Background: One anastomosis gastric bypass (OAGB) is the most common metabolic and bariatric surgery (MBS) in Israel, recognized for its effectiveness in achieving sustainable weight loss and mitigating obesity-related diseases. The metabolic outcomes of OAGB are significantly influenced by the length of the biliopancreatic limb (BPL). The objective of this study is to determine whether tailoring the BPL length to the total small bowel length (TSBL) results in more effective weight loss compared to patients undergoing OAGB with a fixed BPL of 180 cm. Efficacy and safety of this approach will also be evaluated, ensuring it does not lead to long-term morbidity or negatively impact patients’ quality of life. Methods: This multicenter, prospective, randomized trial will enroll at least 200 participants undergoing OAGB across three centers. Participants, aged 18 and older, will be randomized into two groups: one group will undergo a tailored BPL length based on TSBL (40%), while the control group will receive a standard BPL length of 180 cm. The primary endpoint is comparison of total weight loss after 1 and 3 years. Secondary endpoints include postoperative complications, quality of life, and improvements in obesity-related diseases. Results: The study will collect and analyze data as outlined in the protocol. The results will be reported upon completion of data collection and analysis. Conclusions: The TABLE-40 study will provide robust evidence on whether tailoring the BPL to 40% of TSBL offers higher weight loss outcomes compared to a fixed-length approach in OAGB. By assessing both efficacy and safety across multiple centers, the trial aims to inform best practices in limb length selection and optimize long-term outcomes for patients undergoing OAGB. Trial Registration: This study was registered at Clinicaltrials.gov (NCT06829381) on 29/1/2025. Graphical

Background: Severe obesity among adolescents is an increasing global health concern associated with significant metabolic and psychosocial morbidity. Metabolic and bariatric surgery (MBS) has emerged as the most effective treatment for durable weight-loss in selected adolescents; however, national data on trends and outcomes remain limited. We aim to evaluate national trends, characteristics, and outcomes of adolescent MBS in Israel using the Israel National Bariatric Surgery Registry (INBSR). Methods: We conducted a nationwide retrospective analysis of adolescents (< 18 years-old) who underwent MBS between 2017 and 2024. Data were extracted from the INBSR, a mandatory registry capturing procedures across all centers. Baseline demographics, obesity-related diseases, procedures, and weight-loss outcomes were analyzed. Results: A total of 460 adolescents underwent primary MBS. Mean age was 16.9 ± 0.8 years and mean body mass index was 46.4 ± 6.8 kg/m², with a female predominance (58.7%). Sleeve gastrectomy (SG) was most common (87.6%). Comorbidity burden was high, including fatty liver disease (60–73.8%), obstructive sleep apnea (~ 51.3%), and type 2 diabetes (~ 20%). SG achieved mean excess weight loss (%EWL) of 56.3% at 6 months, 70.7% at 2 years, and 68.5% at 4 years. Other procedures demonstrated greater weight-loss (~ 80% EWL at 3 years). Follow-up declined, with dietitian visits decreasing from 47.6% at 1 year to 14.5% at 4 years. Sixteen patients required revisional surgery mainly due to recureent weight gain. Conclusions: Adolescent MBS in Israel results in substantial and durable weight-loss. However, high comorbidity burden and poor long-term follow-up highlight the need for improved multidisciplinary care and retention strategies.

Background and Objectives: Metabolic and bariatric surgery is the most effective long-term intervention for severe obesity, associated with significant reductions in weight, associated medical problems, and cancer risk. While the overall safety profile of metabolic and bariatric surgery has improved, early postoperative complications still occur and may lead to prolonged hospitalization, reintervention, or increased morbidity. This study aimed to identify independent preoperative and perioperative predictors of early postoperative complications following metabolic and bariatric surgery. Materials and Methods: We conducted a retrospective cohort study of 927 patients who underwent metabolic and bariatric surgery at a single tertiary medical center between December 2017 and March 2022. Early postoperative complications, defined as those occurring during the index hospitalization or within 90 days, were recorded and graded using the Clavien-Dindo classification. Univariate analyses were performed to identify candidate predictors, followed by multivariable logistic regression using an unpenalized model. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using maximum likelihood methods with Wald-based intervals. Results: Eighty-four patients (9.1%) experienced postoperative complications, with 38% requiring invasive intervention. Bleeding was the most common complication (46%), followed by leak/intra-abdominal abscess (24%) and cardiorespiratory events (18%). Independent predictors of complications included obstructive sleep apnea (OR: 1.93), bariatric surgery within the past 5 years (OR: 2.39). Conclusions: OSA and recent previous surgery increase the risk of early complications after metabolic and bariatric surgery. These findings support integrating specific risk factors into preoperative planning to improve surgical outcomes.