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.

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.

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.

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 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.

To analyze the status and number of metabolic and bariatric surgeries (MBS) in China in 2024.

Surgical volumes, procedure distribution, and workforce scale were estimated through integrated synthesis with multi-source data cross-validation, based on the Chinese Obesity and Metabolic Surgery Database (COMES Database). This study did not include data from the Hong Kong SAR, Macao SAR, and Taiwan region of China.

190 hospitals were included in this study, covering 29 provinces (autonomous regions and municipalities) and 75 cities, with a total estimated 32 342 cases. It was also estimated that there were 970 hospitals in the country, with 1 430 bariatric surgeons and 800 case managers involved in MBS. The top three most performed MBS were sleeve gastrectomy (SG, 24 443 cases, 75.6%), Roux-en-Y gastric bypass (RYGB, 1 250 cases, 4.7%), one-anastomosis gastric bypass (OAGB, 1 234 cases, 3.8%), and 4 (0.017%) deaths reported.

The number of MBS decreased by 13.2% in 2024. The most performed procedures were SG, RYGB and OAGB. We should leverage the national "Weight Management Year" initiative to develop an integrated multidisciplinary care system for weight management. This requires strengthening standardized training programs, promoting multicenter clinical research, and enhancing international collaborations. Such efforts will advance the discipline’s sustainable development, elevate clinical standards, and expand its global standing.

To explore the effect of body mass index (BMI) of elderly stroke patients on rehabilitation process and their rehabilitation outcome after stroke.

From January 2018 to December 2019, a total of 95 patients were hospitalized for stroke due to stroke in our hospital. The patients were divided into three groups according to their body mass index (BMI), of which 18.5 kg/m²≤BMI<25 kg/m² was normal group (n=40), 25 kg/m²≤BMI<30 kg/m² was hyper-recombination (n=37), BMI≥30 kg/m² is obese group (n=18). The Barthel index score, Ashworth scale score, Fugl-Meyer upper extremity motor function score and Brunel balance score of the three groups of patients were recorded before, after and 3 months after rehabilitation intervention.

There was no statistically significant difference in Barthel index score, Ashworth scale score, Fugl-Meyer upper extremity motor function score and Brunel balance score before intervention in the three groups (P>0.05). The Barthel score, Fugl-Meyer score and Brunel balance score of the obese group after intervention and 3 months of intervention were significantly lower than those of the super-recombinant and normal groups (P<0.05), while the Ashworth scores of the hands, forearms and lower limbs of the obese group were significantly higher normal group and super reorganization (P<0.05).

The BMI index of overweight and obesity impact the rehabilitation process of stroke patients, and affects the rehabilitation of life ability, limb function and balance.

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.

To summarize the application value of rapid rehabilitation surgical measures in the surgery of weight loss and metabolic diseases by implementing various enhanced recovery after surgery (ERAS) measures in the perioperative period of weight loss metabolic surgery.

the clinical data of 91 patients with obesity or type 2 diabetes treated in the Department of weight loss and Metabolic Diseases, Xiaolan Hospital affiliated to Southern Medical University from January 2015 to January 2018 were retrospectively analyzed. According to the principle of random grouping, patients who received rapid rehabilitation measures during perioperative period were included in the rapid rehabilitation surgery group (ERAS group), while patients who only used traditional perioperative measures in gastrointestinal surgery were included in the control group. The differences of postoperative pain score, anal exhaust time, complications, average hospitalization time,total hospitalization cost, weight loss effect, rehospitalization rate and reoperation rate between the two groups were compared, and the application value of ERAS in weight loss metabolic surgery was analyzed and discussed.

The NRS score of postoperative pain in the ERAS group was lower than that in the control group (3.81.2) vs. (6.41.5), P<0.05). The postoperative anal exhaust time was shortened (1.0 ±0.3) d vs. (1.9 ±0.7) d, P<0.05). There were no serious complications, the postoperative hospital stay was shorter (6.4 ±1.3) d vs. (13.7 ±1.5) d, P<0.05), and the hospitalization cost was reduced (46813 ±3070) ￥ vs. (66973 ±4520)￥, P<0.05. The average rate of excess weight loss 1 year after operation in both groups was more than 80%.

In the perioperative period of weight loss and metabolic surgery, the implementation of rapid rehabilitation measures is superior to the traditional mode, which can significantly shorten the time of hospitalization, reduce postoperative complications, rapid recovery and save cost, and has outstanding application value.

To explore the relationship between the expression level of Omentin-1 in children and obesity and insulin resistance.

A total of 86 children who underwent physical examination Maternal and Child Health Hospital of Yangchun, Guangdong from February 2018 to December 2019 were selected, including 43 obese and normal children each. The serum Omentin-1 expression levels of all children were detected and analyzed. The waist-hip ratio, muscle mass, fat-free weight, body fat percentage, visceral fat area and basal metabolic rate, fasting blood glucose and insulin levels were detected and analyzed, and the relationship between serum Omentin-1 and body mass index and insulin resistance was analyzed.

The serum Omentin-1 level in the obese group was significantly lower than that in the normal group, the difference was statistically significant (P<0.001). The waist-hip ratio, muscle mass, fat-free weight, body fat percentage, visceral fat area and basal metabolic rate in the obese group were significantly higher than those in the normal group (P<0.001). Serum Omentin-1 level was significantly negatively correlated with waist-hip ratio, body fat percentage, visceral fat area, fasting insulin and HOMA-IR (P<0.001).

Compared with normal weight children, serum Omentin-1 is significantly lower in obese children. Serum Omentin-1 levels are significantly negatively correlated with waist-hip ratio, body fat percentage, visceral fat area, fasting insulin and HOMA-IR.

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 study the therapeutic effect of microwave ablation and total endoscopic thyroidectomy in the treatment of benign thyroid nodular disease in overweight patients.

I120 patients who were diagnosed as benign unilateral thyroid nodul and treated in our hospital from May 2017 and May 2018 were randomly divides into total endoscopic thyroidectom group and microwave ablation group, body mass index (BMI) of all patients≥24 kg/m². The total endoscopic thyroidectom group (45 cases) were treated with total endoscopic thyroidectom and the microwave ablation group (75 cases) were treated with microwave ablation, and then compared the efficacy.

The operation time and the length of hospital stay of the microwave ablation group is lower than that of the therapy of the total endoscopic thyroidectom group, with lower blood loss and incidence of postoperative complications (P<0.05). Compared with the total endoscopic thyroidectom group, microwave ablation has less postoperative pain and less effect of thyroid function, with higher cosmetic score (P<0.05) . Finally, after 12 months of regular follow-up of microwave ablation group, the decreasing rate of thyroid nodule is 43.7% and the shrinking rate of the volume of thyroid nodule is up to 87.9%, showing obvious therapeutic effect.

Microwave ablation for the treatment of patients with overweight thyroid nodules has the advantages of minimally invasive, less invasive, and high safety. It can significantly reduce postoperative pain and improve cosmetic evaluation, and can avoid affecting the thyroid function of patients. It is worthy of clinical application.