To analyze the status and number of metabolic and bariatric surgery (MBS) in China in 2022.

Based on the Chinese Obesity and Metabolic Surgery Database (COMES Database), we analyzed the types and numbers of MBS and the mortality rate between January 1 and December 31 in 2022; and the numbers of bariatric surgeons and case managers, multidisciplinary team (MDT), and the database of each hospital. We also attempted to estimate the actual number of MBS in the country. The results were presented in the format of the previous annual reports. This study did not include data from the Hong Kong SAR, Macao SAR, and Taiwan region of China.

191 hospitals or centers participated in this study, covering 29 provinces (autonomous regions and municipalities) and 100 cities, with 27 001 cases. There were 26 474 (98.0%) laparoscopic surgeries, including 23 232 (87.8%) sleeve gastrectomy, 896 (3.4%) Roux-en-Y gastric bypass, 1 568 (5.9%) sleeve plus surgeries, 760 (2.9%) one-anastomosis gastric bypass / mini gastric bypass, and 11 (0.042%) fundoplication. One (0.004%) open surgery, 15 (0.1%) endoscopic / swallowing technique cases, 283 (1.0%) robotic-assisted surgery, 228 (0.8%) revisional surgery, and 3 (0.011%) deaths. The estimated total number of MBS was 30 071. There were 181 (94.8%) hospitals with 597 full-time bariatric surgeons and 158 (82.7%) hospitals with 259 full-time case managers. MDT was established in 162 (84.8%) hospitals, and 134 (70.2%) hospitals established a local MBS database.

The number of MBS has increased significantly in 2022. The most popular procedures were still laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). The numbers of LSG combined surgery, endoscopic surgery/swallowing technique and robot-assisted surgery decreased slightly compared with last year, but the revisional surgery still increased slightly. The number of full-time bariatric surgeons and case managers continues to grow. Adhere to the standardized management, improve the education and training system and the national database, strengthen the long-term follow-up of patients, in-depth exploration of emerging technologies, carry out national multi-center studies, and continue to promote the development of the field and quality improvement.

To analyze the status and number of metabolic and bariatric surgery (MBS) in China in 2023.

Based on the Chinese Obesity and Metabolic Surgery Database (COMES Database), we analyzed and estimated the types and numbers of MBS and the mortality rate between January 1 and December 31 in 2023, and the numbers of bariatric surgeons and case managers of each hospital. This study did not include data from the Hong Kong SAR, Macao SAR, and Taiwan region of China.

420 hospitals were included in this study, covering 31 provinces (autonomous regions and municipalities) and 173 cities, with a total estimated 37 249 cases. It was also estimated that there were 850 hospitals in the country, with 1 250 bariatric surgeons and 600 case managers involved in MBS. The top three most performed MBS were sleeve gastrectomy (SG, 30 352 cases, 81.5%), one-anastomosis gastric bypass (OAGB, 1 228 cases, 3.3%), Roux-en-Y gastric bypass (RYGB, 901 cases, 2.4%). Nine (0.02%) deaths were reported.

The number of MBS keep increasing in 2023. The most performed procedures were SG, OAGB and RYGB. It is important to pay attention to the trends of various procedures, strengthen clinical and research collaborations among centers, and promote standardization and quality improvement of MBS. We should focus on the obesity-related humanities, patient education, policy implementation, and international collaborations. This will enhance our influence and competitiveness in MBS globally and better equip us to address the obesity pandemic.

The concept of enhanced recovery after surgery (ERAS) has been widely applied in surgical practice. Bariatric and metabolic surgery has its complexity and particularity. It is necessary to develop the Chinese expert consensus on the ERAS principles in bariatric and metabolic surgery.

The Chinese expert consensus on enhanced recovery after surgery principles in bariatric and metabolic surgery (2021 edition) was built up based on the modified Delphi approach. We created a committee of 20 recognized experts in bariatric and metabolic surgery who were responsible for proposal, review and voting for the statements. The committee invited 56 bariatric and metabolic surgeons to vote on 42 statements concerning on ERAS with the total voters were 76 people. After two rounds of voting, the agreements amongst ≥70.0% were regarded as reaching consensus.

The agreement rate was less than 80% in 14 statements of the 42 statements in the first round voting. At the second round voting, no consensus was achieved in 6 statements. Thirty-six statements were considered achieving consensus.

Based on literature evidence and the specific situation of bariatric and metabolic surgery in China, the Chinese expert consensus on enhanced recovery after surgery principles in bariatric and metabolic surgery (2021 edition) was achieved. This expert consensus can be used as a reference for bariatric and metabolic surgeons in clinical practice.

This expert consensus aims to promote the construction and development of bariatric and metabolic surgery, make preoperative case management more standardized, and provide reference for preoperative clinical nursing work.

Experts and scholars from 33 hospitals or universities, who are experienced in case management, medical and nursing treatment of bariatric and metabolic surgery, formulate the expert recommendation committee. Six experts with more than three years of related experience in case management of bariatric and metabolic surgery are interviewed, and the main writers form the first draft of expert recommendations. Then the first round of discussion is completed by the 6 interviewed experts in the form of letter review. On this basis, 40 experts in relevant fields are invited to collect modification opinions on the revised expert recommendation in the form of letter review to complete the second round of expert discussion. Finally, consultants of the expert recommendation committee are invited to complete the third round of expert discussion and form the final draft of expert recommendation via online meeting.

This expert consensus includes case management content for patients before admission (pre-hospital consultation and notification content, pre-hospital health education and intervention, pre-hospital bed reservation) and after admission (data collection and admission introduction, examination and testing management, clinical care), and the preparation of a clinical pathway template document.

This consensus can provide reference for case management of preoperative clinical pathways of bariatric and metabolic surgery. In the future, regular updates will be made after further summarizing experience and accumulating evidence-based medical evidence to better serve the clinic.

To analyze the status and number of metabolic and bariatric surgery (MBS) in China in 2021.

Based on the Chinese Obesity and Metabolic Surgery Database (COMES Database), we analyzed the types and numbers of MBS and the mortality rate between January 1 and December 31 in 2021; and the numbers of bariatric surgeons and case managers, multidisciplinary team (MDT), and the database of each hospital. We also attempted to estimate the actual number of MBS in the country. Data from Hong Kong SAR, Macao SAR, and Taiwan region of China were not included in this study.

A total of 180 hospitals or centers participated in this study, covering 29 provinces (autonomous regions and municipalities) and 88 cities, with 23 040 cases. There were 22 331 (96.9%) laparoscopic surgeries included 18 533 (83.0%) sleeve gastrectomy, 1 297 (5.8%) Roux-en-Y gastric bypass, 1 894 (8.5%) sleeve plus surgeries, 507 (2.3%) one-anastomosis gastric bypass / mini gastric bypass, and 93 (0.4%) fundoplication. One (0.004%) open surgery, 58 (0.3%) endoscopic / swallowing technique, 433 (1.9%) robotic-assisted surgery, 217 (0.9%) revisional surgery, and 5 (0.02%) deaths. The estimated total number of MBS was 25 208. There were 164 (91.1%) hospitals with 513 full-time bariatric surgeons and 141 (78.3%) hospitals with 242 full-time case managers. MDT was established in 146 (81.1%) hospitals, and 100 (68.5%) hospitals established a local MBS database.

The number of MBS increased significantly this year. The most popular procedures are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). The numbers of LSG plus surgery, endoscopic / swallowing techniques, robot-assisted surgery, and revisional surgery are increasing. The numbers of full-time bariatric surgeons and case managers are also growing. Our future priorities will be strengthening the continuing education and training of medical professionals, surgical safety and quality management, long-term follow-up of patients, clinical data integrity, scientific research translation, and local and global academic exchanges.

Formulating the Chinese expert consensus on case management of bariatric and metabolic surgery (2022 edition) to promote the standardized development of case management of bariatric and metabolic surgery in China.

Based on a systemic literature review of source of case management, international case management model, assessment content for international certified bariatric nurse, guideline and consensus on perioperative management of bariatric and metabolic, and interviewing 7 specialist with >5 years case management experience in bariatric and metabolic, the initial draft of Chinese expert consensus on case management of bariatric and metabolic surgery (2022 edition) was conducted and the first round of expert demonstration on the initial draft was completed. After modified the initial draft according to expert opinions, a total of 37 experts in related fields was invited and the second round of expert demonstration on the modified draft was completed. The final draft of Chinese expert consensus on case management of bariatric and metabolic surgery (2022 edition) was conducted.

The Chinese expert consensus on case management of bariatric and metabolic surgery (2022 edition) includes 4 contents of the definition of case management, the management content of case manager, the model of case management and the effectiveness indicators of case management in bariatric and metabolic surgery.

The Chinese expert consensus on case management of bariatric and metabolic surgery (2022 edition) is scientific and practical which can provide professional guidance and reference for clinical practice of case management in bariatric and metabolic surgery.

To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on the glucose and lipid metabolism in patients with severe obesity and non-alcoholic fatty liver disease (NAFLD).

To retrospectively analyze the clinical data of 78 severely obese patients with non-alcoholic fatty liver disease, followed up for more than 1 year after operation. The change of body weight, glucose and lipid metabolism, liver function (aspartate aminotransferase, ALT; alanine aminotransferase, AST), average liver CT value and liver volume were compared.

The body weight, body mass index (BMI), waist circumference, and hip circumference of the patient decreased significantly compared with that before operation (P<0.01); fasting blood glucose, fasting insulin, glycosylated hemoglobin, and insulin resistance index were significantly improved (P<0.01); Cholesterol, triglyceride and low density lipoprotein were significantly improved (P<0.01); Liver function (ALT, AST) were significantly improved compared with that before operation (P<0.01). The average liver CT value (39.84±4.25) one year after operation was significantly higher than that before operation (22.34±6.64). The liver volume decreased from (1983.61±821.7) cm³ before operation to (1549.32±752.01) cm³ after operation, and the difference was statistically significant (P<0.01). Waist circumference and BMI were positively correlated with insulin resistance and liver volume, and negatively with liver CT value.

LSG can not only effectively reduce the weight of obese patients, improve glucose and lipid metabolism, but also has a significant effect on the treatment of NAFLD. For patients with severe obesity and NAFLD, LSG surgery is an effective treatment.

The prevalence of obesity in China is escalating year by year. A great deal of clinical evidences indicate that laparoscopic sleeve gastrectomy is able to significantly reduce the body weight and improve related metabolic syndrome in obese population. However, there is still no standardized surgical operation guidelines for laparoscopic sleeve gastrectomy in China. For this reason, Chinese Society for Metabolic and Bariatric Surgery initiated to draft the first edition of The clinical guideline for laparoscopic sleeve gastrectomy procedure for the purposes of specifying and standardizing the laparoscopic sleeve gastrectomy procedure, so as to provide a clinical guidance for the metabolic and bariatric surgery practice in China.

统计分析2020年中国肥胖代谢外科手术开展情况。

基于中国肥胖代谢外科数据库（COMES Database），精确统计分析2020年1月1日至2020年12月31日中国减重手术开展的种类、例数，以及专职人员、多学科团队（MDT）及院内数据库建设情况。以此为基础，经多种途径例如文献搜索、企业资料、医院及医护人员提供的信息等，综合推算2020年的减重手术情况。

全国共有138家医院及减重中心参与COMES数据库年度统计，地域涵盖32个省（自治区、直辖市、特别行政区）的62个城市，总手术量12837例，其中腹腔镜手术12514例（97.5%），包括袖状胃切除术10303例（82.3%）、胃旁路术922例（7.4%）、袖状胃联合手术1146例（9.2%）、OAGB/MGB手术100例（0.8%）、胃折叠术29例（0.2%）、BPD/DS手术6例（0.05%）。内镜减重手术13例（0.1%），机器人辅助手术128例（1.0%），修正手术182例（1.4%）。122家（88.4%）医院有专职减重外科医生（共387位），101家（73.2%）医院有专职减重个案管理师（共183位）。113家（81.9%）医院成立了MDT，85家（61.6%）医院建立了院内减重手术数据库。综合推算全国减重手术实际总数量约为14037例。

本年度全国减重手术总数量较2019年大幅度增加，主流手术仍是LSG和LRYGB；专职的减重外科医生及个案管理师人数也较前增加，大部分医院成立了MDT及建立了院内减重手术数据库。我们期待各中心基于庞大的病例基数，做好手术的安全质量管理、患者的长期随访及临床数据的完整性，产生更多高质量的临床研究成果，从而提高肥胖代谢外科的医疗质量及临床疗效，使广大患者受益。

The prevalence of obesity and type 2 diabetes mellitus (T2DM) has been increasing rapidly in China during the past decades. China now has the largest number of obesity and T2DM patients in the world. A great deal of clinical evidences indicate that laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) is able to significantly reduce the body weight of morbidly obese patients, improve T2DM and other obesity related co-morbidities. LRYGB has more than 14 years of history in China. However, there is still not a relevant procedural guideline for this procedure. For this reason, the Chinese Society for Metabolic and Bariatric Surgery (CSMBS) initiated the first edition of the The Procedural Guideline for Laparoscopic Roux-en-Y Gastric Bypass, in order to standardize laparoscopic Roux-en-Y gastric bypass surgical procedure, and to provide reference for surgeons practicing in the field.

Postoperative nausea and vomiting (PONV) is the most common adverse event following laparoscopic sleeve gastrectomy (LSG). The consensus is reached on the prevention and treatment of PONV following LSG to guide clinical practice.

Chinese Society of Diabetes and Bariatric Surgery of Chinese Research Hospital Associationorganizes experts of anesthetists and bariatric surgeonsfamiliar with relevant studies in the field of PONV to write the consensus of prevention and treatment of PONV following LSG to on the published clinical research evidencesand combined with clinical experience. Thirty experts ofanesthesia and bariatric surgery are invited to review the consensus, and the corresponding author sort out expertopinions andcomplete the consensus finally.

The consensus is established on the PONV risk factors, measurements to reduce the risk of PONV, relationship between PONV and LSG and prevention and treatment of PONV following LSG.

Expert consensus on the prevention and treatment of postoperative nausea and vomiting after laparoscopic sleeve gastrectomy (2022 edition) aims to strengthen the attention of bariatric and metabolicsurgeonson the prevention and treatment of PONV after LSG, promote relevant clinical research, reduce the incidence of PONV, ensure surgical safety, and increase patient satisfaction.