As bariatric surgeries (BS) increase, more incidental findings are liable to be discovered. Incidental gastric gastrointestinal stromal tumors (GISTs) during BS can be found in around 0.7% of the cases. In this article, we have performed a systematic review of the literature and added our data to those of the review to review a conceptual treatment strategy to both improve patient outcomes and decrease the risk of overall cancer. With the rise of new bariatric techniques, we have proposed a new classification to BS to enhance our description of the treatment strategy. Graphical Abstract

Background: Esophagogastroduodenoscopy (EGD) is crucial in bariatric surgery for detecting gastro-esophageal conditions and incidental pathologies, impacting surgical decisions and outcomes. The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) recommends routine EGD before and after bariatric procedures to identify incidental pathologies. However, global adherence to these guidelines varies, especially in resource-constrained settings where economic limitations often dictate practice patterns. This study adapts a survey by Quake et al. (2022) to the Egyptian context, offering a comprehensive analysis of EGD utilization alongside broader trends in metabolic and bariatric surgery (MBS) practices in Egypt. Methods: A survey adapted from Quake et al. (2022) was tailored to assess trends in metabolic and bariatric surgery (MBS) practices in Egypt. Conducted between April and August 2024 with a response rate of 53.3%, the survey targeted Egyptian bariatric surgeons. It evaluated EGD utilization, surgical expertise, institutional volumes, types of procedures, revisional surgeries, and adherence to the 2020 IFSO position statement. Data was collected through Google Forms and analyzed for trends, challenges, and gaps in practice, focusing on economic constraints and guideline implementation. Results: Among the 80 respondents, 88.8% were consultants, with 73.8% performing over 100 surgeries annually. The volume of bariatric procedures increased from 2021 to 2023, with significant growth in sleeve gastrectomy (SG) and single-anastomosis sleeve ileal (SASI) bypasses/bipartition. Revisional surgeries were most commonly Roux-en-Y gastric bypass (RYGB). Despite this growth, EGD utilization remained limited. Pre-operatively, only 12.5% of surgeons performed EGD routinely for all patients, while 67.5% used it selectively based on patient or procedural factors. Post-operative EGD at one year was routinely offered by just 3.8% of surgeons, with 55% not routinely using it at all. Institutional and economic factors influenced these practices; surgeons in high-volume or private settings were more likely to adopt selective EGD use. Awareness of the 2020 IFSO guidelines showed a minimal impact on EGD practices, suggesting that financial considerations often outweigh clinical recommendations. Conclusions: This study highlights critical trends in bariatric surgery practices in Egypt, including increasing procedural volumes and the limited utilization of EGD. Economic constraints remain the predominant barrier to routine EGD use, despite its potential to improve surgical outcomes by identifying incidental pathologies. Enhancing patient care requires establishing a national registry, upgrading training programs, and implementing observerships to align with international standards are pivotal in advancing bariatric care in Egypt and guaranteeing high-caliber, evidence-based patient care.

Objectives: The objective of this web-based study is to analyze the attributes of bariatric surgery cases ensuing health implications. Additionally, the study seeks to delve into the factors influencing post-bariatric psychological evaluations and the impact of various bariatric surgeries on weight loss and psycho-social assessment scores for patients who had undergone bariatric surgeries within a specific bariatric surgery center in Egypt between January 2017 and January 2024. Methods: An analytical cross-sectional study recruited 411 adults who had undergone different bariatric procedures by the same surgical team. We collected the data using a validated self-administered questionnaire that included the Body Image Scale (BIS), the Rosenberg Self-Esteem Scale (RSES), the quality-of-life score (QOLS), and the modified General Patient Satisfaction Score after Bariatric Surgeries (GSABS). Results: The most commonly performed bariatric surgery was sleeve gastrectomy (SG), accounting for 82.7% of the procedures. The majority of the patients (78%) were female, with a mean age of 35.8. Among the participants, 32.4% reported experiencing complications, and 21.2% of those individuals were still experiencing complications at the time of assessment. The BIS had a mean score of 16.54 ± 6.27, indicating an average body image perception. The RSES yielded a mean score of 20.11 ± 4.63, indicating average self-esteem, while the GSABS had a mean score of 8.08 ± 2.39, indicating an overall average level of patient satisfaction. No statistically significant differences were found between the various types of bariatric surgeries in terms of total body weight loss percentage, excess body weight loss percentage, or the timing of the intervention. However, increased time intervals from surgeries noted a significant reduction in the BIS. Conclusion: The majority of patients who underwent SG and Roux-en-Y gastric bypass (RYGB) surgeries exhibited high GSABS scores. SG patients also had high BIS scores. However, all other interventions showed normal GSABS and BIS scores. All types of surgeries resulted in normal RSES and QOLS. Furthermore, the BIS score increases with the intervention's recentness, but it significantly decreases after the second-year post-surgery. Conversely, the older the timing of the intervention, the higher the RSES score after surgery.

Since the early 1980s, efforts to standardize ergonomic practices in laparoscopic surgeries have aimed to improve procedural efficiency and reduce complications, but clinical validation remains limited. In metabolic and bariatric surgeries (MBS), innovations in trocar site placements, driven by the popularity of laparoscopic sleeve gastrectomy (LSG), have advanced surgical techniques. However, practices often vary based on individual surgeon preferences rather than standardized evidence-based criteria. This study introduces the Port Site Placement and Outcomes for Surgical Obesity and Metabolic Surgeries (PSPOSO) checklist, aiming to standardize port placements and improve reporting consistency. A systematic review and meta-analysis of LSG studies were conducted following PRISMA guidelines. Data were extracted from 34 studies involving 7173 cases. Key variables included port configurations, manipulation angles, and outcomes such as operative time and excess weight loss percentage (EWL%). Innovative methods were used to estimate manipulation and azimuth angles from available intraoperative images. Statistical analyses and meta-regression were performed to identify associations between port configurations and surgical outcomes. Findings revealed substantial variability in port placements, with no significant effect of manipulation angles or port numbers on operative time or EWL% at 6, 12, and 24 months (p-values > 0.05). High residual heterogeneity suggests that factors beyond manipulation angles and port counts contribute to outcome variability. The PSPOSO checklist provides a framework for standardizing port placement and ergonomic parameters in MBS, enhancing reproducibility and safety. Future studies should validate the checklist across diverse clinical settings to refine surgical approaches and improve patient outcomes. PROSPERO: CRD42024598674.

Background: Individuals with clinically severe obesity and a BMI ≥ 60 kg/m² (class V obesity) have a higher incidence of both obesity-related comorbidities and anticipated operative difficulty, with a subsequent higher risk of perioperative morbidity and mortality and a longer hospital stay. In patients with class V obesity, the definitive bariatric procedure is still a matter of debate. This study compared surgical procedures (SASI vs. RYGB) in people with class V obesity. The primary objective was to compare weight loss after both procedures over a 1-year follow-up. Secondary outcomes included the evaluation of the incidence of the operative time (skin-to-skin), postoperative complications, duration of hospital stay, rate of conversion to the open technique, and quality of life, as well as amelioration of obesity-related comorbidities. Methods: From January 2019 to December 2022, the data of 73 consecutive patients with class V obesity was collected, who underwent either standard RYGB (n = 40) or SASI (n = 33) at the General Surgery Department of Alexandria University Hospital and some non-governmental hospitals. Results: There was no statistically significant difference between both groups as regards mean age (p = 0.012), sex (p = 0.250), preoperative BMI (p = 0.754), or preoperative incidence of obesity-related co-morbidities. The SASI procedure showed a statistically shorter operative time (p < 0.001). There was no significant difference between the two groups as regards the incidence of postoperative surgical complications, either early cmplications (21.1% and 20% in both SASI and RYGB, respectively, p = 0.770) or late (beyond 30 days) complications (15.2% and 15% in SASI and RYGB, respectively, p = 1.000), with neither conversion nor intra-operative mortality in both groups. However, the SASI group showed a significant shorter postoperative hospital stay (p < 0.001). During the follow-up period, both operations demonstrated a significant overall resolution of pre-operative obesity-related comorbidities, a significant increase in postprandial 6 weeks postoperative GLP-1 with statistically more rise in the SASI group in the postprandial GLP-1 compared to the RYGB group (p < 0.001). There was no mortalities in both group during the follow up duration. Conclusion: In patients with class V obesity, the SASI procedure had a statistically shorter operative time (skin-to-skin) and a shorter hospital stay compared to RYGB. Both procedures resulted in satisfactory weight loss, as well as comparable improvements in obesity-related comorbidities.