Noah Jacob Switzer

Laparoscopic sleeve gastrectomy (LSG) and pyloroplasty have been identified as treatment options for gastroparesis refractory to dietary, medical, gastric electrical stimulation, and advanced endoscopic therapies (ie, gastric peroral endoscopic myotomy). This case outlines the management of refractory idiopathic gastroparesis in a 62-year-old man who underwent LSG and pyloroplasty with successful improvements in patient-reported symptoms, gastric emptying rate, and weight gain. This is the first reported case of combined LSG and pyloroplasty being used to treat refractory gastroparesis in a Canadian center and adds to a growing body of evidence that LSG and pyloroplasty can be efficacious for refractory gastroparesis.

Introduction: The role of Collis gastroplasty has traditionally been reserved for patients with a shortened esophagus due to chronic gastroesophageal reflux disease (GERD). However, its necessity has been questioned, leading to a decline in popularity. This systematic review and meta-analysis aimed to evaluate the efficacy of hiatal hernia repair with fundoplication, with versus without Collis gastroplasty. Methods: A systematic search of Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and the Cochrane Library (via Wiley) was performed in May 2025. Studies were included if they compared outcomes or the safety profile of Collis gastroplasty versus no Collis gastroplasty during fundoplication for hiatal hernia repair. Meta-analyses were conducted using a random-effects model and restricted maximum likelihood. Results: Of 664 unique results, 17 studies comprising 4048 patients were included. There was a female predominance (65.4%), with a weighted mean age of 58.9 ± 14.0 years and follow-up of 43.5 ± 43.1 months. Patients who underwent Collis gastroplasty represented 35.8% of the cohort. Nissen fundoplication was the most common procedure in both the Collis (91.9%) and non-Collis (84.5%) groups. Most studies had selection bias, in which only patients who did not have sufficient intraoperative intra-abdominal esophageal length underwent Collis gastroplasty. Recurrence rates were similar (13.5% vs. 13.2%). Collis gastroplasty was not associated with a reduction in hiatal hernia recurrence (OR 0.53, 95% CI 0.23–1.22). Symptom outcomes, including regurgitation (OR 0.53, 95% CI 0.05–5.39), reflux (OR 0.81, 95% CI 0.03–22.12), dysphagia (OR 1.12, 95% CI 0.62–2.04), and use of antireflux medication on follow-up (OR 1.15, 95% CI 0.62–2.15), were not significantly different. However, Collis gastroplasty was associated with a higher risk of complications, including overall complications (OR 2.63, 95% CI 1.55–4.46), leak (OR 3.35, 95% CI 1.11–10.05), and surgical site infection (OR 8.28, 95% CI 1.16–59.10). There were no significant differences in abscess formation (OR 5.97, 95% CI 0.77–46.49), length of stay (mean difference 0.36 days, 95% CI −0.30 to 1.01), readmission (OR 1.13, 95% CI 0.36–3.60), reoperation (OR 1.24, 95% CI 0.64–2.41), or mortality (OR 1.08, 95% CI 0.45–2.57). Conclusions: Collis gastroplasty was not associated with a decreased risk of hiatal hernia recurrence or improvement in other efficacy measures, but this is in the context of a strong component of selection bias. In this context, there may be a role for Collis gastroplasty in difficult cases if the rate of recurrence does not differ from those with sufficient length, but this must be balanced against a significantly increased risk of complications.

Introduction Bariatric surgery is primarily performed using minimally invasive techniques. Intraoperative conversion to open is associated with increased complications. This study aimed to provide a contemporary overview of frequency of conversion to open, compare complication rates and determine factors associated with conversion. Methods The MBSAQIP database from 2020 to 2022 was analyzed to identify two cohorts; those who underwent a minimally invasive approach and those who required conversion to open. Patients undergoing primary sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS) and single anastomosis duodenal-ileal bypass (SADI) were included. Univariate analysis was performed to characterize differences and assess for rate of complications between cohorts. Multivariate logistic regression was performed to determine factors associated with conversion and 30-day serious complications. Results A total of 524 224 patients were identified of which 181 (0.03%) required conversion to open. Factors associated with increased risk of conversion to open included age, BMI, lower albumin, sleep apnea, undergoing RYBG or BPD-DS (vs. SG) and previous foregut surgery. Patients converted were more likely to have 30-day reoperation, reintervention, or readmission on bivariate analysis. Conversion to open was also an independent predictor of serious complications on multivariate analysis. Conclusion Conversion to open in bariatric surgery is rare but associated with significant increased risk of postoperative complications. Patients at increased risk may benefit from preoperative risk mitigation, such as those undergoing BPD-DS or RYGB, with sleep apnea, or with a history of previous foregut surgery.

Background: Drains are often placed during bariatric procedures; however, their use in conversional or revisional bariatric surgery (CRBS) has not been thoroughly explored. Our study sought to identify the frequency of drain placement in CRBS, and characterize factors associated with drain placement and their influence on 30-day serious complications. Methods: Patients undergoing CRBS between 2020 and 2022 were included from the MBSAQIP database. Patients were placed into drain placed (DP) versus no drain (ND) cohorts and baseline characteristics and complication rate were compared. Multivariable logistic regression models were used to identify independent predictors of drain placement and complications. Results: of 64,495 included patients, drains were placed in 19.1% in 2020; this was down to 14.4% in 2022. Drain placement was associated with increased risk of multiple complications such as hemorrhage, readmission, surgical site infection, and gastrointestinal bleeding. On multivariate analysis, drain placement was an independent predictor of serious complications (aOR 1.45, p < 0.001), anastomotic leak (aOR 2.25, p < 0.001), organ space infection (aOR 2.12, p < 0.001), and reoperation (aOR 1.37, p < 0.001), as well as excess LOS (aOR 2.06, p < 0.001). Predictors of drain placement include older age, higher BMI, smoking status, history of venous thromboembolism, and procedural factors, such as undergoing non-sleeve revisional surgery or having an intraoperative leak test. Conclusions: Drain placement during CRBS surgical procedures is common and more likely in higher risk patients and anastomotic revisional procedures. Though the reasons for drain placement were not available, these data suggest that surgeons should be judicious in selecting patients for drain placement due to its association with increased LOS and postoperative morbidity in CRBS.

Background Prophylactic drain use during primary bariatric surgeries continues despite previous literature cautioning against their routine use. Modern drain utilization and associated outcomes remain largely poorly studied which limits selective utilization and perhaps may lead to excess morbidity and healthcare resource utilization. This study aimed to reassess current trends of drain use in primary bariatric procedures, factors driving surgeons to place drains, and patient outcomes associated with drain placement. Methods Patients undergoing the most common primary bariatric surgery operations from 2020 to 2022 were included using the Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) database. Two cohorts were created, a drain placed (DP) cohort and no drain (ND) cohort, which were then compared in terms of baseline characteristics, rates of complications, and length of stay. Multivariate modeling was performed to assess the effect of drains on various complications and factors associated with drain placement. Results Of 526,723 included patients, drain utilization decreased across operative years (8.7% in 2020 to 6.1% in 2022, p < 0.001). Factors associated with drain placement in multivariate models included older age, higher BMI, partially dependent functional status, renal insufficiency, venous thromboembolism, hypoalbuminemia, and non-sleeve anastomotic procedures. Drain placement was associated with increased risk of numerous complications on bivariate analysis, which was still significant in multivariate analysis, including 30-day serious complications (adjusted odds ratio [aOR] 1.24, p < 0.001), anastomotic leak (aOR 2.1, p < 0.001), organ space infection (aOR 2.0, p < 0.001), reoperation (aOR 1.2, p = 0.036), and excess length of stay (LOS, aOR 1.45, p < 0.001). Conclusions The frequency of prophylactic drain placement during primary bariatric surgical procedures has decreased in recent years and patients with drain placement seem to have increased 30-day morbidity, including longer length of stay. Independent predictors of drain placement include increased age and metabolic burden along with anastomotic procedures. Surgeons should be judicious in selecting patients for drain placement and future prospective, controlled studies may better answer drain placement association with complications.

Background: The use of a single anastomosis duodeno-ileal bypass (SADI) as a revisional procedure in patients with pre-operative GERD is not well understood. Thirty-day outcomes in patients with pre-existing GERD undergoing revision with an SADI have not been previously reported. Methods: The Metabolic and Bariatric Accreditation and Quality Improvement Program registry was consulted to identify patients undergoing revisional bariatric surgery with an SADI between 2020 and 2021. Our analysis sought to determine if preoperative GERD had significant impact on thirty-day outcomes. Bivariate and multivariable logistic regression analyses were used to identify independent predictors of 30-day morbidity. Results: Preoperative GERD was seen in 342 patients (36.7%). Preoperative GERD was not associated with anastomotic leak (2.5% non-GERD cohort vs. 1.2% GERD cohort; p = 0.2) nor bleeding (1% non-GERD cohort vs. 1.8% GERD cohort; p = 0.33). There was no difference in thirty-day readmission (5.6% vs. 5.9%, p = 0.9), reintervention (2.4% vs. 1.2%, p = 0.2), or reoperation (3.6% vs. 2.05%; p = 0.19) rates. The multivariable regression analysis revealed that a history of myocardial infarction was associated with a significantly elevated risk of serious complication (OR 12.2; 95% CI 2.79–53.23; p = 0.001), as was dyslipidemia (OR 2.2; 95% CI 1.04–4.56; p = 0.04). Conclusions: Pre-operative GERD does not have any association with anastomotic leak, bleeding, thirty-day readmission, reintervention, or reoperation in patients undergoing revisional bariatric surgery to SADI. A history of myocardial infarction and dyslipidemia are independent predictors of post-operative thirty-day morbidity, irrespective of the presence of preoperative GERD.

Background: The adoption of robotic bariatric surgery has increased dramatically over the last decade. While outcomes comparing bariatric and laparoscopic approaches are debated, little is known about patient factors responsible for the growing delivery of robotic surgery. A better understanding of these factors will help guide the planning of bariatric delivery and resource allocation. Methods: Data were extracted from the MBSAQIP registry from 2020 to 2021. The patient population was organized into primary robot-assisted sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) versus those who underwent laparoscopic procedures. Bivariate analysis and multivariable logistic regression modeling were conducted to characterize cohort differences and identify independent patient predictors of robotic selection. Results: Of 318,151, 65,951 (20.7%) underwent robot-assisted surgery. Patients undergoing robotic procedures were older (43.4 ± 11.8 vs. 43.1 ± 11.8; p < 0.001) and had higher body mass index (BMI; 45.4 ± 7.9 vs. 45.0 ± 7.6; p < 0.001). Robotic cases had higher rates of medical comorbidities, including sleep apnea, hyperlipidemia, gastroesophageal reflux disease (GERD), and diabetes mellitus. Robotic cases were more likely to undergo RYGB (27.4% vs. 26.4%; p < 0.001). Robotic patients had higher rates of numerous complications, including bleed, reoperation, and reintervention, resulting in higher serious complication rates on multivariate analysis. Independent predictors of robotic selection included increased BMI (aOR 1.02), female sex (aOR 1.04), GERD (aOR 1.12), metabolic dysfunction, RYGB (aOR 1.08), black racial status (aOR 1.11), and lower albumin (aOR 0.84). Conclusions: After adjusting for comorbidities, patients with greater metabolic comorbidities, black racial status, and those undergoing RYGB were more likely to receive robotic surgery. A more comprehensive understanding of patient factors fueling the adoption of robotic delivery, as well as those expected to benefit most, is needed to better guide healthcare resources as the landscape of bariatric surgery continues to evolve.

Purpose Small bowel obstruction (SBO) after bariatric surgery is an uncommon but important complication. We sought to characterize bariatric surgery patients who developed SBO, to compare 30-day complications, and to determine the influence of patient and procedure factors on the development of SBO. Methods and Materials All data was extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database using the 2020 operative year. Multivariable logistic regression modelling was used to determine the influence of patient and operative factors on the development of SBO. Results Of a total of 142 111 patients, 408 (0.3%) were identified as having developed an SBO. SBO patients were older (45.7 ± 11.5 vs. 43.5 ± 11.9 years; p = 0.0002), of reduced BMI (43.6 ± 6.8 vs. 45.1 ± 7.7; p = 0.0001), and more likely to be of female sex (92.2% vs. 81.1%; p < 0.0001). At 30 days post-operation, serious complications were increased in SBO patients. Roux-en-Y gastric bypass (RYGB) was the largest independent predicator of the development of SBO (OR 11.91; 95% CI 8.92–15.90; p < 0.0001). With regard to patient factors, COPD (OR 2.60; 95% CI 1.54–4.38; p < 0.0001) and prior DVT (OR 2.37; 95% CI 1.49–3.77; p < 0.0001) were found to be independently predictive of the development of SBO. Additionally having a lower BMI and being of female sex were found to be independently predictive. Conclusion SBO occurred in approximately 0.3% of MBSAQIP cases. SBO is associated with serious outcome measures and patients of female sex and reduced index BMI, and those undergoing RYGB may be at an increased risk. Graphical Abstract

COVID-19 resulted in dramatic changes to the delivery of bariatric surgery; however, the lasting effect on current and future delivery remains uncharacterized. We sought to characterize differences and trends in bariatric surgery care and outcomes between 2020 and 2021. The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) collects data from 902 centers in North America. The MBSAQIP database was evaluated, including patients undergoing sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) with two cohorts described: those receiving surgery in 2020 and those in 2021. Patient selection, operative techniques, and outcomes were compared using bivariate analysis. Multivariable modelling evaluated factors including operative year, independently associated with serious complications and mortality. We evaluated 349,209 patients, with 154,960 (44.4% undergoing bariatric surgery during 2020 compared to 194,249 (55.6%) in 2021. This represents a 20.2% year-to-year increase in total cases, and a 20.7% increase in cases per center (178.5 cases/center in 2020 vs. 215.4 cases/center in 2021). Patients receiving bariatric surgery during 2021 were statistically younger with fewer comorbidities compared to 2020; however, differences were small and groups appeared clinically similar. Length of stay continued to decrease (1.4 ± 1.1 days 2020 vs. 1.3 ± 1.2 days 2021, p < 0.001), yet post-operative outcomes remained similar. Bariatric surgical volumes have increased but may still remain inadequate to meet demand, while trends towards selecting younger, healthier patients for bariatric surgery continue. Efforts to recover from the effects of COVID-19 are ongoing, and long-term evaluation of outcomes following these changes will remain important.