Background: Bariatric surgery effectively treats severe obesity, but postoperative weight loss includes reductions in both fat mass (FM) and fat-free mass (FFM). Excessive FFM loss may increase the risk of sarcopenia, frailty, and long-term weight regain, yet its magnitude and determinants are not fully established. Methods: We conducted a retrospective analysis of a prospectively collected cohort of 179 patients who underwent laparoscopic or robotic Roux-en-Y gastric bypass between January 2020 and December 2022. Anthropometric parameters and body composition (bioelectrical impedance analysis) were measured preoperatively and at 6 and 12 months. The proportion of FFM loss relative to total weight loss (%FFML/WL) was calculated, and excessive FFM loss was defined using published cut-offs (≥25%, ≥30%, and ≥35%). Predictors of FFM preservation were assessed through stepwise regression. Results: Baseline BMI was 44.1 ± 4.6 kg/m², FM 54.6 ± 10.7 kg, and FFM 61.1 ± 11.9 kg. At 6 and 12 months, BMI decreased to 31.0 ± 4.2 and 28.8 ± 4.4 kg/m², respectively; FM decreased to 35.6 ± 11.0 and 22.0 ± 10.0 kg; and FFM to 54.7 ± 9.5 and 50.1 ± 7.0 kg (all p < 0.001). Most FFM loss occurred within the first 6 months (mean − 6.4 kg). Median %FFML/WL was 26.4% at 6 months and 28.7% at 12 months. Excessive FFM loss affected 41–46% of patients (≥25%), 27–31% (≥30%), and 14% (≥35%). In multivariable analysis, FFM at 6 months was the only independent predictor of FFM at 12 months (p < 0.001). Conclusions: Bariatric surgery leads to substantial FM and FFM reductions, with nearly half of patients exceeding established %FFML/WL alert thresholds. Early postoperative body composition monitoring may help identify individuals at higher risk of FFM depletion and guide preventive strategies such as adequate protein intake and resistance training.

Despite major advances in gastric cancer surgery, esophagojejunal anastomotic leakage (EJAL) remains a life-threatening complication after total gastrectomy. Its management is controversial and challenging, encompassing conservative treatment, endoscopic therapy, and surgical reintervention. Given its clinical impact, identifying predictive risk factors is essential to reduce incidence, enable early diagnosis, and improve outcomes. This systematic review aims to evaluate risk factors associated with esophagojejunal anastomotic failure and to propose preventive strategies. Two independent reviewers conducted a systematic electronic search of PubMed, Cochrane Central Register of Controlled Trials, Embase, and Google Scholar up to June 2024. Search terms included gastrectomy OR total gastrectomy AND anastomotic leak OR anastomotic leakage, combined with laparoscopic, robotic, open, and Da Vinci. The protocol was registered in PROSPERO (CRD42021261841). A total of 221 studies were identified. After removal of duplicates and irrelevant studies, 18 studies met inclusion criteria. No additional studies were identified through cross-referencing. Study selection is summarized in a PRISMA flow diagram. Preoperative, intraoperative, and postoperative risk factors for esophagojejunal anastomotic leakage were identified and analyzed. Comprehensive knowledge of these factors is crucial to guide preventive strategies and ultimately reduce the incidence of this severe complication.

Background/Objectives: Sliding and paraesophageal/mixed hiatal hernias differ anatomically and clinically, although surgical outcomes are frequently analyzed together. This study compared postoperative functional outcomes and proton pump inhibitor (PPI) requirements according to hernia type and explored recurrence patterns as secondary outcomes. Methods: We retrospectively analyzed a prospectively maintained database of consecutive patients undergoing hiatal hernia repair at a tertiary referral center between May 2014 and September 2023. Patients were classified as sliding (type I) or paraesophageal/mixed hernias. Symptoms were assessed using an 11-item Likert questionnaire. Functional changes were evaluated using paired analyses in patients with available preoperative and postoperative assessments. Recurrence-free survival was estimated using Kaplan–Meier analysis, with exploratory Cox regression for symptomatic recurrence. Results: Seventy-seven patients were included (37 sliding; 40 paraesophageal/mixed). Sliding hernias showed a predominantly reflux-related phenotype, whereas paraesophageal/mixed hernias were characterized by more obstructive symptoms and dysphagia. Paired analyses confirmed significant improvement in reflux-related symptoms after sliding hernia repair and in obstructive symptoms and dysphagia after paraesophageal/mixed hernia repair. PPI requirements decreased significantly in both groups. Symptomatic recurrence occurred in 12 patients (15.6%) and was more frequent after paraesophageal/mixed repair (log-rank p = 0.011). In an exploratory Cox model stratified by sex and adjusted for age and American Society of Anesthesiologists (ASA) classification, paraesophageal/mixed hernia was associated with a higher hazard of symptomatic recurrence (HR 4.87, 95% CI 1.00–23.74; p = 0.050), although estimates were imprecise. Radiologically documented anatomical recurrence occurred in 15 patients (19.5%) and differed between groups over time (log-rank p < 0.001); postoperative imaging was symptom-driven and therefore did not represent systematic anatomical surveillance. Revisional surgery was required in 6.5% of patients. Conclusions: Sliding and paraesophageal/mixed hiatal hernias showed distinct clinical, surgical, and functional phenotypes. Exploratory analyses also suggested different recurrence patterns, although these findings require cautious interpretation because of the limited number of events, residual confounding, and non-systematic postoperative imaging.