Obesity is considered a risk factor for different types of cancer, including colorectal cancer (CRC). Bariatric surgery has been associated with improvements in obesity-related co-morbidities and reductions in overall cancer risk. However, given the contradictory outcomes of several cohort studies, the impact of bariatric surgery on CRC risk appears controversial. Furthermore, measurement of CRC biomarkers following Roux-en-Y gastric bypass (RYGB) has revealed hyperproliferation and increased pro-inflammatory gene expression in the rectal mucosa. The proposed mechanisms leading to increased CRC risk are alterations of the gut microbiota and exposure of the colorectum to high concentrations of bile acids, both of which are caused by RYGB-induced anatomical rearrangements. Studies in animals and humans have highlighted the similarities between RYGB-induced microbial profiles and the gut microbiota documented in CRC. Microbial alterations common to post-RYGB cases and CRC include the enrichment of pro-inflammatory microbes and reduction in butyrate-producing bacteria. Lower concentrations of butyrate following RYGB may also contribute to an increased risk of CRC, given the anti-inflammatory and anticarcinogenic properties of this molecule. Laparoscopic sleeve gastrectomy appears to have a more moderate impact than RYGB; however, relatively few animal and human studies have investigated its effects on CRC risk. Moreover, evidence regarding the impact of anastomosis gastric bypass on one is even more limited. Therefore, further studies are required to establish whether the potential increase in CRC risk is restricted to RYGB or may also be associated with other bariatric procedures.

Background/Objectives: In metabolic bariatric surgery, structured follow-up protocols may play an essential role in achieving optimal patient outcomes. This study aims to report postoperative biochemical outcomes in a cohort of post-bariatric patients who underwent a structured follow-up protocol. Methods: This retrospective study included patients who underwent metabolic bariatric surgery and completed a one-year follow-up at Cannizaro Hospital from October 2022 to May 2024. Anthropometric, clinical, and laboratory data were collected for each patient at five different timepoints: baseline, 1, 3, 6, and 12 months post-surgery. All data were organized into a database and analyzed through descriptive statistics. Results: The study cohort (n = 80) showed a follow-up adherence equal to 97.5%. The mean value of BMI decreased from 42 to 27 one year after surgery. Lipid profiles improved, with significant reduction in total cholesterol and triglycerides and increase in HDL levels; LDL levels decreased initially but at one year returned to baseline. Thyroid hormones TSH and fT3 decreased significantly, while fT4 remained stable. A reduction in hepatic inflammation was observed, as evidenced by the decrease in GGT and transaminase levels. Pancreatic enzymes showed an initial increase but stabilized at the subsequent timepoints. Glycemic control improved, with statistically significant reductions in insulin, HbA1c, and glucose levels, and complete remission of type 2 diabetes mellitus in affected patients. Conclusions: This study shows significant weight loss and improved health outcomes in post-bariatric patients who underwent a structured follow-up protocol, suggesting the potential benefits of metabolic bariatric surgery.

Background: Obesity is an escalating concern in our society. Bariatric surgery appears to be the only feasible alternative for severe obesity. This study aims to conduct an integrative analysis of the Italian context concerning bariatric surgery, with a specific focus on the surgical procedures of sleeve gastrectomy, mini-gastric bypass, and gastric bypass. Methods: The analysis is based on bibliometric data extracted from the Scopus database to find Italian publications in this field from 2012 to 2022. Along with scientific interest, it is essential to assess the level of public interest in these topics. Google Trends is the most extensively utilized free tool for the analysis of online behavior. Using Google Trends data, we analyzed the amount of internet volume searches (Relative Search Volume = RSV) for the Italian terms “sleeve gastrectomy”, “mini-gastric bypass” and “gastric bypass”, both temporally (from 2012 to 2022 years) and geographically. Furthermore, to illustrate the Italian landscape, we compared Google Trends data with data from the Italian registry “Società Italiana di Chirurgia dell’Obesità e delle malattie metaboliche” (SICOB), which includes information about bariatric surgery procedures performed in the country. Results: Over the past decade, there has been a significant increase in the scientific literature on sleeve gastrectomy, mini-gastric bypass, and gastric bypass surgeries in Italy. Google Trends data has shown an increase in online public interest in these surgical procedures, from 2012 to 2022. The examination of the Google Trends information combined with the SICOB data demonstrated a remarkable association between the two data sets. Conclusions: Bariatric surgery has increased quickly in Italy in terms of scientific research and surgical interventions. The analysis of Google Trends data in conjunction with data from SICOB has revealed an interesting correlation between the two datasets therefore, Google Trends can be useful for estimating the demand for bariatric surgical procedures.

Laparoscopic cholecystectomy is now established as the worldwide gold standard for the treatment of benign gallbladder disease. Despite technical advancements, bile duct injury (BDI) remains a major concern, especially in patients with obesity. It is well known that in patients with a Body Mass Index (BMI) ≥ 30 kg/m², identification of Calot’s triangle and the achievement of the Critical View of Safety (CVS) during laparoscopic cholecystectomy (LC) are made more challenging due to excessive visceral adiposity and concomitant hepatic steatosis reducing the workspace. Near-Infrared Fluorescence Cholangiography (NIRF-C) with Indocyanine Green (ICG) has emerged as an innovative, safe and effective technique to visualize the biliary anatomy and minimize the risk of iatrogenic BDI. However, its specific benefit in patients with obesity remains under-discussed compared to the general population. The main aim of this narrative review is to evaluate whether the intraoperative use of ICG in patients with obesity may reduce operative times and the risk of BDI. A focused review of the literature is performed on articles from 2010 to 2025 published on PubMed, Scopus and Web of Science. The application of ICG fluorescence in LC for patients with obesity represents a tangible clinical advantage, not only for anatomical identification and significant improvement of procedural efficiency, but also for the reduction in operative time.

Introduction and importance: Gastric fistula is one of the most feared complications of laparoscopic sleeve gastrectomy (LSG), potentially leading to patient mortality. Conventional treatments include surgery, conservative therapy, and stenting, each with variable success rates. Endoluminal Vacuum Therapy (EVT) is emerging as an innovative approach offering enhanced recovery through negative pressure. Case presentation: We describe a 29-year-old man active smoker with no pre-existing comorbidities, who had severe postoperative complications after LSG, including bleeding and a refractory gastric fistula. Initial attempts to manage the complication with stenting and drainage were unsuccessful. Subsequent application of EVT using the Eso-Sponge system provided progressive resolution over repeated sessions, resulting in complete closure of the leak. Clinical discussion: EVT involved incremental negative pressure adjustments, precise endoscopic-guided sponge placement and multidisciplinary clinical management. The Eso-Sponge was placed through an overtube under fluoroscopic and endoscopic guidance. Clinical and imaging outcomes confirmed substantial cavity reduction and normalization of inflammatory markers, leading to patient discharge after 40 days. EVT's effectiveness in complex leaks, supported by literature indicating success rates above 80 %, emphasizes its superiority over traditional modalities. However, given this is a single case, EVT should be considered a promising alternative rather than a definitive first-line therapy. Conclusion: Endoluminal vacuum therapy significantly improves recovery and clinical outcomes in patients with complicated gastric leaks after sleeve gastrectomy and could be considered as a valuable option in selected cases. Highlights: