Zilong Wu

Background Bariatric surgery (BS) is widely recognized as an effective intervention for obesity and related metabolic diseases; however, bibliometric analyses of the bariatric surgery literature remain scarce. This study aims to identify and analyze the top 100 most cited articles (T100) in BS to map research trends and influential contributions. Method A comprehensive literature search on BS was conducted using the Web of Science Core Collection database. Through keyword searches and subsequent manual screening, the T100 articles were identified. These were then analyzed bibliometrically using software tools such as CiteSpace, VOSviewer, and Bibliometrix, with data organized in Microsoft Excel. Result As of July 2024, the total citation count for the T100 articles reached 110,623. These papers were published between 2000 and 2021, spanning 46 journals, with the New England Journal of Medicine publishing the most articles (n = 13). 60% of the articles were published in the 2010s, and 68% originated from the United States, with Harvard University being the leading institution, contributing 16 papers. Philip R. Schauer and Sjöström Lars authored 7 and 6 papers, respectively. Among the T100 articles, 89 were classified as Level 1 or 2 evidence. The articles related to surgical procedures included 40 on Roux-en-Y gastric bypass (RYGB), 20 on sleeve gastrectomy (SG), and 14 on adjustable gastric banding. Additionally, 36 articles addressed the treatment of related metabolic complications, including 16 on Type 2 Diabetes Mellitus (T2DM), 14 on nonalcoholic fatty liver disease (NAFLD), and 4 on cardiovascular disease. Conclusions This study systematically analyzed the T100 most-cited articles on BS reveals a dominant contribution from the United States, with a focus on RYGB and SG procedures. These studies demonstrate significant efficacy in treating obesity, T2DM, and NAFLD. However, long-term outcomes and complications require further validation through large-scale prospective research.

Aims To compare weight loss and metabolic parameters changes between laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-gastric bypass (LRYGB) in obese patients. Materials and Methods This retrospective study included 824 patients treated with LSG or LRYGB between January 2014 and August 2022 at the First Affiliated Hospital of Jinan University. A 1:1 propensity score matching method was used to compare the LSG and LRYGB groups. Differences in weight loss outcomes, changes in biochemical levels, and differences in nutritional status at 6- and 12- months postoperatively were assessed in different Chinese populations. Results LSG and LRYGB groups each comprised 412 patients. The baseline characteristics of the two groups showed no significant differences. However, patients with type 2 diabetes mellitus (T2DM) who underwent LRYGB exhibited significantly reduced glycated hemoglobin (HbA1c) levels compared to those who had LSG after the 12-month postoperative follow-up. Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) levels are reduced in patients with nonalcoholic fatty liver disease (NAFLD). Alcohol consumption was shown to adversely affect surgical outcomes, with a notable association observed in postoperative weight regain. Females had lower body mass index (BMI) and blood glucose levels 6 months after LSG and lower BMI and blood pressure levels 12 months after LRYGB. Bariatric surgery caused severe nutritional deficiencies, notably affecting vitamin D levels, with over 60% of patients in both groups experiencing insufficiency postoperatively. Conclusions Both LSG and LRYGB surgeries were determined to be safe and efficacious. LSG proved particularly beneficial for patients with NAFLD, while LRYGB was more efficacious for those with T2DM, hypercholesterolemia, and hypertensive women. Graphical Abstract

Background A considerable body of research has established a strong correlation between obstructive sleep apnea (OSA) and bariatric surgery (BS). Despite this, there has been a lack of systematic analysis and visualization of related publications using bibliometric methods. Methods This research employs bibliometric analysis using the Web of Science Core Collection (WoSCC) to explore the OSA-BS connection from January 1998 to June 2024. Following thorough screening, a total of 1,666 articles were included. Software tools like CiteSpace and VOSviewer were employed to examine the connections among countries, authors, journals, institutions, keywords, and citations. Results The analysis identified the USA leading in research output (732 articles, 43.9% of total) and citations (29,600). Prominent authors include Karmali, Shahzeer, Nico de Vries, and Birch, Daniel W, with Shahzeer contributing 20 articles and accumulating 479 citations. Interdisciplinary collaborations spanned anesthesia, respiratory medicine, and nutrition, with Obesity Surgery emerging as the most prolific journal (318 articles, IF = 2.9/Q1). Keyword co-occurrence analysis revealed core themes: “bariatric surgery” (647 occurrences), “obesity” (477), and “obstructive sleep apnea” (222). Notably, sleep apnea (burst strength: 5.97) and airway management (#2 cluster) dominated recent research, highlighting critical challenges in airway management and respiratory support for individuals with obesity and OSA. Conclusions The bibliometric analysis highlights the global importance of research on the OSA-BS connection, particularly in anesthesia management and respiratory safety. The findings provide key insights for advancing the field and emphasize the need for further focus on optimizing surgical outcomes and patient safety.

Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) has become a prevalent chronic liver disease among patients with obesity. Bariatric surgery, such as sleeve gastrectomy (SG), shows promise in improving the unfavorable condition of MAFLD. Transient elastography (TE) can be utilized to assess the extent of steatosis and liver fibrosis, providing a noninvasive method for preoperative prediction and postoperative evaluation of MAFLD. This study aims to investigate the effectiveness of TE in diagnosing MAFLD by evaluating liver steatosis and tissue stiffness, as well as assessing the early impact of SG in the treatment of obesity-associated MAFLD. Methods: In this study, the authors collected preoperative and 6-month postoperative data from patients with obesity who were diagnosed with MAFLD by intraoperative liver biopsy. The patients underwent SG at our hospital between August 2021 and April 2023. The authors estimated the diagnostic accuracy for the steatosis and fibrosis categories using the area under the receiver operating characteristic curve (AUROC). The authors also evaluated the influence of disease prevalence on the positive predictive value and negative predictive value. MAFLD diagnosis was based on the liver steatosis activity and fibrosis scoring system. The authors used univariate and multivariate logistic regression analyses to identify factors contributing to severe MAFLD. To visualize the results, the authors created a nomogram and enhanced it with bootstrap resampling for internal validation. Additionally, the authors plotted receiver operating characteristic and calibration curves. The authors compared preoperative and postoperative data, including general information, laboratory tests, and TE results, to assess the early impact of SG in the treatment of obesity-associated MAFLD. Results: Based on the results of liver biopsy, the AUROC for controlled attenuation parameter (CAP) in identifying steatosis was found to be 0.843 (95% CI: 0.729–0.957) for S≥S1, 0.863 (95% CI: 0.786–0.940) for S≥S2, and 0.872 (95% CI: 0.810–0.934) for S=S3. The Youden limits for S≥S1, S≥S2, and S≥S3 were determined to be 271 dB/m, 292 dB/m, and 301 dB/m, respectively. Similarly, the AUROC for liver stiffness measurement (LSM)/E in detecting liver fibrosis was 0.927 (95% CI: 0.869–0.984) for F≥F2, 0.919 (95% CI: 0.824–0.979) for F≥F3, and 0.949 (95% CI: 0.861–0.982) for F=F4, with Youden cutoff values of 7.5 kPa, 8.3 kPa, and 10.4 kPa, respectively. Patients with A≥3 and/or F≥3 were classified as having severe MAFLD. Multivariate logistic regression analysis identified CAP, E, LDL, and AST as the best diagnostic factors for severe MAFLD, and a nomogram was constructed based on these factors. The AUROC of the nomogram for the assessment of severe MAFLD was 0.824 (95% CI: 0.761–0.887), which was further validated by 1000 bootstrap resamplings with a bootstrap model area under curve of 0.823. Finally, after a 6-month follow-up period, the steatosis grade and fibrosis stage of the patients were graded based on the optimal cutoff values for CAP and LSM. Significant reductions in BMI, waist circumference, HbA1c, fasting glycemia, triglycerides, high density lipoprotein (HDL), glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), gamma glutamyl transpeptidase (GGT), CAP, LSM, steatosis grade, and fibrosis stage were observed compared to the preoperative values. Conclusion: In this prospective study, the authors investigated the use of CAP and LSM as alternatives to liver biopsy for evaluating hepatic steatosis and fibrosis in patients with obesity combined with MAFLD. Furthermore, the authors examined the impact of SG on metabolic indicators and the progression of fatty liver disease during the early postoperative period, and observed significant improvements in both aspects.