SB), sweet eating habit (SEH), fat eating habit (FEH), night eating syndrome (NES), excessive eating habit (EEH), or no present EP. Demographics, morbidity, weight loss, comorbidities, and complications were assessed over 5 years. Outcomes were measured using the SF-BARI score. Results: EPs were common (67.6%), with many patients exhibiting multiple patterns. Patients with EPs were younger (40.8 vs. 43.3 years; p < 0.01) and had higher baseline BMI (44.5 vs. 43.8 kg/m²; p = 0.046) compared to patients with no EP. They showed slightly higher % total weight loss (%TWL) in the first year (31.9% vs. 30.6%; p < 0.01), but differences diminished over time. At 5 years, SF-BARI scores remained slightly higher in the EP group (84.2 vs. 79.1; p = 0.046). RYGB was performed more frequently (69.9%) and yielded better outcomes than SG. Conclusion: Preoperative EPs, including EDs, do not significantly impact postoperative outcomes after MBS, suggesting a need to reassess guidelines on EDs as contraindications

Objective: The aim of this study was to identify risk factors for conversion and assess its consequences on clinical outcomes after robotic distal pancreatectomy (RPD). Summary of Background Data: RDP has gained popularity due to its lower conversion rate (3–8%) when compared to laparoscopic distal pancreatectomy (10–20%). Methods: This retrospective multicenter study included RDPs performed at 16 international centers from May 2007 to March 2024. Perioperative outcomes of patients requiring conversion were compared to fully robotic RDP patients. Risk factors for conversion were identified by multivariable logistic regression analysis. Results: Of 2,452 patients undergoing RDP, 75 (3.1%) required conversion to open surgery. In converted RDPs, operative time was longer (300 (243–376) vs. 180 (120–240) minutes; PPP=0.017), major complications (41% vs. 25%; PPPP51 mm; OR 2.86 (95% CI 1.56–5.08)), BMI (>28 kg/m²; OR 3.03 (1.75–5.30)), previous abdominal surgery (OR 2.48 (1.31–4.51)), patients outside benchmark criteria (OR 2.09 (1.19–3.72)), and age (>62 years; OR 2.21 (1.24–4.05)) were associated with conversion. Conclusion: This international cohort study confirmed a very low conversion rate for RDP. Yet, converted cases experienced substantially impaired postoperative outcomes, highlighting the need for adequate patient selection through validated difficulty scoring systems.