Metabolic bariatric surgery (MBS) helps reduce comorbidities, such as hypertension and gestational diabetes, and is more effective than diet management for women with obesity-related health issues. Vitamin B₁₂, vitamin D, and iron play important roles in ensuring the health of a neonate. However, pregnancies occurring after MBS may face complications related to micronutrient deficiencies, particularly of vitamins B₁₂ and D and iron. This study aimed to investigate the vitamin B₁₂, vitamin D, ferritin, and iron status of pregnant women who underwent MBS compared with women without MBS history. The study included 217 pregnant women (105 with a history of MBS and 112 without a history of MBS) who visited a major maternity hospital in Abu Dhabi, United Arab Emirates (UAE) between July 2021 and November 2022. The maternal vitamin B₁₂, vitamin D, iron, and ferritin levels were measured twice, initially during the first or second trimester and subsequently during the third trimester. The iron was measured once during the pregnancy. Vitamin B₁₂ deficiency was higher among pregnant women with MBS history compared to non-bariatric pregnant women (24.4% vs. 3.9%, p < 0.001). Women with a history of MBS had a higher prevalence of vitamin D deficiency (62.3% vs. 37.7%, p < 0.002). Linear regression analysis indicated that vitamin B₁₂ levels decreased by 55 pg/mL in women with a history of MBS and by 4.6 pg/mL with a unit increase in body mass index (kg/m²). Furthermore, vitamin D levels in women with a history of MBS decreased by 4.9 ng/mL during pregnancy. Metabolic bariatric surgery is associated with vitamin B₁₂, vitamin D, and iron deficiencies during pregnancy.

To determine the incidence of human epidermal growth factor receptor 2 (HER2) over expression in oesophageal cancers. A retrospective study, of one hundred consecutive cases of endoscopic histological samples of oesophageal cancers from a single British cancer network were included. Cancer cases were diagnosed between April 2007 and June 2010. HER2 over expression was assessed using immunohistochemistry, those that scored "0" and "+1" were considered "negative" for HER2; those that scored "+3" were considered "Positive". Cases that were scored "+2" on immunohistochemistry further went on to have HER2 gene analysis using the Ventana HER brightfield dual-colour in situ hybridisations (HER B DISH) assay and either came back to be positive or negative for HER2 over expression. Overall survival was measured from date of histological diagnosis until date of death. 93% of the cases were followed up till five years or death, and all were followed up till two years. Cases of gastro-oesophageal junctional tumours were excluded. The median age of our sample was 66 years (range: 38-91 years). Eighty one were male and 19 female. Ninety-one of the cases were adenocarcinoma of the oesophagus and the rest were cases of squamous cell carcinoma. The anatomical distribution of the tumours was; upper oesophagus 2, middle oesophagus 11, and 87 were in the lower oesophagus. Operative resection was completed in 15 cases; seven cases had attempted surgical resections, i.e., open and close, 33 patients received definitive chemo-radiation and 52 had palliative treatment. Twenty-five of the cancers showed evidence of HER2 over expression, all were adenocarcinomas. Of the 25 cases that showed evidence of HER2 over expression, 21 (84%) were located in the lower third of the oesophagus. On staging, 24 out of the 25 HER2 positive cases were at stage 3 or more (13 at stage 3 and 11 at stage 4), For HER2 negative cases 37 were at stage 3 and 32 were staged as stage 4. Seventeen out of twenty five cases (68%) with HER2 over expression received palliative therapy, in comparison to thirty five out of seventy five (46.7%) in tumours not expressing HER2. No significant difference in overall survival was demonstrated between patients whose cancers showed evidence of HER2 over expression and those who did not; median overall survival for HER2 positive tumours was 15 mo (95%CI, 11-19 mo) compared to 13 mo (95%CI, 9-17 mo) for HER2 negative ones. Two years cumulative survival for cases with HER2 over expression was 33.7% compared to 31.6% in cases without HER2 over expression (P = 0.576). Only cancer's stage significantly affected overall survival on both univariant and multivariable analysis (P = 0.034 and P = 0.009 respectively). None of the patients included in this study received Trastuzumab. Twenty-seven point five percent of oesophageal adenocarcinomas showed evidence of HER2 over expression. Routine testing for human HER2 in oesophageal adenocarcinomas can have significant implication on treatments offered to patients that may potentially affect their prognosis.

Background: Roux-en-Y gastric bypass (RYGB) is a widely performed metabolic and bariatric surgery (MBS) procedure with proven efficacy. However, significant variability exists in its technical execution. This study aimed to evaluate global practice patterns among surgeons affiliated with the International Federation for the Surgery and Other Therapies for Obesity (IFSO), identifying key variations and factors influencing intraoperative decision-making. Methods: A cross-sectional survey was distributed between January and November 2025 to active IFSO members performing RYGB. The survey explored techniques related to the gastric pouch configuration, intestinal limb lengths, gastrojejunostomy, ring augmentation, and adjunct use. Responses from 245 surgeons across 47 countries were analyzed using descriptive statistics, subgroup comparisons, and multivariable logistic regression. Results: Technical variability was widespread. Only 53.5% routinely measured gastric pouch length; 67.3% described their pouches as “short” or “small,” with variable anatomical endpoints. Bougie sizes ranged from 28 to 46 Fr, with 36 Fr being most common (41.2%). Only 21.6% of respondents reported routinely measuring total bowel length. Ring-augmentation was used by 20.4%, with significant regional and experiential variation. Linear stapling was preferred for gastrojejunostomy (81.2%), but stoma size and suture materials varied. Routine closure of both Petersen’s space and the jejunojejunal mesenteric defect was common (69%) yet non-uniform. High-volume surgeons had shorter hospital stays and longer follow-up, but technical patterns were similar. Conclusion: Global RYGB practice exhibits heterogeneity in several key operative steps. Improved reporting of intraoperative technical variables may help clarify which differences are most relevant to perioperative, long-term, and registry-based outcomes, and may support future consensus-building in areas where standardization is clinically justified.

Background: Sleeve gastrectomy (SG) is effective but prone to late recurrent weight gain (RWG). Ring-augmented SG (Ra-SG) may preserve restriction and enhance long-term durability. Methods: In this single-center, prospective, single-blind randomized trial, adults with a BMI > 50 kg/m² were randomized to SG or Ra-SG and followed for 36 months. The primary endpoint was percent total weight loss (%TWL) at 36 months. Secondary outcomes included RWG, gastric pouch volumetry, relapse of associated medical problems, complications, endoscopic findings, laboratory parameters, and patient-reported outcomes (SF-36, Suter). Results: Ra-SG produced significantly greater weight loss at 36 months (48.8 ± 8.3 vs. 45.5 ± 9.0%TWL; mean difference 3.25% points, 95% CI 0.86 to 5.63; p 0.008). Exploratory analyses showed lower rates of clinically significant RWG (≥ 30% regain: 5.9% vs. 16.3%; absolute risk difference − 10.4%, 95% CI − 19.6 to − 1.2; p = 0.033) and smaller pouch volumes (160.1 ± 8.9 vs. 194.2 ± 10.3 mL; p < 0.001). Perioperative complications were infrequent and comparable. At three years, the prevalence of endoscopic GERD was similar (17.3% vs. 19.6%). Food tolerance scores were consistently better after SG (all p < 0.05). HRQoL improved significantly in both groups, with no differences observed at 36 months. Two Ra-SG patients (1.8%) underwent ring removal. Conclusions: Ra-SG enhanced weight-loss durability and lowered RWG compared to SG, with similar safety and GERD outcomes but decreased food tolerance at mid-term. Ra-SG may be considered in patients at higher risk of RWG, though multicenter studies with longer follow-up are needed to confirm these findings.