Background: Spontaneous intragastric balloon hyperinflation (SIBH) is a rare and concerning complication of intragastric balloons (IGBs). The mechanisms underlying SIBH remain unclear. This systematic review aims to synthesise the current evidence regarding the clinical presentation, management, complications, and hypothesised aetiologies of SIBH. Methods: A comprehensive literature search was conducted using PubMed, EMBASE, MEDLINE, and Ebsco databases. Studies reporting on cases of SIBH were identified and reviewed. Data points were extracted on patient presentation, management strategies, complications, outcomes, and proposed mechanisms. Results: Eighteen publications describing 29 patients with SIBH were included. The most common clinical presentation was gastric outlet obstruction (86%). Emergency endoscopy was required in 96% of cases, with balloon removal performed in 82%. Reported complications included acute pancreatitis and mucosal erosions; however, neither long-term morbidity nor mortality was observed. Microbial colonisation was hypothesised as the underlying cause in 62% of publications, supported by culture findings from balloon contents in 90% of cases, most commonly isolating gas-producing organisms such as Candida (80%) and anaerobic bacteria (40%). Conclusions: SIBH most frequently presents with gastric outlet obstruction and typically necessitates emergency endoscopic intervention. Gas-producing microbial colonisation of the balloon is the predominant hypothesised aetiology. Preventive strategies targeting microbial colonisation may be crucial in reducing the incidence of SIBH.

Background: The objective of this study was to evaluate sleeve gastrectomy plus jejunal bypass (SG-JJB) for type 2 diabetes mellitus (T2DM) in Chinese patients with a body mass index (BMI) ≥32.5 kg/m2. We also compared the outcomes of SG-JJB to those of sleeve gastrectomy (SG). Methods: This retrospective study included 60 patients between September 2023 and October 2024 at shanghai ninth people’s Hospital, in shanghai, or lancing first people’s Hospital, Pu’er, China. Among them, 40 patients were underwent SG and 20 patients were received SG-JJB. SG-JJB consists of SG and performing a jejunoileal anastomosis 240 cm distal to the angle of Treitz. Postoperative total weight loss (TWL), T2DM remission and patient complication were compared. Resluts: All the operations were performed laparoscopically and the mean postoperative follow-up was 18 months (13-27). The mean age was 36 years (21–53), 85 % of patients were female and Mean preoperative BMI was 37.6 kg/m2 (33–50.2 kg/m2) in SG group, while it was 37 years (23–61), 83 % and 38.3 kg/m2 (34.5–48.8 kg/m2) in SG-JJB group (P>0.05). Patients in SG-JJB group had a longer operation time (135± 15 min vs 106± 10 min) and postoperative hospital stay (6 days vs 4 days) than patients in SG group (P<0.01). SG-JJB yielded higher TWL than SG alone (32.3±7.1% vs 28.9±9.1%, P<0.05). Complete T2DM remission was achieved in 85% of patients (17/20) and partial remission in 15% (3/20) in SG-JJB, while it was 70% (28/40) and 30% (12/40) in SG group. It suggests that SG-JJB has a greater advantage in T2DM. There were no deaths, no postoperative bleeding, no re-operation and no gastric fistula in all patients. The incidence of postoperative gastroesophageal reflux disease (GERD) symptoms is similar in SG-JJB (10%, 2/20) and SG (12.5% 5/40)(P>0.05). Conclusion: SG-JJB is a safe surgical technique for T2DM in patients with BMI ≥32.5 kg/m2, it yielded higher TWL and diabetes remission than SG.

Purpose Metabolic bariatric surgery in adolescents is an evolving field, and data is limited in Australia. Surgery in this age group has special safety, social and ethical considerations. The impact of MBS on psychiatric, mental health and psychosocial wellbeing is poorly understood. We review the patient demographics, mental health conditions, weight outcomes, complications and follow-up of a cohort of adolescents who underwent laparoscopic sleeve gastrectomy (SG) by a single surgeon in a large volume clinic with an established adolescent multidisciplinary team program receiving patients from across Australia and New Zealand. Methods A prospective bariatric database was retrospectively analysed to review the adolescents aged 13-19 who underwent a primary SG from December 2011 to December 2024. Patients who were a minimum of six months post-surgery were included. Results 63 patients aged 13-19 years old underwent primary SG. Median pre-operative weight and body mass index (BMI) was 123 kg and 42.1 kg/m2. Pre-operatively, 26 adolescents reported a Psychiatric and/or mental health disorder, seven reported suicidal ideation or self-harm history and six reported experiencing severe weight- bullying. At three months, six months, twelve months and two years after SG, median BMI decreased to 33.6, 30.6, 27.5 and 28.1 kg/m2 respectively. Follow-up rates progressively decreased and was 42% at two years. There was no mortality and one staple line leak. Conclusion SG is a safe and promising option for the treatment of adolescents living with obesity in the short to medium-term. The high prevalence of mental health disorders and poor follow-up are major concerns. Long-term data with better follow-up is required in Australia.

Purpose PONV is common after bariatric surgery, involving neurohormonal and vagally-mediated mechanisms triggered by surgical alteration of gastric anatomy. We adopted a novel approach of intraperitoneal blockade of the anterior Vagus nerve (VNB) from a recent study that showed a substantial reduction in PONV following VNB in laparoscopic sleeve gastrectomy [1]. Despite obvious improvement with this innovation, some patients still suffered from PONV. Therefore, we introduced the neurokinin-1 inhibitor (NKI) antiemetic Fosaprepitant as part of our anaesthetic. Methodology We conducted a three-phase prospective clinical audit of PONV in PACU and Day 1 post-op, following the sequential introduction of 3 separate techniques in patients undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LGB). Phase one involved spraying the gastric staple lines and lesser omentum with intraperitoneal bupivacaine (IPB). Phase two involved replacing the first technique with a laparoscopic VNB using bupivacaine injected at 6 points along the Vagus nerve. The third approach added Fosaprepitant to the VNB (VNB+F). Outcomes included the presence of nausea and vomiting in PACU and on Day 1 post-op, and interference with ADLs. Patients were included between April 2022 to December 2025. Results Ninety-two patients were enrolled: 62 for LSG, 30 for LGB. In LSG, PACU nausea was 21% in VNB, 32% in VNB+F and 63% in IPB. In LGB, nausea in PACU was 0% in VNB+F, 35% in VNB and 46% in IPB. Vomiting in PACU was negligible overall. In both procedures, vomiting over 24 hours was absent in VNB+F. Reported interference with ADLs progressively decreased across the three interventions, reaching 0% in VNB+F. Conclusion The addition of VNB and Fosaprepitant to a standard antiemetic regimen may reduce nausea in recovery and facilitate a faster return to function following bariatric surgery. Prospective controlled trials are warranted. References [1]Daes J et al. Obes Surg. 2022;32(11):3551–3560.

PURPOSE: As bariatric surgery volumes continue to rise globally, concerns regarding occupational musculoskeletal injury and surgeon wellbeing have become increasingly prominent. Minimally invasive surgery is associated with substantial ergonomic strain; however, the comparative risks of bariatric robotic and laparoscopic approaches remain incompletely characterised. METHODOLOGY: A mixed-methods systematic review without meta-analysis was conducted in accordance with PRISMA guidelines and a prospectively registered protocol (PROSPERO ID: CRD420251109094). Medline, Embase, Cochrane, CINAHL, Scopus, and Web of Science were searched from database inception to 02/08/2025. RESULTS: Of 5,849 records identified, 181 full-text articles were assessed, with 11 studies included, collectively representing at least 183 bariatric surgeons and 307 procedures. Objective ergonomic assessments demonstrated higher overall ergonomic risk and greater upper-extremity burden during laparoscopic bariatric surgery compared with robotic surgery. Robotic surgery was associated with region-specific trade-offs, including increased wrist loading and static trunk demands, suggesting redistribution rather than elimination of biomechanical strain. Subjective ergonomic outcomes were heterogeneous. Cross-sectional studies consistently reported a high prevalence of work-related musculoskeletal issues among bariatric surgeons, affecting up to 66%. Qualitative findings highlighted limited ergonomics training and ergonomic strain impacting fatigue and career longevity. CONCLUSION: This is the first systematic review to specifically synthesise surgeon ergonomics in bariatric surgery. Robotic bariatric surgery demonstrates a more favourable objective ergonomic profile with reduced upper-extremity loading. Interpretation is limited by heterogeneity in study design and ergonomic measures. Future research should prioritise ergonomic interventions and structured ergonomics training to promote surgeon wellbeing.

Purpose: To evaluate long-term weight loss, patient-reported benefit, regret, revisional surgery rates, and gastrointestinal symptoms 10 years after primary laparoscopic sleeve gastrectomy (SG) or gastric bypass (GB). Methods: Patients 10 years following primary SG or GB were contacted and invited to participate in structured follow-up. Participants completed a questionnaire and underwent blood testing and clinic review. Outcomes included body mass index (BMI), percent total body weight loss (%TBWL) at nadir and 10 years, self-reported health improvement, regret, revisional procedures, and prevalence of long-term gastrointestinal symptoms including reflux, bowel dysfunction, and abdominal pain. Results: Sixty-six patients participated (SG n=44, GB n=22); 48 were female (72%) and 18 male (27%). Mean pre-operative BMI was 45.6 kg/m² (SG) and 47.8 kg/m² (GB), with mean BMI at 10 years of 34.8 kg/m² and 31.0 kg/m², respectively. Mean nadir %TBWL was 37% at 20 months post-SG and 42% at 33.6 months post-GB. At 10 years, mean %TBWL was 24% (SG) and 32% (GB). Overall, 80% reported improved health at 10 years compared with pre-surgery, and 94% reported no regret. Long-term symptoms were common: in SG, 52% reported bowel issues, 58% reflux (96% requiring PPI), and 26% abdominal pain; in GB, 62% reported bowel issues, 24% reflux, and 23% abdominal pain. Revisional surgery occurred in 26%, including six SG-to-GB conversions and one re-sleeve. Conclusion: At 10 years, both SG and GB provide sustained weight loss and high patient satisfaction, with greater long-term %TBWL after GB. However, gastrointestinal symptoms and revisional surgery remain common, highlighting the importance of structured long-term follow-up and symptom surveillance.