Luigi Angrisani

Obesity is a chronic disease associated with increased morbidity and mortality and reduced quality of life. Pharmacotherapy can be associated with life style changes in increasing and maintaining weight loss and ameliorating obesity-related complications and comorbidities. In patients affected by obesity and uncontrolled obesity-associated complica...

The 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) updated the indications for Metabolic and Bariatric Surgery (MBS), replacing the previous guidelines established by the NIH over 30 years ago. The evidence supporting these updated guidelines ha...

Background: The prevalence of obesity is already a worldwide health concern. The development of straightforward guidelines regarding the whole available armamentarium (i.e., medical, endoscopic, and surgical interventions in conjunction with a guidance program) is paramount to offering the best multimodal approach to patients with obesity. Methods:...

Purpose With the global epidemic of obesity, the importance of metabolic and bariatric surgery (MBS) is greater than ever before. Performing these surgeries requires academic training and the completion of a dedicated fellowship training program. This study aimed to develop guidelines based on expert consensus using a modified Delphi method to crea...

Obesity/overweight and its complications are a growing problem in many countries. Italian Society of Bariatric and Metabolic Surgery for Obesity (Società Italiana di Chirurgia dell'Obesità e delle Malattie Metaboliche-SICOB) decided to develop the first Italian guidelines for the endoscopic bariatric treatment of obesity. The creation of SICOB Guid...

Purpose This IFSO survey aims to describe the current trends of metabolic and bariatric surgery (MBS) reporting on the number and types of surgical and endoluminal procedures performed in 2020 and 2021, in the world and within each IFSO chapter. Methods All national societies belonging to IFSO were asked to complete the survey form. The number and...

Obesity is now recognized as a chronic disease associated with a pro-inflammatory state and is often undertreated. It has become a global epidemic, affecting populations worldwide1,2. Metabolic and bariatric surgery (MBS) is considered the most effective treatment option for obesity, which is a chronic, relapsing, and progressive disease3. These su...

Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was...

Introduction This survey of international experts in obesity management was conducted to achieve consensus on standardized definitions and to identify areas of consensus and non-consensus in metabolic bariatric surgery (MBS) to assist in an algorithm of clinical practice guidelines for the management of obesity. Methods A three-round Delphi survey...

Laparoscopic sleeve Gastrectomy (LSG) is the most performed bariatric procedure worldwide but it is associated with an increased incidence of de-novo or recurrent GERD. Recently a new technique consisting in LSG with associated fundoplication has been described. Morgagni-Larrey hernia is very rare and there is a lack of evidences on its correct sur...

During the last decades laparoscopic adjustable gastric banding has been one of the most performed bariatric procedures. The trend has changed since long-term follow ups showed high percentage of complications especially, weight loss failure leading to revisional surgeries. Possible secondary interventions are laparoscopic sleeve gastrectomy (LSG),...

Objective: This study aimed to survey international experts in metabolic and bariatric surgery (MBS) to improve and consolidate perioperative interventions to prevent gastroesophageal reflux disease (GERD) and marginal ulcers (MU) after MBS. Background: Very important long-term complications after MBS include GERD, Barrett's esophagus, and MU. P...

Novel impedance-pH parameters, Mean Nocturnal Baseline Impedance (MNBI) and Post-Reflux Swallow-Induced Peristaltic Wave (PSPW) index, have been proposed to improve the gastro-esophageal reflux disease (GERD) diagnostic yield. This study aims to determine the integrity of the esophageal epithelial barrier and chemical clearance using these novel pa...

Background Bariatric surgery (BS) is a relatively novel surgical field and is in continuous expansion and evolution. Purpose Aim of this study was to report changes in Italian surgical practice in the last decade. Methods The Società Italiana di Chirurgia dell’Obesità (SICOB) conducted annual surveys to cense activity of SICOB centers between 201...

Background Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic cl...

Major updates to 1991 National Institutes of Health guidelines for bariatric surgery Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) > 35 kg/m ² , regardless of presence, absence, or severity of co-morbidities. MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m ²...

Background The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams. Materials and Methods The current study is...

Background The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams. Materials and Methods The current study i...

Major updates to 1991 National Institutes of Health guidelines for bariatric surgery •Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) ≥35 kg/m², regardless of presence, absence, or severity of co-morbidities. •MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m²....

Purpose Bariatric surgery (BS) is considered the most efficient treatment for severe obesity. International guidelines recommend multidisciplinary approach to BS (general practitioners, endocrinologists, surgeons, psychologists, or psychiatrists), and access to BS should be the final part of a protocol of treatment of obesity. However, there are in...

Laparoscopic Roux-en-Y gastric bypass (RYGB) is the second most performed bariatric procedure and it is considered the procedure of choice to treat patients with severe obesity and gastroesophageal reflux disease (GERD). However, some authors described the new onset or the recurrence of GERD symptoms after RYGB, and data at follow-up were scanty. I...

Introduction Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide. Yet there is significant variation in practice concerning its various aspects. This paper report results from the first modified Delphi consensus-building exercise on SG. Methods We established a committee of 54 globally recognized opinion makers in this field. Th...

The published colorectal cancer (CRC) outcomes after bariatric surgery (BS) are conflicting, with some anecdotal studies reporting increased risks. The present nationwide survey CRIC-ABS 2020 (Colo-Rectal Cancer Incidence-After Bariatric Surgery-2020), endorsed by the Italian Society of Obesity Surgery (SICOB), aims to report its incidence in Italy...

Background The 2018 IFSO Survey focused on similarities and disparities in the number and types of surgical and endoluminal interventions among the IFSO chapters occurred in the last decade. Methods All IFSO Societies were asked to fill in the IFSO survey form on how many and which surgical and endoluminal interventions have been performed in the...

Introduction There is a paucity of data in scientific literature on the impact of Coronavirus Disease 2019 (COVID-19) pandemic on bariatric surgery. The aim of this study was to evaluate the impact of COVID-19 pandemic on Bariatric Surgery globally. Methods We conducted a global online survey of bariatric surgeons between 16/04/20 – 15/05/20. The...

Background and aim Bariatric surgery (BS) is a pillar for the treatment of morbid obesity and its related comorbidities. However, it might be associated with long-term deficiencies and absorption issues. Adherence to micronutrient supplementation is a crucial aspect in the management of these patients. Aim The aim of the present survey was to eval...

Background and objective Laparoscopic Roux en Y gastric bypass (LRYGB) is the second most frequently performed bariatric procedure worldwide; however, long-term results are not frequently reported. The aim of this study is to evaluate the outcomes of LRYGB on weight loss and comorbidities in a single center 15 years after the operation. Setting Te...

The purpose of this study was to achieve consensus amongst a global panel of expert bariatric surgeons on various aspects of resuming Bariatric and Metabolic Surgery (BMS) during the Coronavirus Disease-2019 (COVID-19) pandemic. A modified Delphi consensus-building protocol was used to build consensus amongst 44 globally recognised bariatric surgeo...

Background: The pandemic pattern of COVID-19 in some countries appears to have started a deceleration stage. It is recommended to restart as soon as the situation is under control and some tools exist for interpreting the ICU capacity under conditions of health system stress. However, there are no clear guidelines or a strategy to restart Bariatric...

Background: Obese patients (Ob) with a binge eating disorders (BED) behavior pattern have a higher prevalence of postprandial distress syndrome (PDS) compared to Ob without a BED behavior pattern, while an increase of PDS has been described in Ob after sleeve gastrectomy (SG). Hedonic response to a meal is dissociable from satiation in healthy sub...

Setting Tertiary-care referral hospital. Objectives Hiatal hernia repair (HHR) during Sleeve Gastrectomy (SG) is recommended when the defect is intraoperatively found; however, the long term effect on gastro-esophageal reflux disease (GERD) remains controversial. This study aimed to report the long term follow-up data, at least after 7 years, of S...

Background Revisional bariatric surgery (RBS) constitutes a possible solution for patients who experience an inadequate response following bariatric surgery or significant weight regain following an initial satisfactory response. This paper reports results from the first modified Delphi consensus-building exercise on RBS. Methods We created a comm...

Background Hiatal hernia (HH) is common in obese patients undergoing bariatric surgery. Preoperative traditional techniques such as upper gastrointestinal endoscopy (UGIE) or barium swallow/esophagram do not always correlate with intraoperative findings. High-resolution manometry (HRM) has shown a higher sensitivity and specificity than traditional...

Bleeding after bariatric surgery may occur during the operation or immediately after as a consequence of vascular or parenchymal injury related to laparoscopy or of failure after hemostasis at the suture line or anastomosis. Although the occurrence of bleeding is rare, it represents a true emergency and needs immediate diagnostic and therapeutic me...

Background Standardization of the key measurements of a procedure's finished anatomic configuration strengthens surgical practice, research, and patient outcomes. A consensus meeting was organized to define standard versions of 25 bariatric metabolic procedures. Methods A panel of experts in bariatric metabolic surgery from multiple continents was...

A case of acute colonic obstruction in an elderly patient is presented, with a brief discussion about peculiar aspects to pseudo-obstruction and particularly chronic idiopathic intestinal pseudo-obstruction (CIIP), in which it was classified by pathologists. Clinical and therapeutic implications of this classification are also discussed. In authors...

Background and aim: Several bariatric surgery worldwide surveys have been previously published to illustrate the evolution of bariatric surgery in the last decades. The aim of this survey is to report an updated overview of all bariatric procedures performed in 2014.For the first time, a special section on endoluminal techniques was added. Method...

IntroductionIn 2013, a worldwide bariatric surgery survey showed that laparoscopic adjustable gastric banding (LAGB) has been abandoned in favor of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-y gastric bypass (LRYGBP). PurposeThe aim of this study was to compare results of LRYGBP and LSG performed as a revisional procedure after...

Background: In one anastomosis gastric bypass (OAGB), the measurement of the afferent limb starting at the angle of Treitz may result in insufficient absorptive surface of the intestine of the remaining efferent limb. To address this concern, we recently modified the technique of OAGB by constructing the gastrointestinal anastomosis at a fixed dis...

Background: Bariatric surgery (BS) is known to favorably impact fasting lipid profile. Fasting and postprandial lipids were evaluated before and 2 years after BS in obese type 2 diabetic (T2DM) patients. Methods: A prospective study was conducted in 19 obese T2DM patients: ten undergoing sleeve gastrectomy (SG) and nine undergoing Roux-en-Y gast...

The aim of the work was to compare the hormonal and the metabolic mechanisms involved in weight loss and remission of T2DM one year after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) in morbidly obese type 2 diabetic (T2DM) patients. Insulin sensitivity, insulin secretion, and the gastrointestinal (GI) hormone response to a...

Laparoscopic adjustable gastric banding (LAGB) is generally safe and well tolerated but complications are not infrequent. As with all other bariatric procedures, there are patients who experience poor weight loss or even weight regain at long term follow up. Some of these complications require prompt management whereas more chronic problems require...

Several options are available after failed and/or complicated bariatric restrictive procedures as vertical banded gastroplasty and laparoscopic adjustable gastric banding. Laparoscopic Roux-en-Y gastric bypass seems at moment to be the best bariatric procedure in terms of safety and weight loss results as compared to other surgical procedures. Redo...

Background: Laparoscopic sleeve gastrectomy (LSG) is becoming the most performed bariatric procedure; however, data available on long-term follow-up are scanty. Objectives: The aim of the present study was to evaluate the 5-year efficacy of LSG on weight loss, gastroesophageal reflux disease (GERD) symptoms, and obesity-associated co-morbidities...

The first global survey of bariatric/metabolic surgery based on data from the nations or national groupings of the International Federation for the Surgery of Obesity and Metabolic Diseases (IFSO) was published in 1998, followed by reports in 2003, 2009, 2011, and 2012. In this survey, we report a global overview of worldwide bariatric surgery in 2...

Surgery for morbid obesity has been carried out since 1950s, but it was only after the introduction of biliopancreatic diversion by Scopinaro that the surgical approach to obesity gain worldwide consensus and diffusion [1, 2]. During the years, gastric restrictive procedures, malabsorptive or combined procedures were introduced in the bariatric sur...

Comparing the different possible surgical procedures and the results in urgent/emergency and in elective surgery for obstructing colorectal cancer. From 2008 we operated on 238 patients affected by colorectal cancer, 136 complicated tumours, 115 obstructing and 19 perforated. 23 patients had right-sided and 92 left-sided obstructing colonic tumour,...

Aims To evaluate the clinical efficacy of bariatric surgery vs medical therapy with liraglutide on weight loss, glycemic control and cardiovascular risk profile in patients with type 2 diabetes and severe obesity. Methods A retrospective evaluation was conducted in 31 patients with type 2 diabetes and severe obesity who had undergone bariatric s...

Bariatric surgery should be considered in the management of adult patients (age range 18–60 years) with severe obesity (BMI >40 kg/m2 or BMI >35 kg/m2 with comorbid conditions) who failed to lose weight or to maintain long-term weight loss, despite appropriate nonsurgical medical care, and are willing to participate in a postoperative long-term fol...

Class I obesity conveys an increased risk of comorbidities, impairs physical and mental health-related quality of life, and it is associated to an increased psychosocial burden, particularly in women. The need for effective and safe therapies for class I obesity is great and not yet met by nonsurgical approaches. Eligibility to bariatric surgery ha...

The first survey on worldwide diffusion of bariatric surgery was published by Scopinaro in 1998. After 15 years the bariatric surgery is changed. Surely this practice is more diffuse; physicians, surgeons, and institutions have more knowledge on the problems linked to obesity. Several new bariatric options were introduced into the armamentarium of...

The relationship between GI symptoms and obesity has yet to be completely clarified. Aim. To determine in a morbidly obese southern Italy adult population the prevalence of Functional Gastrointestinal Disorders (FGID) and its association with the presence of a Binge Eating (BE) behavior pattern. Methods. Consecutive obese patients eligible for bari...

Aim. Recent studies indicate that bariatric surgery (BS) leads to greater body weight loss and improvement of glucose control than medical treatment in patients with type 2 diabetes (DM2) and obesity. However, no study has compared BS with GLP-1 analogues, a novel class of hypoglycemic drugs that help achieve weight loss. The aim of this retrospect...

Bariatric surgery (BS) is able to positively influence fasting lipid profile in obese type 2 diabetic patients (T2DM), but no data is available on the impact of BS on postprandial lipid metabolism neither on its relation with incretin hormones. We evaluated the short-term (2 weeks) effects of BS on fasting and postprandial lipid metabolism in obese...

Background Obesity is an independent risk factor for gastroesophageal reflux disease (GERD), which is often associated with the presence of a hiatal hernia (HH). Despite increasing popularity of laparoscopic sleeve gastrectomy (LSG) in bariatric surgery, its effect on GERD is still unclear. The objective of this study was to evaluate the effect of...

Unlabelled: The relationship between GI symptoms and obesity has yet to be completely clarified. Aim: To determine in a morbidly obese southern Italy adult population the prevalence of Functional Gastrointestinal Disorders (FGID) and its association with the presence of a Binge Eating (BE) behavior pattern. Methods: Consecutive obese patients...

BACKGROUND: There are few studies of long-term outcomes for either laparoscopic adjustable gastric banding (LAGB) or laparoscopic Roux-en-Y gastric bypass (LRYGB). The objective of this study was to compare outcomes of patients randomly assigned to undergo LAGB or LRYGB at 10 years. METHODS: LAGB, using the pars flaccida technique, and standard LRY...

Background: Overweight and obesity independently increase cardiovascular risk, while even modest weight loss can result in clinically significant improvements in cardiovascular risk and reduce long-term mortality. Lowering the body mass index (BMI) threshold for bariatric surgery to those with moderate obesity might be one way to lower the burden...

Background: Laparoscopic sleeve gastrectomy (LSG) is an approved primary procedure for morbid obesity, but it is associated with serious complications, such as staple line leaks and bleeding. The objective of this study was to assess the effectiveness of staple line reinforcement (SLR) in reducing leaks and bleeding after LSG. Methods: A total o...

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are performed in patients with obesity and type 2 diabetes mellitus (T2DM). The aim of this study is to evaluate retrospectively the clinical efficacy of RYGB and SG in two groups of obese T2DM patients. From the hospital database, we extracted the clinical records of 31 obese T2DM patient...