Global Variations in Practices After Bariatric and Metabolic Surgery; the PARTNER study

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Metabolic and bariatric surgery (MBS) has emerged as a cornerstone intervention for severe obesity and its associated comorbidities. Despite its efficacy, postoperative care and follow-up after MBS remains highly variable worldwide. Objective: The PARTNER study aimed to evaluate global clinical practices in the postoperative management following MBS by surveying multidisciplinary healthcare professionals . Methods: This study was an international online survey conducted between October 2024 and January 2025. A multidisciplinary team developed the questionnaire based on existing literature and international guidelines. The survey assessed five domains: follow-up care, postoperative treatment, dietary management, patient support, and measurement of surgical outcomes. Responses were analysed descriptively. Results: A total of 262 responses were received from 62 countries. Most respondents were bariatric surgeons (72.1%) working in public healthcare systems (73.3%). While 78.7% reported conducting three-month postoperative reviews, only 23.7% offered indefinite follow-up. Hybrid models of care (virtual and in-person) were common (56.9%). VTE prophylaxis and postoperative PPI use were recommended by 64.1% and 84.3% respectively. Nearly all respondents (98.1%) provided dietary advice, with protein and micronutrient supplementation widely endorsed. Only 56.1% routinely referred patients for psychological follow-up. Definitions of surgical success and failure varied widely, with inconsistent objective outcome measures. Conclusion: The PARTNER study reveals significant international variation in postoperative management practices following MBS. These findings underscore the need for more standardized, evidence-based guidelines to improve long-term outcomes and equity of care worldwide. Bariatric and metabolic surgery postoperative care follow-up Key Points Study highlights substantial global variation in postoperative practices following metabolic and bariatric surgery Many aspects of care, including pharmacological prophylaxis and psychological follow-up, lack consensus Definitions of surgical success and failure remain inconsistent across international centres Findings support the need for international, multidisciplinary collaboration to standardize care Introduction Global obesity rates have surged in recent decades; in 2024 the Non-Communicable Disease Risk Factor Collaborative (NCD-RisC) estimated that more than 1 billion people in the world were living with obesity with a further 2 billion living with overweight 1 . Obesity-attributable deaths now surpass those related to starvation 2 . As a result, metabolic and bariatric surgery (MBS) has become a cornerstone in the management of severe obesity and obesity-related comorbidities, including type 2 diabetes mellitus (T2DM), hypertension, and dyslipidaemia 3 – 4 . It is now a widely accepted intervention, with the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) reported that in 2021 over 500,000 MBS procedures were performed annually 5 – 8 . Initially indicated for severe obesity (BMI ≥ 35 kg/m²), MBS has since been recognised for its significant metabolic benefits, particularly in patients with comorbidities such as type 2 diabetes mellitus (T2DM), where remission has been observed independent of weight loss 5 – 7 , 9 – 10 . Despite its demonstrated efficacy, postoperative management of bariatric surgery remains inconsistent globally, with considerable variability in clinical practices and follow-up care. 11 – 15 Although the 2022 updates to the ASMBS and IFSO guidelines sought to standardize MBS indications and emphasize comprehensive preoperative assessments, discrepancies persist in postoperative protocols. 16 The variability in global practices can be attributed to the limited evidence regarding the optimal management of patients following metabolic and bariatric surgery (MBS). To establish a clearer framework for postoperative care, it is essential to gain a deeper understanding of the practices currently implemented in different countries. This article presents the results of an extensive global survey conducted among healthcare professionals involved in MBS, highlighting significant variations in postoperative approaches, including diagnostic procedures, management strategies, and the criteria used to assess surgical outcomes. Material and Methods Survey Design An online questionnaire, p ractices a fter ba r ia t ric a n d m e tabolic su r gery study (PARTNER study), was designed by a multidisciplinary team which included professionals from global Metabolic and Bariatric Surgery units. The survey was constructed using Microsoft Forms™. It was based on insights gathered from a comprehensive literature review and an examination of international guidelines concerning postoperative care following bariatric surgery. The initial draft of the questionnaire was revised by the multidisciplinary team members to ensure the questions were appropriately adapted for data categorisation, collection, and subsequent analysis. The selected statements covered the following 5 key areas relating to postoperative care following MBS; Follow-up after Metabolic and Bariatric Surgery (including guidelines applied; type, frequency and duration of follow-up; postoperative investigations) Post-operative Treatment: VTE Prophylaxis, PPI Prophylaxis, and UDCA Use Post-Operative Diet following MBS (including recommended dietary supplements; nutritional screening) Post-operative Support Surgical Outcome Measures A complete version of the questionnaire with all responses is included in Appendix 1. Survey Distribution The survey was disseminated to professionals involved in multidisciplinary bariatric surgical services worldwide. Target audience included any member of the Metabolic and Bariatric Surgery MDT including bariatric surgeons, nurse specialists, physicians in related sub-specialties (e.g. endocrinology), psychologists, dietitians and MDT coordinators. To further promote participation, the survey was also advertised on social media channels. Participation in the survey was voluntary, and responses were anonymised for analysis. Monthly reminder emails and continued social media advertisements were used to maintain engagement throughout the data collection period, which lasted from October 20, 2024, to January 31, 2025, based on the rate of responses. Survey Analysis and Statistics Following data collection, responses were exported into a Microsoft Excel (Redmond, Washington, USA) spreadsheet for analysis. The study adhered to the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines, and a completed checklist is provided in Appendix 2. Analysis was conducted using Microsoft Excel. Data from the questionnaire are presented as percentages. Results Healthcare Facility and Role in the Metabolic and Bariatric Surgery MDT A total of 262 participants responded to the survey from 62 countries. Most respondents (55%) worked in public healthcare facilities, while 19% exclusively worked in private facilities. A smaller proportion (23.3%) worked in both public and private settings. The survey included respondents working in the bariatric tourism sector (1.9%). The remainder (2%) did not declare their healthcare facility. In terms of roles within the multidisciplinary team (MDT); most respondents were bariatric surgeons (72.1%), followed by case managers/coordinators (6.9%). Other roles, including dietitians, endocrinologists, psychologists, and researchers, were less commonly represented (Table 1 ). Follow-up After Metabolic and Bariatric Surgery (MBS) Guidelines although diverse were frequently used with only 1.1% of respondents reporting not following guidelines. The guidelines used for follow-up after MBS were diverse, with the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) guidelines being the most applied (64.5%), followed by the American Society of Metabolic and Bariatric Surgery (ASMBS) guidelines (46.6%). Most respondents (78.7%) follow-up with patients 3 months post-surgery, with similar frequencies observed at 6 months (78.0%) and annually (78.3%) (Table 2 ). Follow-up durations varied; 37.4% of respondents reported a follow-up time between 1 and 4 years. 23.7% of respondents following up patients indefinitely within the bariatric team. 35.1% of respondents reported follow up time periods of 6 months or less and 1.9% of respondents reported no follow up. Many respondents (56.9%) utilised a hybrid approach to follow-up combining both virtual and in-person visits, while 39.7% conducted in-person follow-ups and 3.1% used virtual follow-ups only (Table 2 ). Post-Operative Treatment: VTE Prophylaxis, PPI Prophylaxis, and UDCA Use A significant proportion of respondents (64.1%) routinely recommended pharmacological VTE prophylaxis for all patients and 67.2% also recommended non-pharmacological VTE prophylaxis. 1.9% did not use pharmacological VTE prophylaxis. The majority of those who prescribed pharmacological VTE prophylaxis did so for variable durations depending on risk stratification, 22.2% prescribed only whilst in hospital, 19.1% for 7 days or less, 17.9% for 8–14 days and 17.6% recommending it for more than 14 days after surgery (Table 3 ). For PPI prophylaxis, 84.3% of respondents recommended it for all patients, with 83.7% initiating treatment immediately after MBS. Pantoprazole (23.3%) and omeprazole (22.5%) were the most prescribed PPIs. The majority (48.5%) recommended a daily dose of 40mg, with a substantial portion (51.5%) recommending a duration of 3 months or less. A further 25.2% of respondents recommended 3–5 months (Table 3 ). A smaller portion of respondents (32.1%) recommended ursodeoxycholic acid (UDCA) for all patients, typically starting treatment immediately after surgery (43.9%). 23.7% recommended UDCA selectively and 36.3% of respondents (36.3%) did not recommend UDCA use. 43.5% recommended a duration of 3–12 months (Table 3 ). Post-Operative Diet Following MBS Dietary advice was given to nearly all respondents' patients (98.1%) after MBS. The most common post-surgery diet was a liquid diet (76.3%), followed by semi-solid or solid diets for smaller groups. 10.7% of respondents provide selective dietary advice depending on the surgical procedure performed. Most patients (90.5%) met with a dietitian or nutritionist pre-operatively to discuss the post-operative diet. The duration of specific dietary recommendations varied, with 22.5% recommending a diet for less than three months, while 12.2% recommended lifelong dietary changes (Table 4 ). Post-operative nutritional screening was recommended routinely by 84.3% of respondents, with 62.6% advising protein supplementation for all patients. Protein supplementation was most recommended at 60g daily (28.3%), and 55.3% of respondents advised lifelong supplementation to patients (Table 4 ) A significant number of respondents (40.1%) did not recommend a specific timeline for when patients should resume alcohol consumption post-surgery. In contrast, 32.1% recommended waiting less than one month before drinking caffeine. 83.6% of respondents reported starting vitamin and mineral supplements with 1 month of surgery. 55.3% recommended this lifelong. Regarding objective scores used during follow-up, the Bariatric Analysis and Reporting Outcome System (BAROS) was the most frequently applied (34.7%), followed by the SF-36 Health Survey (27.9%) and the Beck Depression Inventory (13.4%) (Table 2 ). Blood tests were routinely carried out. There was much variation between frequency of blood monitoring (Table). 85.1% of respondents checking HbA1c, 75.7% checking serum fasting glucose and 78.3% performing nutritional screening. Other commonly checked blood tests included liver function (88.1%), renal function (84.0%) and lipid profiles (81.7%). Regarding investigations, upper GI endoscopy was included in routine follow-up for 50.0% of respondents, while abdominal ultrasound for gallbladder assessment was recommended for 49.2% of respondents, though some practices reported no routine investigations (27.1%). Post-Operative Support A significant number of respondents (82.2%) provided physical activity advice to all patients’ post-surgery. Screening for mood disorders (60.3%) and eating disorders (63.4%) were frequently conducted. However, only 56.1% recommended routine follow-up with a bariatric behavioural health professional with 27.1% advocating for ongoing psychotherapy. Support groups were offered to 61.9% of patients, with 43.5% recommending hybrid peer support (both face-to-face and virtual). Regarding emergency contact, 47.3% of respondents provided surgeon contact information, while 38.2% provided bariatric nurse or case manager contacts (Table 5 ). Measuring Surgical Outcomes The definition of "non-responders" after MBS varied widely. 21% defined non responder as less than 10% total weight loss (%TWL), 16.4% defined non responder as less than 15% total weight loss (%TWL). 31.3% defined non-responders as those with less than 20% total weight loss (%TWL). 11.1% did not measure %total weight loss. For % excess weight loss 15.7% did not routinely measure %EWL For those who did measure it, thresholds varied, but the most common definition of non-response was patients with less than 50% excess weight loss (%EWL)- 34.7% (Table 6 ). Discussion This study has highlighted notable variations in postoperative management and follow-up practices for patients undergoing metabolic and bariatric surgery worldwide. It is among the few international multidisciplinary studies that focus on postoperative care, assessment, and patient follow-up while also incorporating insights from specialists in the field. One factor contributing to the variation in postoperative metabolic and bariatric surgery (MBS) practices is the lack of universally accepted guidelines for bariatric surgery teams and a lack of adherence to those that are available 16 . This is evident in the diverse guidelines followed by respondents, with the IFSO guidelines being the most commonly used (64.5%), followed by the ASMBS guidelines (46.6%). Additionally, 78.6% of respondents reported relying on local MBS society guidelines, national government-approved protocols, or similar frameworks for patient follow-up. One respondent reported that they use the British Obesity and Metabolic Surgery Society Guidelines specifically to guide postoperative blood monitoring. 17 These variations may partly be due to differences in resource availability across countries 11 , 18 , 19 . Many respondents cited limitations in government healthcare funding as a key barrier, noting that while they would prefer to offer more comprehensive postoperative care, financial constraints restrict their ability to do so. Follow-up after MBS: the Role of the Multidisciplinary Team, Diet and Patient Support Following bariatric surgery, long-term follow-up is critical to ensuring optimal patient outcomes by monitoring nutritional status, managing comorbidities, and supporting sustained weight loss 21 – 23 . Both the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) emphasise the importance of structured, multidisciplinary postoperative care 16 . Their recommendations suggest frequent follow-ups within the first year, with visits scheduled at one week, one month, three months, six months, and twelve months post-surgery to assess recovery, nutritional intake, and potential complications. Beyond the first year, annual follow-ups are generally advised to evaluate weight maintenance, nutritional health, and the emergence of late complications. These recommendations align with current clinical practice trends, as demonstrated by our study in which 78.7% of practitioners reported conducting follow-ups at three months, with similar adherence rates at six months (78.0%) and annually (78.3%). Furthermore, while 23.7% of bariatric teams provided indefinite follow-up, a hybrid model combining virtual and in-person visits was the most common approach (56.9%). The reported application of validated assessment tools such as the Bariatric Analysis and Reporting Outcome System (34.7%) and the SF-36 Health Survey (27.9%) further supports the structured approach advocated by ASMBS and IFSO. The comprehensive, multidisciplinary approach to postoperative MBS care involves a diverse team of healthcare professionals, each playing a vital role in optimising patient outcomes 21 – 23 . Surgeons oversee recovery and manage any procedural complications, ensuring a smooth healing process. In terms of emergency contact, 47.3% of respondents provided direct access to a surgeon, while 38.2% designated a bariatric nurse or case manager as the primary point of contact, highlighting the collaborative nature of postoperative support. Dietitian support is a fundamental component of postoperative care for patients undergoing metabolic and bariatric surgery (MBS), as dietary modifications and nutritional monitoring are critical for long-term success 24 – 25 . Following surgery, patients must adapt to significant changes in their eating habits and nutrition, which can be challenging due to altered gastric anatomy and the need for long-term dietary modifications. Nearly all patients (98.1%) received dietary counselling post-surgery, with the majority (90.5%) engaging with a dietitian preoperatively to discuss postoperative nutrition. Research emphasises that ongoing dietitian involvement is essential for optimising weight loss outcomes, preventing nutrient deficiencies, and supporting the development of healthy eating behaviours 24 – 27 . This is reflected by our findings in which post-operative nutritional screening was recommended routinely by 84.3% of respondents but routinely performed by only 78.3% of respondents. Additionally, dietitian-led interventions have also been shown to address complications such as dehydration, constipation, and dumping syndrome, which are common after certain bariatric procedures 26 , 28 . Mental health professionals, including psychologists and psychiatrists, offer essential support in managing postoperative psychological challenges, such as body image issues and disordered eating behaviours. A systematic review and meta-analysis concluded that there was no significant improvement in mental health quality of life for patients undergoing bariatric surgery compared to those receiving non-surgical interventions 29 . These findings suggested that despite the physical health benefits MBS showed no benefit to mental health over non-surgical treatments 26 . The study concluded that patients undergoing MBS are often characterised by high-risk baseline psychosocial profiles and therefore should receive intensive mental health follow-up as a routine component of postoperative care 29 . The importance of psychological follow-up was reflected in the current worldwide clinical practice with 60.3% of our respondents routinely screening for mood disorders and 63.4% for eating disorders postoperatively. Other studies have identified specific psychopathological factors, such as binge eating disorder, as a predictor of poor post-operative outcomes 30 . Preoperative mental illness was also found to result in lower long-term weight loss and an increased risk of weight regain after bariatric surgery 31 . and increased presentations to metal health services were also recognised following MBS 32 .Despite this, only 56.1% recommended routine follow-up with a bariatric behavioural health professional with 27.1% advocating for ongoing psychotherapy. Support groups were offered to 61.9% of patients, with 43.5% recommending hybrid peer support (both face-to-face and virtual). A significant number of respondents (82.2%) provided physical activity advice to all patients’ post-surgery. The impact of formal exercise training is supported with habitual physical activity being shown to play an important role in the long-term weight maintenance as well as greater improvements in body composition and overall physical fitness 33 – 36 . Post-Operative Treatment: VTE Prophylaxis and PPI Prophylaxis Venous thromboembolism (VTE) remains a significant concern following metabolic and bariatric surgery (MBS) due to factors such as obesity, prolonged operative times, and postoperative immobility. The American Society for Metabolic and Bariatric Surgery (ASMBS) underscores the necessity of a VTE risk assessment for all patients undergoing MBS with risk of VTE being reported to be as high as 4% in selected patients undergoing MBS 37 , 38 . ASMBS advocate for a combination of mechanical methods, like intermittent pneumatic compression devices, and pharmacologic agents, such as low-molecular-weight heparin (LMWH) 37 . ASMBS caveat their statements by acknowledging that there is a lack of robust data on this particular issue 37 , 39 . Risk stratification is pivotal in tailoring prophylactic strategies; patients with additional risk factors—including advanced age, prior VTE history, or obesity-related comorbidities—may benefit from extended anticoagulation therapy 40 – 41 . In clinical practice, 64.1% of surveyed practitioners routinely prescribe pharmacological VTE prophylaxis for all patients, while 67.2% incorporate non-pharmacological measures. These numbers are significantly lower than those reported in another international survey published in 2023, they reported that both mechanical and chemical VTE prophylaxis was used by 97.1% of the participants, knee-high compression devices by 84.7% 39 .However, this study specifically targeted Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited centres which possibly leads to a biased view of overall worldwide practices 42 . Among those respondents recommending pharmacological prophylaxis, 17.6% suggest continuation beyond 14 days post-surgery, highlighting the emphasis on individualized patient care. Despite the critical role of VTE prophylaxis, concerns about bleeding risks and determining the optimal duration of treatment persist, underscoring the need for personalized approaches. Proton pump inhibitors (PPIs) are commonly employed to mitigate acid-related complications, such as gastro-oesophageal reflux disease (GORD) and marginal ulcers, following MBS procedures like Roux-en-Y gastric bypass (RYGB). The ASMBS recommends routine postoperative PPI prophylaxis for all patients after RYGB and other anastomotic MBS procedures for at least 90 days to significantly reduce the risk of marginal ulcers 37 , 43 . In practice, 84.3% of respondents advocate for PPI prophylaxis universally, with 83.7% initiating treatment immediately after MBS. These numbers are similar to a dedicated survey carried out by the ASMBS Research Committee which reported PPIs were prescribed by 85.4% of the 112 surveyed surgeons to all patients during their hospitalisation 44 . Another international study conducted in 2022 also reported that > 90% of experts prescribe postoperative acid suppression medications following MBS 45 . This survey also reported that life-long proton pump inhibitors prophylaxis was also recommended in smokers (66%) and recommendation to avoid non-steroidal anti-inflammatory drugs (73%) following any type of gastric bypass 45 . Pantoprazole (23.3%) and omeprazole (22.5%) are the most frequently prescribed PPIs, commonly administered at a daily dose of 40 mg. The duration of prophylaxis varies, with 28.6% recommending treatment for less than three months. While short-term PPI use is beneficial, prolonged therapy has been associated with adverse effects, including micronutrient deficiencies such as magnesium and vitamin B12 46 . Therefore, ongoing evaluation of PPI necessity is essential to balance therapeutic benefits with potential risks. Outliers in Postoperative Care: Variability and Gaps in Private Practice A small subset of respondents (5 out of 262; 1.9%) indicated that they did not provide routine postoperative follow-up for their patients. Interestingly, although this group endorsed early postoperative nutritional screening and supplementation—typically within one month of surgery—they did not implement these measures in their own practice. They also reported using pharmacological VTE prophylaxis either immediately postoperatively or only during the inpatient stay. While this represents a minority, the deviation from standard postoperative protocols—such as follow-up care, dietitian input, nutritional support, and VTE prevention—is noteworthy. All five respondents were based in private practice, with one primarily treating international patients. However, among the four other respondents also caring mainly for overseas patients, no consistent pattern emerged. This variation in postoperative care highlights the need for clear, standardized guidelines to promote consistent and high-quality management for all bariatric patients globally. Limitations One limitation of our study is the inability to validate the submitted responses against actual clinical practices within individual units. Furthermore, due to the anonymous nature of the questionnaire, we are unable to determine an exact response rate. Despite these constraints, the primary aim was to explore variations in international practice. With 262 responses received from 62 different countries or regions, we believe our findings offer a reasonable representation of global practice patterns. Conclusion This study highlights the considerable variability in postoperative management following metabolic and bariatric surgery (MBS) across different healthcare settings worldwide. Despite international guidelines aiming to standardise follow-up protocols, significant discrepancies persist in areas such as nutritional monitoring, psychological support, pharmacological prophylaxis, and long-term patient care. The findings underscore the need for further research and guidelines to establish evidence-based, universally accepted postoperative strategies that optimise patient outcomes. Future efforts should focus on improving access to multidisciplinary care, ensuring guideline adherence, and addressing barriers to comprehensive follow-up, particularly in resource-limited settings. By refining global best practices, healthcare providers can enhance the long-term success of MBS, improve patient quality of life and attempt to achieve equity for patients worldwide. Declarations Author Contribution W.Y., A.G.N.R., and D.C. contributed to the study concept, conducted the literature search, and prepared the primary statements. All listed authors made substantial contributions to the design of the survey and publicised the survey to increase participation. W.Y., A.G.N.R., and D.C. oversaw the entire process. D.C. analysed the data, generated figures, and wrote the primary manuscript. K.K.M. and O.G. revised the first draft of the paper critically for intellectual content. C.G., J.A.A.C. and D.C. adjusted formatting of the document suitable for submission. All listed authors participated in writing the paper and provided final approval of the submitted and published versions. Acknowledgement Authors would like to thank PARTNER Study Collaborators: Chén Qǐyūn, Case Manager/Coordinator, The First People's Hospital of Yunnan Province, Kunming, China; Dr Xin He, Bariatric Surgeon, Changchun Jiahe Surgical Hospital, Changchun City, Jilin Province, China; Dr Shu Jian, Bariatric Surgeon, The General Hospital of Hunan University of Medicine, Huaihua City, Hunan Province, China; Wang Ying, Case Manager, The Second People's Hospital of Zhengzhou City, Henan Province, China; Li Ruyu, Case Manager, Dehong Prefecture People's Hospital, Mangshi City, Yunnan Province; Zeng Lianlian, Case Manager, Weight Loss Center, The First Hospital of Changsha Changsha City, Hunan Province; Dr Yin Jianhui, Bariatric Surgeon, The First People's Hospital of Kunming City, Yunnan Province, China; Liu Yi, Director of MDT, The First Affiliated Hospital of Nanchang University, Nanchang, China; Qiu Yanyu, Nurse in Charge, The First People's Hospital of Huaian City, Jiangsu Province; Zhu Yifeng, Case Manager, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Li Huiqi, Bariatric Surgeon, The First Affiliated Hospital of Xi'an Medical University, Baoji City, Shaanxi Province, China; Zhou Lingling, Specialist Nurse, The First People's Hospital of Huaian City, Jiangsu Province, China; Ding Mingxing, Director of MDT, Weight Loss Center Changchun City, Jilin Province, China; Zhang Huiqin , Director of MDT, The First Affiliated Hospital of Xiamen University, Fujian Province, China; Dr Yosuke Seki, Bariatric Surgeon, Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube 7-7 Nibancho, Tokyo, Japan; Yongqian Cai, Case Manager, The Central Hospital of DaZhou city, SiChuan province, China; Yan Xueqiang, Bariatric Surgeon, Wuhan Children’s Hospital, Wuhan, China; Xiuying Li, Case Manager, The Central Hospital of DaZhou City, SiChuan Province, China; Xing Dong, Bariatric Surgeon, Henan Province, China; Xiaocheng Zhu, Leader of MDT, The Affiliated hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China; Wanying Shi, Dietician, The First Hospital of China Medical University, Shenyang, Liaoning Province, China; Vice Professor, Xiaogang Li, Bariatric Surgeon, Affiliated Hospital of Yunnan University, Kunming, Yunnan Province, China; Dr Yuntong Guo, Bariatric Surgeon, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China; Prof. Rodolfo J. Oviedo, Medical Director, Nacogdoches Medical Center, Nacogdoches, Texas, USA; Shangguan Changsheng, Director of MDT, Wuhan Sixth Hospital, Hubei, China; Dr Hosam Mohamed Elghadban, Bariatric Surgeon, Ibra Hospital, Ibra city, Oman; Rui Tao, Bariatric Surgeon, The Affiliated Bishan Hospital of Chongqing Medical University, Chongqing City, China; Professor Oktyabr Teshaev Ruxillayevich, Bariatric Surgeon, Tashkent Medical Academy, Tashkent, Uzbekistan; Professor Yang Fan, Researcher, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Professor Wu Jianjun, Bariatric Physician ,2nd affiliated hospital of Harbin medical university, Harbin, Heilongjiang, China; Professor Thejana Kamil Wijeratne, Bariatric Surgeon, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; Professor Shahrad Taheri, Bariatric Physician, Hamad Medical Corporation, Doha, Qatar; Professor Dr Kenneth YY Kok, Bariatric Surgeon, Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Brunei; Professor Abdullah Şişik, Bariatric Surgeon, Gedik University, Istanbul, Turkey; Prof. Gianluca Vanni, Bariatric Surgeon, University of Rome Tor Vergata, Roma, Italy; Prof. Francesco Saverio Papadia, Bariatric Surgeon, University of Genoa, Genoa, Italy; Prof. Dr. Shu Zhang, Bariatric Surgeon, Fudan University Shanghai Cancer Center, Shanghai, China; Prof. Dr. Rudolf Weiner, Bariatric Surgeon, Sana-Klinikum Offenbach, Offenbach, Hessen, Germany; Prof. Dr. Daniel Moritz Felsenreich, Bariatric Surgeon, Medical University of Vienna, Vienna, Austria; Prof. Dr. Tadeja Pintar, Bariatric Surgeon, UMC Ljubljana, Ljubljana, Slovenia; Prof. Christine Stroh, Bariatric Surgeon, SRH Muncipial Hospital Gera, Gera, Germany; Dr Marco Materazzo, Bariatric Surgeon, Tor Vergata University, Roma, Italy; Faiza Himasa Idris, Pharmacist, Getslim Bariatrics and Surgical Centre, Abuja, Nigeria; Dr Nimin Nanning, Bariatric Physician, Second Hospital Nanning, Guangxi, China; Mr Shayanthan Nanthakumaran, Bariatric Surgeon, Aberdeen Royal Infirmary, Aberdeen, Scotland; Mr Bassem Amr, Bariatric Surgeon, County Durham and Darlington NHS Foundation Trust, United Kingdom; Dr Mohamed Ali Chaouch, Bariatric Surgeon, Monastir University Hospital, Monastir, Tunisie; Dr Miljana Vladimirov, Head of Department Bariatric and Metabolic Surgery, University Bielefeld-Campus Lippe, Detmold, Germany; Dr Miguel Alejandro Miranda De León, Bariatric Surgeon, Cirugía bariatrica, Tamaulipas , México; Dr Fifso Taryel Omarov, Clinical Lead, Department of Surgical Disease, Azerbaijan Medical University, Azerbaijan, Baku; Dr Gang Li, Bariatric Surgeon, Union Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province, China; Dr Yu Li, Bariatric Surgeon, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China; Dr Suzanne Hedberg, Bariatric Surgeon, Sahlgrenska University Hospital, Gothenburg, Sweden; Dr Idan Carmeli, Bariatric Surgeon, Assuta Ashdod University Hospital affiliated to the Ben Gurion University of the Negev, Beer Sheva , Israel; Dr Guillermo Ponce de León Ballesteros, Bariatric Surgeon, Hospital Ángeles Morelia, Michoacán, México; Dr Vincenzo Schiavone, Bariatric Surgeon, Naples Federico II University, Naples, Italy; Lisheng Wu, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui province, China; Dr Junzhao Ye, Bariatric Physician, The first affiliated hospital, Sun yat-sen university, Guangzhou, Guangdong, China; Dr Jun Wang, Bariatric Surgeon, Tangshan Gongren Hospital, Tangshan City, Hebei Province, China; Guozhi Yin, Director of MDT, The first Affiliated Hospital of Xi 'an Jiaotong University, Xi'an, Shaanxi, China; Assistant Professor Abdullah AlMunifi, Bariatric Surgeon, Majmaah University, Al-Majmaah, Saudi Arabia; Dr Francesca Abbatini, Bariatric Surgeon, Ospedale dei Castelli, Ariccia, Rome, Italy; Dr Weiqiang Liu, Bariatric Surgeon, Shandong Second Provincial General Hospital, Jinan, Shandong Province, China; Dr. Mohammad Hayssam ElFawal, Director of MDT, Makassed General Hospital, Beirut, Lebanon; Dr. Jesús Antonio Gil, Bariatric surgeon, Obesity not for me, Tijuana, Baja California, México; Dr. Adisa Poljo, Bariatric Surgeon, University Digestive Health Care Center Basel - Clarunis Basel, Switzerland; Dr. Zoe Pafili, Dietician, Evangelismos General Hospital, Athens, Greece; Dr. Sonja Chiappetta, Bariatric Surgeon, Ospedale Evangelico Betania, Naples, Italy; Dr. Shadike Apaer, Bariatric Surgeon, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China; Dr. Sebastián Arana-Garza, Bariatric Surgeon, Christus Muguerza Hospital, Monterrey, Mexico; Dr. Philipp Beckerhinn, Bariatric Surgeon, Chirurgie Landesklinikum Hollabrunn, Niederoesterreich, Austria; Dr. mult. Sjaak Pouwels, Bariatric Surgeon, Marien Hospital Herne, University Hospital of Ruhr University Bochum, Herne, Germany; Dr. İsmail Çalıkoğlu, Bariatric Surgeon, Çalıkoğlu Bariatric and Metabolic Surgery Clinic, Istanbul, Şişli, Turkiye; Dr r. Frederik Lecot, Bariatric Surgeon, AZ Sint-Jan Hospital, Bruges, Belgium; Dr. EdS Gabriel A.Molina, Bariatric Surgeon, Universidad San Francisco, Quito, Pichincha, Ecuador; Dr. Chonin Cheang, Endocrinologist, Macau Yin Kui Hospital, Macau SAR, China; Dr. Bruno Dillemans, Bariatric Surgeon, AZ Sint-Jan Hospital, Bruges, Belgium; Dr. Abdulellah Niyaz, Bariatric Surgeon, Neuwerk Hospital in Moenchengladbach, Germany; Dr. Kin Hung Simon Wong, Bariatric Surgeon, CUHK medical Centre, Hong Kong SAR, China; Dr. Cihan Şahan, Bariatric Surgeon, İstanbul, Üsküdar, Turkey; Dr Muhammad Umar Younis, Bariatric Surgeon, Mediclinic City Hospital, Dubai, UAE; Dr Karin Dolezalova, Bariatric Surgeon, Faculty Hospital Vinohrady, Prague, Czech Republic; Dr Humberto Jimenez, Bariatric Surgeon, Clinica Colsanitas, Bogota, Colombia; Dr Gennaro Martines, Bariatric Surgeon, Azienda Ospedaliero Universitaria Policlinico, Bari, Italy; Dr Ala Wafa, Bariatric Surgeon, Gaddur medical center, Tripoli, Libya; Dr Roxanna Zakeri, Bariatric Surgeon, University College London Hospital, London, United Kingdom; Dr Ravi Rao Director of Surgey, Perth Surgical and Bariatrics, Perth, Australia; Dr Matthew Kroh, Bariatric Surgeon, Cleveland Clinic, Cleveland, Ohio, USA; Dr Luis Meza, Bariatric Surgeon, IntelliMed Cirugía, Mérida, México; Dr Kon Voi Tay, Bariatric Surgeon, Woodlands Health, Singapore; Dr Janey SA Pratt, Clinical Professor of Surgery, Stanford University School of Medicine, Palo Alto, California, USA; Dr Hu Songahao, Bariatric Surgeon, First affiliated hospital of Jinan University, Guangzhou, China; Dr Francesk Mulita, Bariatric Surgeon, General University Hospital of Patras, Achaia, Greece; Dr Daniel Leonard Chan, Bariatric Surgeon, St George Hospital, Kogarah, NSW, Australia; Dr Chun Hai Tan, Bariatric Surgeon, Surgicare Bariatric and General Surgery, Gleneagles Hospital, Singapore; Dr Bo Li, General surgeon, The First Hospital of Lanzhou University, Lanzhou Gansu Province, China; Dr Belinda De Simone, Bariatric Surgeon, Infermi Hospital, AUSL Romagna, Rimini, Italy; Dr Bing Yang, Gastrointestinal Surgeon, Central hospital affiliated to Shandong First Medical University, Ji‘nan, Shan Dong province,China; Dr Gabriel Alejandro Molina, Universidad San Francisco School of Medicine, Quito, Pichincha, Ecuador; Dr Silvana Leanza, General Surgeon, G. Giglio Institute, Cefalù, Palermo, Italy; Dr Omar Ghazouani, General Surgeon, Ospedale Santa Corona, Pietra Ligure, Savona, Italy; Dr Eleftherios Spartalis, Director of Surgery, REA Maternity Hospital, Athens, Greece; Dr Christine Stier, Endoscopist, University Medicine Mannheim, Heidelberg University, Germany; Dr Dimitris P. Lapatsanis, Chief Bariatric Surgeon, Bariatric and Metabolic Disorders Surgical Unit Athens Medical Center, Psychiko Clinic Athens, Greece; Professor Chetan Parmar, Bariatric Surgeon, Whittington Hospital + University College London, London, UK; Dr Arshad Ali, Bariatric Surgeon, Health department, Peshawar, Pakistan; Dr Adrian Marius Nedelcu Elsan, Bariatric Surgeon, Bouchard Private Hospital, Marseille, France; Dr Haval Saber Faqesmail, Bariatric surgeron, IQSMBS, Kurdistan, Iraq; Dr Athanasios G. Pantelis, Bariatric Surgeon, Athens Medical Group, Psychiko Clinic, Athens, Greece; Associate Professor Ruth Blackham, Department of Surgery, Notre Dame University, Perth, Western Australia; Assistant professor Abd-Elfattah Morsi Kalmoush, Bariatric Surgeon, Al-Azhar university, Cairo, Egypt; Assistant Prof Kanokkan Tepmalai, Bariatric Surgeon. Chiangmai University, Chiangmai, Thailand; Dr Arshad Ali, Bariatric Surgeon, Iran University, Tehran, Iran; Dr Andre Costa-Pinho, Bariatric Surgeon, São João Local Health Unit, Porto, Portugal; Dr Aikebaier Aili, Bariatric Surgeon, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, China; Dr Ahmad Ghazal, Bariatric Surgeon, Nabd Alhayat Centre, Aleppo, Syria; Prof Michael L Talbot, UNSW St George and Sutherland Clinical School, Sydney, Australia; Dr Gang Yang, Bariatric Surgeon, Zhangye Second People's Hospital, Zhangye City, China; Dr Jun Wang, Bariatric Surgeon, Tangshan Gongren hospital, Tangshan, China; Mr Qiongfeng Tan, Bariatric Surgeon, The Second People's Hospital of Yichang, Yichang, China; Dr Wang Hongmei, Bariatric Physician, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Professor Zhong Cheng, Bariatric Surgeon, West China Hospital, Sichuan University, Chengdu, China; Professor Nik Ritza Kosai, Bariatric Surgeon, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Dr Mudr Elias Liolis, Bariatric Surgeon, University General hospital of Patras, Rio, Greece; Dr Yuezhi Chen, Bariatric Surgeon, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China; Dr Jie Zhu, Bariatric Surgeon, The second people's hospital of Yibin, Yibin, China; Dr Adam Abu-Abeid, Bariatric Surgeon, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Dr Guangnian Ji, Bariatric Surgeon, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, China; Dr Lana Al-Sabe, Bariatric Surgeon, University of Jordan, Amman, Jordan; Dr Adrian Gerard, Bariatric Surgeon, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia; Dr Mei Hong, Deputy Chief Physician, Jilin City People's Hospital, Jilin City, China; Dr Muhammad Ismail Yar Khan Uttra, Bariatric Surgeon, Shalimar Hospital, Lahore, Pakistan; Dr Wenhui Liu , Deputy Chief Physician of the Department of General Surgery at Zhongshan Hospital in Hefei, China; Dr Chen Li, Researcher, First Affiliated Hospital of Guangxi Medical University, Nanning, China; Shuyin Guo, Deputy Chief Nurse, Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China; Professor Mauricio Zuluaga, Bariatric Surgeon, Universidad Del Velle / Hospital Universitario Del Valle / Clinica De Occidente, Cali, Colombia; Dr Adedire Timilehin Adenuga, Bariatric Surgeon, Getslim Bariatric center, Guzape, Nigeria; Dr. Jianli Han, Bariatric Surgeon, Shanxi Bethune Hospital, Tiayuan, China; Dr ChuanRong Zhu, Bariatric Surgeon, The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huaian, China; Professor Oral B. Ospanov, Bariatric Surgeon, Astana Medical University, Astana, Kazakhstan; Dr. Karl Peter Rheinwalt, Bariatric Surgeon, St. Franziskus Hospital Cologne, Cologne, Germany; Ms Patricia Castillo Vacaflor, Dietician, Comité de Cirugía Bariátrica, Santa Cruz, Bolivia; Dr Hang Tuo, Bariatric Surgeon, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi province, China; Dr Rob Snoekx, Bariatric Surgeon, Bariatrisch Centrum Zuid West Nederland / Bravis Hospital, Bergen op Zoom, The Netherlands; Mr Suhaib Ahmad, Bariatric Surgeon, Betsi Cadwaldr Health Board, Bangor, Wales; Dr Nozim Adxamovich Jumaev, Bariatric Surgeon, Tashkent Medical Academy, Tashkent, Uzbekistan; Dr Fabio Massimo Oddi, Bariatric Surgeon, University of Rome "Tor Vergata", Rome, Italy; Dr Tobias Van De Winkel, Bariatric Physician, AZ Sint-Jan, Brugge, Belgium; Dr Jose Giordano, Department of Surgery, Bariatric Surgeon, Clinica Indisa, Santiago, Chile; Dr Adelina Coturel, Cariatric Surgeon, Hospital del Bicentenario de Esteban Echeverria, Buenos Aires, Argentina; Dr Huhammed Said Dalkılıç, Bariatric Surgeon, Marmara University School of Medicine, Istanbul, Türkiye (Turkey); Dr Felipe Martin Bianco Rossi, Bariatric Surgeon, RR Médicos Cirurgiões, Santo André, Brazil; Dr Shekina Iyefu Adanu, Bariatric Physician, Getslim Bariatric and Surgical Centre, Abuja, Nigeria; Dr Jason Widjaja, Bariatric Surgeon, Sichuan University West China Hospital, Sichuan, China; Dr Donatas Danys, Bariatric Surgeon, Faculty of Medicine at Vilnius University, Vilnius, Lithuania; Dr Juan Francisco Ortega Puy, Bariatric Surgeon, Clínica Integral Bariátrica, Mexico City, Mexico; Dr Andrés Albán Rivas, Bariatric Surgeon, Hospital Universitario Semedic, Guayaquil, Ecuador; Dr Maria Lapeña-Rodriguez, Bariatric Surgeon, Hospital Clinico Universitario de Valencia, Valencia, Spain; Dr Guo Hou Loo, Bariatric Surgeon, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia; Dr Beniamino Pascatto, Bariatric Surgeon, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg; Dr Adam Abu-Abeid, Bariatric Surgeon, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Dr Jose Luis Calderón, Bariatric Surgeon, Mexicali, México; Associate Professor Wang Bing, Bariatric Surgeon, Chengdu Third People's Hospital, Chengdu, Sichuan, China; Associate Professor Muhammed Rasid Aykota, Bariatric Surgeon, Tekden Hospitals, Denizli, Türkiye; Associate Professor Jerry Dang, Bariatric Surgeon, Cleveland Clinic Lerner College of Medicine of Wase Western Reserve University, Cleveland, Ohio, USA; Associate Professor Mehmet Celal Kizilkaya, Bariatric Surgeon, Acibadem University Atakent Hospital, Istanbul, Türkiye; Assistant Professor Sahnoun Moez, Bariatric Surgeon, Interior Forces of Security Hospital, Marsa, Tunisia; Dr Yanxin An, Bariatric Surgeon, The First Affiliated Hospital of Xi 'an Medical College, Xi'an, Shaanxi province, China; Mr Isaiah Oluwasegun Atoyebi, Registered Dietician Nutritionist, Getslim Bariatrics and Surgical Limited, Guzape, Nigeria; Dr Xavier Sousa, Bariatric Surgeon, ULS Amadora, Portugal; Professor Guiqi Wang, Bariatric Surgeon, The First Hospital of Hebei Medical Univeristy, Shijiazhuang City, China; Dr Marius Nedelcu, Bariatric Surgeon, Centre de Chirurgie de l'Obésité, Bordeaux, France; Dr Ahmed Abokhozima, Bariatric Surgeon, Alexandria University, Cairo, Egypt; Dr Mohd Yaqoob Bhat, Bariatric Surgeon, Government Medical College Srinagar, Srinagar, India; Miss Jennifer Darrien, Bariatric Surgeon, Nuffield Health, Chester, UK; PD Dr med Tarik Delko, Bariatric Surgeon, Chirurgie Zentrum St Anna, Lucerne, Switzerland; Dr Faiz U Shariff, Bariatric Surgeon, Wellspan Bariatric Surgery, York, PA, USA; Dr Bernabé Matías Quesada, Bariatric Surgeon, Universidad de Buenos Aires, Buenos Aires, Argentina; Professor Corrigan McBride, Bariatric Surgeon, University of Nebraska Medical Centre, Nebraska, USA; Mr Islam Omar, Bariatric Surgeon, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Mr Simon Gibson, Consultant Bariatric Surgeon, NHS Greater Glasgow and Clyde, Glasgow, Scotland; Professor Javed Sultan, Bariatric Surgeon, Northern Care Alliance NHS Trust, Greater Manchester, England; Professor Helen Heneghan, Bariatric Surgeon, University College Dublin Medical School, Dublin, Ireland; Mr Andrew Beamish, Bariatric Surgeon, Swansea University, Swansea, Wales; Miss Katharine Hallworth-Cook, Specialist Nurse, Royal Berkshire NHS Foundation Trust, Berkshire, England; Professor Alexander Miras, Endocrinologist, Imperial College London, London, UK; Guangzhong Xu, Bariatric Surgeon, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, People’s Republic of China; Fathi Elzowawi, Bariatric Surgeon Specialist, Misurata Medical Centre, Misrata, Libya; Dr Omar Paipilla, Bariatric Surgeon, Hospital Ciba, Tijuana, Mexico; Dr Natan Zundel, Bariatric Surgeon, Herbert Wheitmer College of Medicine, Miami, USA; Mr Bassem Amr, Consultant Bariatric and UGI surgeon, County Durham and Darlington NHS Foundation Trust, UK. 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Finks, J.F., English, W.J., Carlin, A.M., et al. (2012) 'Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative', Annals of Surgery . 2012; 255(6): 1100–4. Aminian, A., Vosburg, R.W., Altieri, M.S., Hinojosa, M.W. and Khorgami, Z. 'The American Society for Metabolic and Bariatric Surgery (ASMBS) updated position statement on perioperative venous thromboembolism prophylaxis in bariatric surgery', Surgery for Obesity and Related Diseases. 2022; 18(2): 165-174. Hamad, G.G. and Choban, P.S. 'Enoxaparin for thromboprophylaxis in morbidly obese patients undergoing bariatric surgery: findings of the prophylaxis against VTE outcomes in bariatric surgery patients receiving enoxaparin (PROBE) study', Obesity Surgery . 2005; 15(10): 1368-1374. Guzman-Pruneda, F.A., Garcia, A., Crum, R.W., Chen, T., Krikhely, A. and Bessler, M. 'Extended Post Discharge Prophylaxis for Venous Thromboembolism Prevention After Bariatric Surgery'. Obesity Surgery . 2024; 34(4): 1217-1223. Giannopoulos, S., Motamedi, S.M.K., Athanasiadis, D.I., Clapp, B., Lyo, V., Ghanem, O., Edwards, M., Puzziferri, N., Stefanidis, D. and ASMBS Research Committee. 'Venous thromboembolism (VTE) prophylaxis after bariatric surgery: a national survey of MBSAQIP director practices', Surgery for Obesity and Related Diseases . 2023; 19(8): 799-807. Ying, V.W., Kim, S.H., Khan, K.J., et al. 'Prophylactic PPI help reduce marginal ulcers after gastric bypass surgery: a systematic review and meta-analysis of cohort studies', Surgical Endoscopy . 2015; 29(5): 1018-1023. Giannopoulos, S., Athanasiadis, D.I., Clapp, B., Lyo, V., Ghanem, O., Puzziferri, N., Stefanidis, D. and Bariatric Surgery Research Committee 'Proton pump inhibitor prophylaxis after Roux-en-Y gastric bypass: a national survey of surgeon practices', Surgery for Obesity and Related Diseases. 2023; 19(4): 303-308. Chiappetta, S., Stier, C., Ghanem, O.M., Dayyeh, B.K.A., Boškoski, I., Prager, G., LaMasters, T. and Kermansaravi, M. 'Perioperative interventions to prevent gastroesophageal reflux disease and marginal ulcers after bariatric surgery—An international experts’ survey', Obesity Surgery. 2023; 33(5):1449-1462. Malfertheiner, P., Kandulski, A. and Venerito, M. 'Proton-pump inhibitors: understanding the complications and risks', Nature Reviews Gastroenterology & Hepatology . 2017; 14(12): 697-710. Tables Tables are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Appendix12.docx Cite Share Download PDF Status: Published Journal Publication published 11 Nov, 2025 Read the published version in Obesity Surgery → Version 1 posted Editorial decision: Accepted 21 Oct, 2025 Reviews received at journal 12 Oct, 2025 Reviews received at journal 08 Oct, 2025 Reviews received at journal 01 Oct, 2025 Reviewers agreed at journal 29 Sep, 2025 Reviewers agreed at journal 29 Sep, 2025 Reviewers agreed at journal 23 Sep, 2025 Reviews received at journal 29 Aug, 2025 Reviewers agreed at journal 18 Aug, 2025 Reviewers agreed at journal 16 Aug, 2025 Reviewers invited by journal 04 Aug, 2025 Editor assigned by journal 12 Jun, 2025 Submission checks completed at journal 05 Jun, 2025 First submitted to journal 29 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6779565","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":495524042,"identity":"fe5397c2-960b-431f-921d-33bf5dd723d1","order_by":0,"name":"Danielle Clyde","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYDCCAyBUYAFkMTcw8DDYMBgQp8VAAshiBGlJg2nBo/MAWB6u5TBhLXzHzx488MFAQo6B/WCbxJuK83nm/AeYP/yo+INTi+SZvISDMwwkjBl4Etsk55y5XWw5I4FNsucMblsMDuQYHOYxkEhskGBsk+Ztu5244QYDGzNjGx4t598YHP5jIFEP0fLvXOKG8weYP+PVcgNoC9D7CQxgLQ0HEjccSGCQxqdF8sYbg4M9BhKGbTyJzZZzjiUDHQb0VM8ZY5xa+M7nGAPDx0aen/3wwRtvauyADjt8GCgih1MLHLAxMLBIQJjACCIWMH8gWukoGAWjYBSMKAAAenhX8NFTMxUAAAAASUVORK5CYII=","orcid":"","institution":"Edinburgh Royal Infirmary","correspondingAuthor":true,"prefix":"","firstName":"Danielle","middleName":"","lastName":"Clyde","suffix":""},{"id":495524043,"identity":"6ff78b50-1533-435e-8f47-b7ead3a04c3e","order_by":1,"name":"Callum Grant","email":"","orcid":"","institution":"University of Edinburgh","correspondingAuthor":false,"prefix":"","firstName":"Callum","middleName":"","lastName":"Grant","suffix":""},{"id":495524044,"identity":"de866ce7-b2e1-41b6-ae10-6545c4d488bb","order_by":2,"name":"Juan Andres Aguiar Canales","email":"","orcid":"","institution":"University of Edinburgh","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Andres Aguiar","lastName":"Canales","suffix":""},{"id":495524045,"identity":"d7d58da3-9df6-4654-bc23-8388997b1888","order_by":3,"name":"Reza Adib","email":"","orcid":"","institution":"Wesley Hospital","correspondingAuthor":false,"prefix":"","firstName":"Reza","middleName":"","lastName":"Adib","suffix":""},{"id":495524046,"identity":"211c28f6-9ed4-43b0-9e46-e29bd9ba2d5c","order_by":4,"name":"Sarfaraz Baig","email":"","orcid":"","institution":"Digestive Surgery Clinic","correspondingAuthor":false,"prefix":"","firstName":"Sarfaraz","middleName":"","lastName":"Baig","suffix":""},{"id":495524047,"identity":"685c028f-71ce-4ede-a1f3-d25841e4c1f6","order_by":5,"name":"Aparna G. 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N.","lastName":"Robertson","suffix":""},{"id":495524102,"identity":"34bcf249-4536-4157-98c0-ab25a8449737","order_by":57,"name":"Wah Yang","email":"","orcid":"","institution":"Department of Metabolic and Bariatric Surgery","correspondingAuthor":false,"prefix":"","firstName":"Wah","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2025-05-29 22:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6779565/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6779565/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11695-025-08356-9","type":"published","date":"2025-11-11T15:58:38+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":96105287,"identity":"da13c69a-3956-46db-ac0c-fc9f158f6200","added_by":"auto","created_at":"2025-11-17 16:10:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1170469,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6779565/v1/3fa8d7c2-1fe8-491b-8f57-b92babcbfff8.pdf"},{"id":88451141,"identity":"7acf10b8-9764-46c8-93d9-b5f73184afd0","added_by":"auto","created_at":"2025-08-06 14:35:30","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":56860,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix12.docx","url":"https://assets-eu.researchsquare.com/files/rs-6779565/v1/ef8957113793c82b0904f7ba.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eGlobal Variations in Practices After Bariatric and Metabolic Surgery; the PARTNER study\u003c/p\u003e","fulltext":[{"header":"Key Points","content":"\u003col\u003e\n \u003cli\u003eStudy highlights substantial global variation in postoperative practices following metabolic and bariatric surgery\u003c/li\u003e\n \u003cli\u003eMany aspects of care, including pharmacological prophylaxis and psychological follow-up, lack consensus\u003c/li\u003e\n \u003cli\u003eDefinitions of surgical success and failure remain inconsistent across international centres\u003c/li\u003e\n \u003cli\u003eFindings support the need for international, multidisciplinary collaboration to standardize care\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Introduction","content":"\u003cp\u003eGlobal obesity rates have surged in recent decades; in 2024 the Non-Communicable Disease Risk Factor Collaborative (NCD-RisC) estimated that more than 1\u0026nbsp;billion people in the world were living with obesity with a further 2\u0026nbsp;billion living with overweight\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Obesity-attributable deaths now surpass those related to starvation\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAs a result, metabolic and bariatric surgery (MBS) has become a cornerstone in the management of severe obesity and obesity-related comorbidities, including type 2 diabetes mellitus (T2DM), hypertension, and dyslipidaemia\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. It is now a widely accepted intervention, with the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) reported that in 2021 over 500,000 MBS procedures were performed annually\u003csup\u003e\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eInitially indicated for severe obesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;35 kg/m\u0026sup2;), MBS has since been recognised for its significant metabolic benefits, particularly in patients with comorbidities such as type 2 diabetes mellitus (T2DM), where remission has been observed independent of weight loss\u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eDespite its demonstrated efficacy, postoperative management of bariatric surgery remains inconsistent globally, with considerable variability in clinical practices and follow-up care.\u003csup\u003e\u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Although the 2022 updates to the ASMBS and IFSO guidelines sought to standardize MBS indications and emphasize comprehensive preoperative assessments, discrepancies persist in postoperative protocols.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e The variability in global practices can be attributed to the limited evidence regarding the optimal management of patients following metabolic and bariatric surgery (MBS). To establish a clearer framework for postoperative care, it is essential to gain a deeper understanding of the practices currently implemented in different countries. This article presents the results of an extensive global survey conducted among healthcare professionals involved in MBS, highlighting significant variations in postoperative approaches, including diagnostic procedures, management strategies, and the criteria used to assess surgical outcomes.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003e\u003cem\u003eSurvey Design\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAn online questionnaire, \u003cstrong\u003ep\u003c/strong\u003eractices \u003cstrong\u003ea\u003c/strong\u003efter ba\u003cstrong\u003er\u003c/strong\u003eia\u003cstrong\u003et\u003c/strong\u003eric a\u003cstrong\u003en\u003c/strong\u003ed m\u003cstrong\u003ee\u003c/strong\u003etabolic su\u003cstrong\u003er\u003c/strong\u003egery study (PARTNER study), was designed by a multidisciplinary team which included professionals from global Metabolic and Bariatric Surgery units. The survey was constructed using Microsoft Forms\u0026trade;. It was based on insights gathered from a comprehensive literature review and an examination of international guidelines concerning postoperative care following bariatric surgery. The initial draft of the questionnaire was revised by the multidisciplinary team members to ensure the questions were appropriately adapted for data categorisation, collection, and subsequent analysis. The selected statements covered the following 5 key areas relating to postoperative care following MBS;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eFollow-up after Metabolic and Bariatric Surgery\u003c/strong\u003e (including guidelines applied; type, frequency and duration of follow-up; postoperative investigations)\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePost-operative Treatment: VTE Prophylaxis, PPI Prophylaxis, and UDCA Use\u003c/strong\u003e\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePost-Operative Diet following MBS\u003c/strong\u003e (including recommended dietary supplements; nutritional screening)\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePost-operative Support\u003c/strong\u003e\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSurgical Outcome Measures\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;A complete version of the questionnaire with all responses is included in Appendix 1. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSurvey Distribution\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe survey was disseminated to professionals involved in multidisciplinary bariatric surgical services worldwide. Target audience included any member of the Metabolic and Bariatric Surgery MDT including bariatric surgeons, nurse specialists, physicians in related sub-specialties (e.g. endocrinology), psychologists, dietitians and MDT coordinators. To further promote participation, the survey was also advertised on social media channels. Participation in the survey was voluntary, and responses were anonymised for analysis. Monthly reminder emails and continued social media advertisements were used to maintain engagement throughout the data collection period, which lasted from October 20, 2024, to January 31, 2025, based on the rate of responses.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSurvey Analysis and Statistics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFollowing data collection, responses were exported into a Microsoft Excel (Redmond, Washington, USA) spreadsheet for analysis. The study adhered to the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines, and a completed checklist is provided in Appendix 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnalysis was conducted using Microsoft Excel. Data from the questionnaire are presented as percentages.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eHealthcare Facility and Role in the Metabolic and Bariatric Surgery MDT\u003c/h2\u003e\n \u003cp\u003eA total of 262 participants responded to the survey from 62 countries. Most respondents (55%) worked in public healthcare facilities, while 19% exclusively worked in private facilities. A smaller proportion (23.3%) worked in both public and private settings. The survey included respondents working in the bariatric tourism sector (1.9%). The remainder (2%) did not declare their healthcare facility. In terms of roles within the multidisciplinary team (MDT); most respondents were bariatric surgeons (72.1%), followed by case managers/coordinators (6.9%). Other roles, including dietitians, endocrinologists, psychologists, and researchers, were less commonly represented (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eFollow-up After Metabolic and Bariatric Surgery (MBS)\u003c/h3\u003e\n\u003cp\u003eGuidelines although diverse were frequently used with only 1.1% of respondents reporting not following guidelines. The guidelines used for follow-up after MBS were diverse, with the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) guidelines being the most applied (64.5%), followed by the American Society of Metabolic and Bariatric Surgery (ASMBS) guidelines (46.6%). Most respondents (78.7%) follow-up with patients 3 months post-surgery, with similar frequencies observed at 6 months (78.0%) and annually (78.3%) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv\u003eFollow-up durations varied; 37.4% of respondents reported a follow-up time between 1 and 4 years. 23.7% of respondents following up patients indefinitely within the bariatric team. 35.1% of respondents reported follow up time periods of 6 months or less and 1.9% of respondents reported no follow up. Many respondents (56.9%) utilised a hybrid approach to follow-up combining both virtual and in-person visits, while 39.7% conducted in-person follow-ups and 3.1% used virtual follow-ups only (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003ePost-Operative Treatment: VTE Prophylaxis, PPI Prophylaxis, and UDCA Use\u003c/h2\u003e\n \u003cp\u003eA significant proportion of respondents (64.1%) routinely recommended pharmacological VTE prophylaxis for all patients and 67.2% also recommended non-pharmacological VTE prophylaxis. 1.9% did not use pharmacological VTE prophylaxis. The majority of those who prescribed pharmacological VTE prophylaxis did so for variable durations depending on risk stratification, 22.2% prescribed only whilst in hospital, 19.1% for 7 days or less, 17.9% for 8\u0026ndash;14 days and 17.6% recommending it for more than 14 days after surgery (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv\u003eFor PPI prophylaxis, 84.3% of respondents recommended it for all patients, with 83.7% initiating treatment immediately after MBS. Pantoprazole (23.3%) and omeprazole (22.5%) were the most prescribed PPIs. The majority (48.5%) recommended a daily dose of 40mg, with a substantial portion (51.5%) recommending a duration of 3 months or less. A further 25.2% of respondents recommended 3\u0026ndash;5 months (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/div\u003e\n \u003cp\u003eA smaller portion of respondents (32.1%) recommended ursodeoxycholic acid (UDCA) for all patients, typically starting treatment immediately after surgery (43.9%). 23.7% recommended UDCA selectively and 36.3% of respondents (36.3%) did not recommend UDCA use. 43.5% recommended a duration of 3\u0026ndash;12 months (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003ePost-Operative Diet Following MBS\u003c/h2\u003e\n \u003cp\u003eDietary advice was given to nearly all respondents\u0026apos; patients (98.1%) after MBS. The most common post-surgery diet was a liquid diet (76.3%), followed by semi-solid or solid diets for smaller groups. 10.7% of respondents provide selective dietary advice depending on the surgical procedure performed. Most patients (90.5%) met with a dietitian or nutritionist pre-operatively to discuss the post-operative diet. The duration of specific dietary recommendations varied, with 22.5% recommending a diet for less than three months, while 12.2% recommended lifelong dietary changes (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv\u003ePost-operative nutritional screening was recommended routinely by 84.3% of respondents, with 62.6% advising protein supplementation for all patients. Protein supplementation was most recommended at 60g daily (28.3%), and 55.3% of respondents advised lifelong supplementation to patients (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/div\u003e\n \u003cp\u003eA significant number of respondents (40.1%) did not recommend a specific timeline for when patients should resume alcohol consumption post-surgery. In contrast, 32.1% recommended waiting less than one month before drinking caffeine.\u003c/p\u003e\n \u003cp\u003e83.6% of respondents reported starting vitamin and mineral supplements with 1 month of surgery. 55.3% recommended this lifelong.\u003c/p\u003e\n \u003cp\u003eRegarding objective scores used during follow-up, the Bariatric Analysis and Reporting Outcome System (BAROS) was the most frequently applied (34.7%), followed by the SF-36 Health Survey (27.9%) and the Beck Depression Inventory (13.4%) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Blood tests were routinely carried out. There was much variation between frequency of blood monitoring (Table). 85.1% of respondents checking HbA1c, 75.7% checking serum fasting glucose and 78.3% performing nutritional screening. Other commonly checked blood tests included liver function (88.1%), renal function (84.0%) and lipid profiles (81.7%).\u003c/p\u003e\n \u003cp\u003eRegarding investigations, upper GI endoscopy was included in routine follow-up for 50.0% of respondents, while abdominal ultrasound for gallbladder assessment was recommended for 49.2% of respondents, though some practices reported no routine investigations (27.1%).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003ePost-Operative Support\u003c/h2\u003e\n \u003cp\u003eA significant number of respondents (82.2%) provided physical activity advice to all patients\u0026rsquo; post-surgery. Screening for mood disorders (60.3%) and eating disorders (63.4%) were frequently conducted. However, only 56.1% recommended routine follow-up with a bariatric behavioural health professional with 27.1% advocating for ongoing psychotherapy. Support groups were offered to 61.9% of patients, with 43.5% recommending hybrid peer support (both face-to-face and virtual). Regarding emergency contact, 47.3% of respondents provided surgeon contact information, while 38.2% provided bariatric nurse or case manager contacts (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eMeasuring Surgical Outcomes\u003c/h2\u003e\n \u003cp\u003eThe definition of \u0026quot;non-responders\u0026quot; after MBS varied widely. 21% defined non responder as less than 10% total weight loss (%TWL), 16.4% defined non responder as less than 15% total weight loss (%TWL). 31.3% defined non-responders as those with less than 20% total weight loss (%TWL). 11.1% did not measure %total weight loss. For % excess weight loss 15.7% did not routinely measure %EWL For those who did measure it, thresholds varied, but the most common definition of non-response was patients with less than 50% excess weight loss (%EWL)- 34.7% (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\n \n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study has highlighted notable variations in postoperative management and follow-up practices for patients undergoing metabolic and bariatric surgery worldwide. It is among the few international multidisciplinary studies that focus on postoperative care, assessment, and patient follow-up while also incorporating insights from specialists in the field.\u003c/p\u003e\u003cp\u003eOne factor contributing to the variation in postoperative metabolic and bariatric surgery (MBS) practices is the lack of universally accepted guidelines for bariatric surgery teams and a lack of adherence to those that are available\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. This is evident in the diverse guidelines followed by respondents, with the IFSO guidelines being the most commonly used (64.5%), followed by the ASMBS guidelines (46.6%). Additionally, 78.6% of respondents reported relying on local MBS society guidelines, national government-approved protocols, or similar frameworks for patient follow-up. One respondent reported that they use the British Obesity and Metabolic Surgery Society Guidelines specifically to guide postoperative blood monitoring.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e These variations may partly be due to differences in resource availability across countries\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Many respondents cited limitations in government healthcare funding as a key barrier, noting that while they would prefer to offer more comprehensive postoperative care, financial constraints restrict their ability to do so.\u003c/p\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eFollow-up after MBS: the Role of the Multidisciplinary Team, Diet and Patient Support\u003c/h2\u003e\u003cp\u003eFollowing bariatric surgery, long-term follow-up is critical to ensuring optimal patient outcomes by monitoring nutritional status, managing comorbidities, and supporting sustained weight loss\u003csup\u003e\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Both the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) emphasise the importance of structured, multidisciplinary postoperative care\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Their recommendations suggest frequent follow-ups within the first year, with visits scheduled at one week, one month, three months, six months, and twelve months post-surgery to assess recovery, nutritional intake, and potential complications. Beyond the first year, annual follow-ups are generally advised to evaluate weight maintenance, nutritional health, and the emergence of late complications. These recommendations align with current clinical practice trends, as demonstrated by our study in which 78.7% of practitioners reported conducting follow-ups at three months, with similar adherence rates at six months (78.0%) and annually (78.3%). Furthermore, while 23.7% of bariatric teams provided indefinite follow-up, a hybrid model combining virtual and in-person visits was the most common approach (56.9%). The reported application of validated assessment tools such as the Bariatric Analysis and Reporting Outcome System (34.7%) and the SF-36 Health Survey (27.9%) further supports the structured approach advocated by ASMBS and IFSO.\u003c/p\u003e\u003cp\u003eThe comprehensive, multidisciplinary approach to postoperative MBS care involves a diverse team of healthcare professionals, each playing a vital role in optimising patient outcomes\u003csup\u003e\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Surgeons oversee recovery and manage any procedural complications, ensuring a smooth healing process. In terms of emergency contact, 47.3% of respondents provided direct access to a surgeon, while 38.2% designated a bariatric nurse or case manager as the primary point of contact, highlighting the collaborative nature of postoperative support.\u003c/p\u003e\u003cp\u003eDietitian support is a fundamental component of postoperative care for patients undergoing metabolic and bariatric surgery (MBS), as dietary modifications and nutritional monitoring are critical for long-term success\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Following surgery, patients must adapt to significant changes in their eating habits and nutrition, which can be challenging due to altered gastric anatomy and the need for long-term dietary modifications. Nearly all patients (98.1%) received dietary counselling post-surgery, with the majority (90.5%) engaging with a dietitian preoperatively to discuss postoperative nutrition. Research emphasises that ongoing dietitian involvement is essential for optimising weight loss outcomes, preventing nutrient deficiencies, and supporting the development of healthy eating behaviours\u003csup\u003e\u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. This is reflected by our findings in which post-operative nutritional screening was recommended routinely by 84.3% of respondents but routinely performed by only 78.3% of respondents. Additionally, dietitian-led interventions have also been shown to address complications such as dehydration, constipation, and dumping syndrome, which are common after certain bariatric procedures\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMental health professionals, including psychologists and psychiatrists, offer essential support in managing postoperative psychological challenges, such as body image issues and disordered eating behaviours. A systematic review and meta-analysis concluded that there was no significant improvement in mental health quality of life for patients undergoing bariatric surgery compared to those receiving non-surgical interventions\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. These findings suggested that despite the physical health benefits MBS showed no benefit to mental health over non-surgical treatments\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. The study concluded that patients undergoing MBS are often characterised by high-risk baseline psychosocial profiles and therefore should receive intensive mental health follow-up as a routine component of postoperative care\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. The importance of psychological follow-up was reflected in the current worldwide clinical practice with 60.3% of our respondents routinely screening for mood disorders and 63.4% for eating disorders postoperatively. Other studies have identified specific psychopathological factors, such as binge eating disorder, as a predictor of poor post-operative outcomes\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Preoperative mental illness was also found to result in lower long-term weight loss and an increased risk of weight regain after bariatric surgery\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. and increased presentations to metal health services were also recognised following MBS\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e.Despite this, only 56.1% recommended routine follow-up with a bariatric behavioural health professional with 27.1% advocating for ongoing psychotherapy. Support groups were offered to 61.9% of patients, with 43.5% recommending hybrid peer support (both face-to-face and virtual). A significant number of respondents (82.2%) provided physical activity advice to all patients\u0026rsquo; post-surgery. The impact of formal exercise training is supported with habitual physical activity being shown to play an important role in the long-term weight maintenance as well as greater improvements in body composition and overall physical fitness\u003csup\u003e\u003cspan additionalcitationids=\"CR34 CR35\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003ePost-Operative Treatment: VTE Prophylaxis and PPI Prophylaxis\u003c/h2\u003e\u003cp\u003eVenous thromboembolism (VTE) remains a significant concern following metabolic and bariatric surgery (MBS) due to factors such as obesity, prolonged operative times, and postoperative immobility. The American Society for Metabolic and Bariatric Surgery (ASMBS) underscores the necessity of a VTE risk assessment for all patients undergoing MBS with risk of VTE being reported to be as high as 4% in selected patients undergoing MBS\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. ASMBS advocate for a combination of mechanical methods, like intermittent pneumatic compression devices, and pharmacologic agents, such as low-molecular-weight heparin (LMWH)\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. ASMBS caveat their statements by acknowledging that there is a lack of robust data on this particular issue\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Risk stratification is pivotal in tailoring prophylactic strategies; patients with additional risk factors\u0026mdash;including advanced age, prior VTE history, or obesity-related comorbidities\u0026mdash;may benefit from extended anticoagulation therapy\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. In clinical practice, 64.1% of surveyed practitioners routinely prescribe pharmacological VTE prophylaxis for all patients, while 67.2% incorporate non-pharmacological measures. These numbers are significantly lower than those reported in another international survey published in 2023, they reported that both mechanical and chemical VTE prophylaxis was used by 97.1% of the participants, knee-high compression devices by 84.7%\u003csup\u003e39\u003c/sup\u003e.However, this study specifically targeted Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited centres which possibly leads to a biased view of overall worldwide practices\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. Among those respondents recommending pharmacological prophylaxis, 17.6% suggest continuation beyond 14 days post-surgery, highlighting the emphasis on individualized patient care. Despite the critical role of VTE prophylaxis, concerns about bleeding risks and determining the optimal duration of treatment persist, underscoring the need for personalized approaches.\u003c/p\u003e\u003cp\u003eProton pump inhibitors (PPIs) are commonly employed to mitigate acid-related complications, such as gastro-oesophageal reflux disease (GORD) and marginal ulcers, following MBS procedures like Roux-en-Y gastric bypass (RYGB). The ASMBS recommends routine postoperative PPI prophylaxis for all patients after RYGB and other anastomotic MBS procedures for at least 90 days to significantly reduce the risk of marginal ulcers\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. In practice, 84.3% of respondents advocate for PPI prophylaxis universally, with 83.7% initiating treatment immediately after MBS. These numbers are similar to a dedicated survey carried out by the ASMBS Research Committee which reported PPIs were prescribed by 85.4% of the 112 surveyed surgeons to all patients during their hospitalisation\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. Another international study conducted in 2022 also reported that \u0026gt;\u0026thinsp;90% of experts prescribe postoperative acid suppression medications following MBS\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. This survey also reported that life-long proton pump inhibitors prophylaxis was also recommended in smokers (66%) and recommendation to avoid non-steroidal anti-inflammatory drugs (73%) following any type of gastric bypass\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. Pantoprazole (23.3%) and omeprazole (22.5%) are the most frequently prescribed PPIs, commonly administered at a daily dose of 40 mg. The duration of prophylaxis varies, with 28.6% recommending treatment for less than three months. While short-term PPI use is beneficial, prolonged therapy has been associated with adverse effects, including micronutrient deficiencies such as magnesium and vitamin B12\u003csup\u003e46\u003c/sup\u003e. Therefore, ongoing evaluation of PPI necessity is essential to balance therapeutic benefits with potential risks.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eOutliers in Postoperative Care: Variability and Gaps in Private Practice\u003c/h2\u003e\u003cp\u003eA small subset of respondents (5 out of 262; 1.9%) indicated that they did not provide routine postoperative follow-up for their patients. Interestingly, although this group endorsed early postoperative nutritional screening and supplementation\u0026mdash;typically within one month of surgery\u0026mdash;they did not implement these measures in their own practice. They also reported using pharmacological VTE prophylaxis either immediately postoperatively or only during the inpatient stay. While this represents a minority, the deviation from standard postoperative protocols\u0026mdash;such as follow-up care, dietitian input, nutritional support, and VTE prevention\u0026mdash;is noteworthy. All five respondents were based in private practice, with one primarily treating international patients. However, among the four other respondents also caring mainly for overseas patients, no consistent pattern emerged. This variation in postoperative care highlights the need for clear, standardized guidelines to promote consistent and high-quality management for all bariatric patients globally.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eOne limitation of our study is the inability to validate the submitted responses against actual clinical practices within individual units. Furthermore, due to the anonymous nature of the questionnaire, we are unable to determine an exact response rate. Despite these constraints, the primary aim was to explore variations in international practice. With 262 responses received from 62 different countries or regions, we believe our findings offer a reasonable representation of global practice patterns.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the considerable variability in postoperative management following metabolic and bariatric surgery (MBS) across different healthcare settings worldwide. Despite international guidelines aiming to standardise follow-up protocols, significant discrepancies persist in areas such as nutritional monitoring, psychological support, pharmacological prophylaxis, and long-term patient care. The findings underscore the need for further research and guidelines to establish evidence-based, universally accepted postoperative strategies that optimise patient outcomes. Future efforts should focus on improving access to multidisciplinary care, ensuring guideline adherence, and addressing barriers to comprehensive follow-up, particularly in resource-limited settings. By refining global best practices, healthcare providers can enhance the long-term success of MBS, improve patient quality of life and attempt to achieve equity for patients worldwide.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eW.Y., A.G.N.R., and D.C. contributed to the study concept, conducted the literature search, and prepared the primary statements. All listed authors made substantial contributions to the design of the survey and publicised the survey to increase participation. W.Y., A.G.N.R., and D.C. oversaw the entire process. D.C. analysed the data, generated figures, and wrote the primary manuscript. K.K.M. and O.G. revised the first draft of the paper critically for intellectual content. C.G., J.A.A.C. and D.C. adjusted formatting of the document suitable for submission. All listed authors participated in writing the paper and provided final approval of the submitted and published versions.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eAuthors would like to thank PARTNER Study Collaborators: Ch\u0026eacute;n Qǐyūn, Case Manager/Coordinator, The First People's Hospital of Yunnan Province, Kunming, China; Dr Xin He, Bariatric Surgeon, Changchun Jiahe Surgical Hospital, Changchun City, Jilin Province, China; Dr Shu Jian, Bariatric Surgeon, The General Hospital of Hunan University of Medicine, Huaihua City, Hunan Province, China; Wang Ying, Case Manager, The Second People's Hospital of Zhengzhou City, Henan Province, China; Li Ruyu, Case Manager, Dehong Prefecture People's Hospital, Mangshi City, Yunnan Province; Zeng Lianlian, Case Manager, Weight Loss Center, The First Hospital of Changsha Changsha City, Hunan Province; Dr Yin Jianhui, Bariatric Surgeon, The First People's Hospital of Kunming City, Yunnan Province, China; Liu Yi, Director of MDT, The First Affiliated Hospital of Nanchang University, Nanchang, China; Qiu Yanyu, Nurse in Charge, The First People's Hospital of Huaian City, Jiangsu Province; Zhu Yifeng, Case Manager, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Li Huiqi, Bariatric Surgeon, The First Affiliated Hospital of Xi'an Medical University, Baoji City, Shaanxi Province, China; Zhou Lingling, Specialist Nurse, The First People's Hospital of Huaian City, Jiangsu Province, China; Ding Mingxing, Director of MDT, Weight Loss Center Changchun City, Jilin Province, China; Zhang Huiqin , Director of MDT, The First Affiliated Hospital of Xiamen University, Fujian Province, China; Dr Yosuke Seki, Bariatric Surgeon, Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube 7-7 Nibancho, Tokyo, Japan; Yongqian Cai, Case Manager, The Central Hospital of DaZhou city, SiChuan province, China; Yan Xueqiang, Bariatric Surgeon, Wuhan Children\u0026rsquo;s Hospital, Wuhan, China; Xiuying Li, Case Manager, The Central Hospital of DaZhou City, SiChuan Province, China; Xing Dong, Bariatric Surgeon, Henan Province, China; Xiaocheng Zhu, Leader of MDT, The Affiliated hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China; Wanying Shi, Dietician, The First Hospital of China Medical University, Shenyang, Liaoning Province, China; Vice Professor, Xiaogang Li, Bariatric Surgeon, Affiliated Hospital of Yunnan University, Kunming, Yunnan Province, China; Dr Yuntong Guo, Bariatric Surgeon, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China; Prof. Rodolfo J. Oviedo, Medical Director, Nacogdoches Medical Center, Nacogdoches, Texas, USA; Shangguan Changsheng, Director of MDT, Wuhan Sixth Hospital, Hubei, China; Dr Hosam Mohamed Elghadban, Bariatric Surgeon, Ibra Hospital, Ibra city, Oman; Rui Tao, Bariatric Surgeon, The Affiliated Bishan Hospital of Chongqing Medical University, Chongqing City, China; Professor Oktyabr Teshaev Ruxillayevich, Bariatric Surgeon, Tashkent Medical Academy, Tashkent, Uzbekistan; Professor Yang Fan, Researcher, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Professor Wu Jianjun, Bariatric Physician ,2nd affiliated hospital of Harbin medical university, Harbin, Heilongjiang, China; Professor Thejana Kamil Wijeratne, Bariatric Surgeon, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; Professor Shahrad Taheri, Bariatric Physician, Hamad Medical Corporation, Doha, Qatar; Professor Dr Kenneth YY Kok, Bariatric Surgeon, Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Brunei; Professor Abdullah Şişik, Bariatric Surgeon, Gedik University, Istanbul, Turkey; Prof. Gianluca Vanni, Bariatric Surgeon, University of Rome Tor Vergata, Roma, Italy; Prof. Francesco Saverio Papadia, Bariatric Surgeon, University of Genoa, Genoa, Italy; Prof. Dr. Shu Zhang, Bariatric Surgeon, Fudan University Shanghai Cancer Center, Shanghai, China; Prof. Dr. Rudolf Weiner, Bariatric Surgeon, Sana-Klinikum Offenbach, Offenbach, Hessen, Germany; Prof. Dr. Daniel Moritz Felsenreich, Bariatric Surgeon, Medical University of Vienna, Vienna, Austria; Prof. Dr. Tadeja Pintar, Bariatric Surgeon, UMC Ljubljana, Ljubljana, Slovenia; Prof. Christine Stroh, Bariatric Surgeon, SRH Muncipial Hospital Gera, Gera, Germany; Dr Marco Materazzo, Bariatric Surgeon, Tor Vergata University, Roma, Italy; Faiza Himasa Idris, Pharmacist, Getslim Bariatrics and Surgical Centre, Abuja, Nigeria; Dr Nimin Nanning, Bariatric Physician, Second Hospital Nanning, Guangxi, China; Mr Shayanthan Nanthakumaran, Bariatric Surgeon, Aberdeen Royal Infirmary, Aberdeen, Scotland; Mr Bassem Amr, Bariatric Surgeon, County Durham and Darlington NHS Foundation Trust, United Kingdom; Dr Mohamed Ali Chaouch, Bariatric Surgeon, Monastir University Hospital, Monastir, Tunisie; Dr Miljana Vladimirov, Head of Department Bariatric and Metabolic Surgery, University Bielefeld-Campus Lippe, Detmold, Germany; Dr Miguel Alejandro Miranda De Le\u0026oacute;n, Bariatric Surgeon, Cirug\u0026iacute;a bariatrica, Tamaulipas , M\u0026eacute;xico; Dr Fifso Taryel Omarov, Clinical Lead, Department of Surgical Disease, Azerbaijan Medical University, Azerbaijan, Baku; Dr Gang Li, Bariatric Surgeon, Union Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province, China; Dr Yu Li, Bariatric Surgeon, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China; Dr Suzanne Hedberg, Bariatric Surgeon, Sahlgrenska University Hospital, Gothenburg, Sweden; Dr Idan Carmeli, Bariatric Surgeon, Assuta Ashdod University Hospital affiliated to the Ben Gurion University of the Negev, Beer Sheva , Israel; Dr Guillermo Ponce de Le\u0026oacute;n Ballesteros, Bariatric Surgeon, Hospital \u0026Aacute;ngeles Morelia, Michoac\u0026aacute;n, M\u0026eacute;xico; Dr Vincenzo Schiavone, Bariatric Surgeon, Naples Federico II University, Naples, Italy; Lisheng Wu, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui province, China; Dr Junzhao Ye, Bariatric Physician, The first affiliated hospital, Sun yat-sen university, Guangzhou, Guangdong, China; Dr Jun Wang, Bariatric Surgeon, Tangshan Gongren Hospital, Tangshan City, Hebei Province, China; Guozhi Yin, Director of MDT, The first Affiliated Hospital of Xi 'an Jiaotong University, Xi'an, Shaanxi, China; Assistant Professor Abdullah AlMunifi, Bariatric Surgeon, Majmaah University, Al-Majmaah, Saudi Arabia; Dr Francesca Abbatini, Bariatric Surgeon, Ospedale dei Castelli, Ariccia, Rome, Italy; Dr Weiqiang Liu, Bariatric Surgeon, Shandong Second Provincial General Hospital, Jinan, Shandong Province, China; Dr. Mohammad Hayssam ElFawal, Director of MDT, Makassed General Hospital, Beirut, Lebanon; Dr. Jes\u0026uacute;s Antonio Gil, Bariatric surgeon, Obesity not for me, Tijuana, Baja California, M\u0026eacute;xico; Dr. Adisa Poljo, Bariatric Surgeon, University Digestive Health Care Center Basel - Clarunis Basel, Switzerland; Dr. Zoe Pafili, Dietician, Evangelismos General Hospital, Athens, Greece; Dr. Sonja Chiappetta, Bariatric Surgeon, Ospedale Evangelico Betania, Naples, Italy; Dr. Shadike Apaer, Bariatric Surgeon, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China; Dr. Sebasti\u0026aacute;n Arana-Garza, Bariatric Surgeon, Christus Muguerza Hospital, Monterrey, Mexico; Dr. Philipp Beckerhinn, Bariatric Surgeon, Chirurgie Landesklinikum Hollabrunn, Niederoesterreich, Austria; Dr. mult. Sjaak Pouwels, Bariatric Surgeon, Marien Hospital Herne, University Hospital of Ruhr University Bochum, Herne, Germany; Dr. İsmail \u0026Ccedil;alıkoğlu, Bariatric Surgeon, \u0026Ccedil;alıkoğlu Bariatric and Metabolic Surgery Clinic, Istanbul, Şişli, Turkiye; Dr r. Frederik Lecot, Bariatric Surgeon, AZ Sint-Jan Hospital, Bruges, Belgium; Dr. EdS Gabriel A.Molina, Bariatric Surgeon, Universidad San Francisco, Quito, Pichincha, Ecuador; Dr. Chonin Cheang, Endocrinologist, Macau Yin Kui Hospital, Macau SAR, China; Dr. Bruno Dillemans, Bariatric Surgeon, AZ Sint-Jan Hospital, Bruges, Belgium; Dr. Abdulellah Niyaz, Bariatric Surgeon, Neuwerk Hospital in Moenchengladbach, Germany; Dr. Kin Hung Simon Wong, Bariatric Surgeon, CUHK medical Centre, Hong Kong SAR, China; Dr. Cihan Şahan, Bariatric Surgeon, İstanbul, \u0026Uuml;sk\u0026uuml;dar, Turkey; Dr Muhammad Umar Younis, Bariatric Surgeon, Mediclinic City Hospital, Dubai, UAE; Dr Karin Dolezalova, Bariatric Surgeon, Faculty Hospital Vinohrady, Prague, Czech Republic; Dr Humberto Jimenez, Bariatric Surgeon, Clinica Colsanitas, Bogota, Colombia; Dr Gennaro Martines, Bariatric Surgeon, Azienda Ospedaliero Universitaria Policlinico, Bari, Italy; Dr Ala Wafa, Bariatric Surgeon, Gaddur medical center, Tripoli, Libya; Dr Roxanna Zakeri, Bariatric Surgeon, University College London Hospital, London, United Kingdom; Dr Ravi Rao Director of Surgey, Perth Surgical and Bariatrics, Perth, Australia; Dr Matthew Kroh, Bariatric Surgeon, Cleveland Clinic, Cleveland, Ohio, USA; Dr Luis Meza, Bariatric Surgeon, IntelliMed Cirug\u0026iacute;a, M\u0026eacute;rida, M\u0026eacute;xico; Dr Kon Voi Tay, Bariatric Surgeon, Woodlands Health, Singapore; Dr Janey SA Pratt, Clinical Professor of Surgery, Stanford University School of Medicine, Palo Alto, California, USA; Dr Hu Songahao, Bariatric Surgeon, First affiliated hospital of Jinan University, Guangzhou, China; Dr Francesk Mulita, Bariatric Surgeon, General University Hospital of Patras, Achaia, Greece; Dr Daniel Leonard Chan, Bariatric Surgeon, St George Hospital, Kogarah, NSW, Australia; Dr Chun Hai Tan, Bariatric Surgeon, Surgicare Bariatric and General Surgery, Gleneagles Hospital, Singapore; Dr Bo Li, General surgeon, The First Hospital of Lanzhou University, Lanzhou Gansu Province, China; Dr Belinda De Simone, Bariatric Surgeon, Infermi Hospital, AUSL Romagna, Rimini, Italy; Dr Bing Yang, Gastrointestinal Surgeon, Central hospital affiliated to Shandong First Medical University, Ji\u0026lsquo;nan, Shan Dong province,China; Dr Gabriel Alejandro Molina, Universidad San Francisco School of Medicine, Quito, Pichincha, Ecuador; Dr Silvana Leanza, General Surgeon, G. Giglio Institute, Cefal\u0026ugrave;, Palermo, Italy; Dr Omar Ghazouani, General Surgeon, Ospedale Santa Corona, Pietra Ligure, Savona, Italy; Dr Eleftherios Spartalis, Director of Surgery, REA Maternity Hospital, Athens, Greece; Dr Christine Stier, Endoscopist, University Medicine Mannheim, Heidelberg University, Germany; Dr Dimitris P. Lapatsanis, Chief Bariatric Surgeon, Bariatric and Metabolic Disorders Surgical Unit Athens Medical Center, Psychiko Clinic Athens, Greece; Professor Chetan Parmar, Bariatric Surgeon, Whittington Hospital + University College London, London, UK; Dr Arshad Ali, Bariatric Surgeon, Health department, Peshawar, Pakistan; Dr Adrian Marius Nedelcu Elsan, Bariatric Surgeon, Bouchard Private Hospital, Marseille, France; Dr Haval Saber Faqesmail, Bariatric surgeron, IQSMBS, Kurdistan, Iraq; Dr Athanasios G. Pantelis, Bariatric Surgeon, Athens Medical Group, Psychiko Clinic, Athens, Greece; Associate Professor Ruth Blackham, Department of Surgery, Notre Dame University, Perth, Western Australia; Assistant professor Abd-Elfattah Morsi Kalmoush, Bariatric Surgeon, Al-Azhar university, Cairo, Egypt; Assistant Prof Kanokkan Tepmalai, Bariatric Surgeon. Chiangmai University, Chiangmai, Thailand; Dr Arshad Ali, Bariatric Surgeon, Iran University, Tehran, Iran; Dr Andre Costa-Pinho, Bariatric Surgeon, S\u0026atilde;o Jo\u0026atilde;o Local Health Unit, Porto, Portugal; Dr Aikebaier Aili, Bariatric Surgeon, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, China; Dr Ahmad Ghazal, Bariatric Surgeon, Nabd Alhayat Centre, Aleppo, Syria; Prof Michael L Talbot, UNSW St George and Sutherland Clinical School, Sydney, Australia; Dr Gang Yang, Bariatric Surgeon, Zhangye Second People's Hospital, Zhangye City, China; Dr Jun Wang, Bariatric Surgeon, Tangshan Gongren hospital, Tangshan, China; Mr Qiongfeng Tan, Bariatric Surgeon, The Second People's Hospital of Yichang, Yichang, China; Dr Wang Hongmei, Bariatric Physician, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Professor Zhong Cheng, Bariatric Surgeon, West China Hospital, Sichuan University, Chengdu, China; Professor Nik Ritza Kosai, Bariatric Surgeon, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Dr Mudr Elias Liolis, Bariatric Surgeon, University General hospital of Patras, Rio, Greece; Dr Yuezhi Chen, Bariatric Surgeon, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China; Dr Jie Zhu, Bariatric Surgeon, The second people's hospital of Yibin, Yibin, China; Dr Adam Abu-Abeid, Bariatric Surgeon, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Dr Guangnian Ji, Bariatric Surgeon, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, China; Dr Lana Al-Sabe, Bariatric Surgeon, University of Jordan, Amman, Jordan; Dr Adrian Gerard, Bariatric Surgeon, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia; Dr Mei Hong, Deputy Chief Physician, Jilin City People's Hospital, Jilin City, China; Dr Muhammad Ismail Yar Khan Uttra, Bariatric Surgeon, Shalimar Hospital, Lahore, Pakistan; Dr Wenhui Liu , Deputy Chief Physician of the Department of General Surgery at Zhongshan Hospital in Hefei, China; Dr Chen Li, Researcher, First Affiliated Hospital of Guangxi Medical University, Nanning, China; Shuyin Guo, Deputy Chief Nurse, Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China; Professor Mauricio Zuluaga, Bariatric Surgeon, Universidad Del Velle / Hospital Universitario Del Valle / Clinica De Occidente, Cali, Colombia; Dr Adedire Timilehin Adenuga, Bariatric Surgeon, Getslim Bariatric center, Guzape, Nigeria; Dr. Jianli Han, Bariatric Surgeon, Shanxi Bethune Hospital, Tiayuan, China; Dr ChuanRong Zhu, Bariatric Surgeon, The Affiliated Huaian No.1 People\u0026rsquo;s Hospital of Nanjing Medical University, Huaian, China; Professor Oral B. Ospanov, Bariatric Surgeon, Astana Medical University, Astana, Kazakhstan; Dr. Karl Peter Rheinwalt, Bariatric Surgeon, St. Franziskus Hospital Cologne, Cologne, Germany; Ms Patricia Castillo Vacaflor, Dietician, Comit\u0026eacute; de Cirug\u0026iacute;a Bari\u0026aacute;trica, Santa Cruz, Bolivia; Dr Hang Tuo, Bariatric Surgeon, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi province, China; Dr Rob Snoekx, Bariatric Surgeon, Bariatrisch Centrum Zuid West Nederland / Bravis Hospital, Bergen op Zoom, The Netherlands; Mr Suhaib Ahmad, Bariatric Surgeon, Betsi Cadwaldr Health Board, Bangor, Wales; Dr Nozim Adxamovich Jumaev, Bariatric Surgeon, Tashkent Medical Academy, Tashkent, Uzbekistan; Dr Fabio Massimo Oddi, Bariatric Surgeon, University of Rome \"Tor Vergata\", Rome, Italy; Dr Tobias Van De Winkel, Bariatric Physician, AZ Sint-Jan, Brugge, Belgium; Dr Jose Giordano, Department of Surgery, Bariatric Surgeon, Clinica Indisa, Santiago, Chile; Dr Adelina Coturel, Cariatric Surgeon, Hospital del Bicentenario de Esteban Echeverria, Buenos Aires, Argentina; Dr Huhammed Said Dalkılı\u0026ccedil;, Bariatric Surgeon, Marmara University School of Medicine, Istanbul, T\u0026uuml;rkiye (Turkey); Dr Felipe Martin Bianco Rossi, Bariatric Surgeon, RR M\u0026eacute;dicos Cirurgi\u0026otilde;es, Santo Andr\u0026eacute;, Brazil; Dr Shekina Iyefu Adanu, Bariatric Physician, Getslim Bariatric and Surgical Centre, Abuja, Nigeria; Dr Jason Widjaja, Bariatric Surgeon, Sichuan University West China Hospital, Sichuan, China; Dr Donatas Danys, Bariatric Surgeon, Faculty of Medicine at Vilnius University, Vilnius, Lithuania; Dr Juan Francisco Ortega Puy, Bariatric Surgeon, Cl\u0026iacute;nica Integral Bari\u0026aacute;trica, Mexico City, Mexico; Dr Andr\u0026eacute;s Alb\u0026aacute;n Rivas, Bariatric Surgeon, Hospital Universitario Semedic, Guayaquil, Ecuador; Dr Maria Lape\u0026ntilde;a-Rodriguez, Bariatric Surgeon, Hospital Clinico Universitario de Valencia, Valencia, Spain; Dr Guo Hou Loo, Bariatric Surgeon, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia; Dr Beniamino Pascatto, Bariatric Surgeon, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg; Dr Adam Abu-Abeid, Bariatric Surgeon, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Dr Jose Luis Calder\u0026oacute;n, Bariatric Surgeon, Mexicali, M\u0026eacute;xico; Associate Professor Wang Bing, Bariatric Surgeon, Chengdu Third People's Hospital, Chengdu, Sichuan, China; Associate Professor Muhammed Rasid Aykota, Bariatric Surgeon, Tekden Hospitals, Denizli, T\u0026uuml;rkiye; Associate Professor Jerry Dang, Bariatric Surgeon, Cleveland Clinic Lerner College of Medicine of Wase Western Reserve University, Cleveland, Ohio, USA; Associate Professor Mehmet Celal Kizilkaya, Bariatric Surgeon, Acibadem University Atakent Hospital, Istanbul, T\u0026uuml;rkiye; Assistant Professor Sahnoun Moez, Bariatric Surgeon, Interior Forces of Security Hospital, Marsa, Tunisia; Dr Yanxin An, Bariatric Surgeon, The First Affiliated Hospital of Xi 'an Medical College, Xi'an, Shaanxi province, China; Mr Isaiah Oluwasegun Atoyebi, Registered Dietician Nutritionist, Getslim Bariatrics and Surgical Limited, Guzape, Nigeria; Dr Xavier Sousa, Bariatric Surgeon, ULS Amadora, Portugal; Professor Guiqi Wang, Bariatric Surgeon, The First Hospital of Hebei Medical Univeristy, Shijiazhuang City, China; Dr Marius Nedelcu, Bariatric Surgeon, Centre de Chirurgie de l'Ob\u0026eacute;sit\u0026eacute;, Bordeaux, France; Dr Ahmed Abokhozima, Bariatric Surgeon, Alexandria University, Cairo, Egypt; Dr Mohd Yaqoob Bhat, Bariatric Surgeon, Government Medical College Srinagar, Srinagar, India; Miss Jennifer Darrien, Bariatric Surgeon, Nuffield Health, Chester, UK; PD Dr med Tarik Delko, Bariatric Surgeon, Chirurgie Zentrum St Anna, Lucerne, Switzerland; Dr Faiz U Shariff, Bariatric Surgeon, Wellspan Bariatric Surgery, York, PA, USA; Dr Bernab\u0026eacute; Mat\u0026iacute;as Quesada, Bariatric Surgeon, Universidad de Buenos Aires, Buenos Aires, Argentina; Professor Corrigan McBride, Bariatric Surgeon, University of Nebraska Medical Centre, Nebraska, USA; Mr Islam Omar, Bariatric Surgeon, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Mr Simon Gibson, Consultant Bariatric Surgeon, NHS Greater Glasgow and Clyde, Glasgow, Scotland; Professor Javed Sultan, Bariatric Surgeon, Northern Care Alliance NHS Trust, Greater Manchester, England; Professor Helen Heneghan, Bariatric Surgeon, University College Dublin Medical School, Dublin, Ireland; Mr Andrew Beamish, Bariatric Surgeon, Swansea University, Swansea, Wales; Miss Katharine Hallworth-Cook, Specialist Nurse, Royal Berkshire NHS Foundation Trust, Berkshire, England; Professor Alexander Miras, Endocrinologist, Imperial College London, London, UK; Guangzhong Xu, Bariatric Surgeon, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, People\u0026rsquo;s Republic of China; Fathi Elzowawi, Bariatric Surgeon Specialist, Misurata Medical Centre, Misrata, Libya; Dr Omar Paipilla, Bariatric Surgeon, Hospital Ciba, Tijuana, Mexico; Dr Natan Zundel, Bariatric Surgeon, Herbert Wheitmer College of Medicine, Miami, USA; Mr Bassem Amr, Consultant Bariatric and UGI surgeon, County Durham and Darlington NHS Foundation Trust, UK.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSources of financial support\u003c/em\u003e\u003c/strong\u003e: None\u003cstrong\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConflicts of interest:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eNone\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical Board Approval\u003c/em\u003e\u003c/strong\u003e: Not required\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Obesity Federation (2024) \u0026apos;Prevalence of obesity\u0026apos;. 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(2020) \u0026apos;Follow-up after bariatric surgery: A review\u0026apos;. \u003cem\u003eNutrition\u003c/em\u003e. 2020; 78: 110831.\u003c/li\u003e\n\u003cli\u003eShen, R., Dugay, G., Rajaram, K. et al. \u0026apos;Impact of patient follow-up on weight loss after bariatric surgery\u0026apos;, \u003cem\u003eObesity Surgery\u003c/em\u003e. 2004; 14(4); 514-519.\u003c/li\u003e\n\u003cli\u003eEndevelt, R., Ben-Assuli, O., Klain, E. and Zelber-Sagi, S. \u0026apos;The role of dietitian follow-up in the success of bariatric surgery\u0026apos;, \u003cem\u003eSurgery for Obesity and Related Diseases\u003c/em\u003e. 2013; 9(6): 963-968.\u003c/li\u003e\n\u003cli\u003eGradaschi, R., Molinari, V., Sukkar, S.G. et al. \u0026apos;Effects of the postoperative dietetic/behavioral counseling on the weight loss after bariatric surgery\u0026apos;, \u003cem\u003eObesity Surgery\u003c/em\u003e. 2020; 30: 244-248.\u003c/li\u003e\n\u003cli\u003eArgyrakopoulou, G., Konstantinidou, S.K., Dalamaga, M. and Kokkinos, A. \u0026apos;Nutritional deficiencies before and after bariatric surgery: Prevention and treatment\u0026apos;, \u003cem\u003eCurrent Nutrition Reports\u003c/em\u003e. 2022; 11(2): 95-101.\u003c/li\u003e\n\u003cli\u003eNuzzo, A., Czernichow, S., Hertig, A., Ledoux, S., Poghosyan, T., Quilliot, D., Le Gall, M., Bado, A. and Joly, F. (2021) \u0026apos;Prevention and treatment of nutritional complications after bariatric surgery\u0026apos;. \u003cem\u003eThe Lancet Gastroenterology \u0026amp; Hepatology\u003c/em\u003e. 2021; 6(3): 238-251.\u003c/li\u003e\n\u003cli\u003eHassan, M., Barajas-Gamboa, J.S., Kanwar, O., Lee-St John, T., Tannous, D., Corcelles, R., Rodriguez, J. and Kroh, M. \u0026apos;The role of dietitian follow-ups on nutritional outcomes post\u0026ndash;bariatric surgery\u0026apos;, \u003cem\u003eSurgery for Obesity and Related Diseases\u003c/em\u003e. 2024; 20(4): 407-412.\u003c/li\u003e\n\u003cli\u003eSzmulewicz, A., Wanis, K.N., Gripper, A., Angriman, F., Hawel, J., Elnahas, A., Alkhamesi, N.A. and Schlachta, C.M. \u0026apos;Mental health quality of life after bariatric surgery: A systematic review and meta‐analysis of randomized clinical trials\u0026apos;, \u003cem\u003eClinical Obesity\u003c/em\u003e. 2019; 9(1): e12290.\u003c/li\u003e\n\u003cli\u003eHerpertz, S., Kielmann, R., Wolf, A.M., Hebebrand, J. and Senf, W. \u0026apos;Do psychosocial variables predict weight loss or mental health after obesity surgery? A systematic review\u0026apos;. \u003cem\u003eObesity Research\u003c/em\u003e. 2004; 12(10): 1554-1569.\u003c/li\u003e\n\u003cli\u003eM\u0026uuml;ller, M., Nett, P.C., Borb\u0026eacute;ly, Y.M., Buri, C., Stirnimann, G., Laederach, K. and Kr\u0026ouml;ll, D. \u0026apos;Mental illness has a negative impact on weight loss in bariatric patients: a 4-year follow-up\u0026apos;, \u003cem\u003eJournal of Gastrointestinal Surgery\u003c/em\u003e. 2019; 23(2): 232-238.\u003c/li\u003e\n\u003cli\u003eMorgan, D.J., Ho, K.M. and Platell, C. \u0026apos;Incidence and determinants of mental health service use after bariatric surgery\u0026apos;, JAMA Psychiatry. 2020; 77(1), pp. 60-67.\u003c/li\u003e\n\u003cli\u003eBellicha, A., Ciangura, C., Roda, C., Torcivia, A., Aron-Wisnewsky, J., Poitou, C. and Oppert, J.M. \u0026apos;Effect of exercise training after bariatric surgery: A 5-year follow-up study of a randomized controlled trial\u0026apos;, \u003cem\u003ePLOS One\u003c/em\u003e. 2022; 17(7): e0271561.\u003c/li\u003e\n\u003cli\u003eBellicha, A., van Baak, M.A., Battista, F., Beaulieu, K., Blundell, J.E., Busetto, L., Carra\u0026ccedil;a, E.V., Dicker, D., Encantado, J., Ermolao, A. and Farpour-Lambert, N. \u0026apos;Effect of exercise training before and after bariatric surgery: A systematic review and meta-analysis\u0026apos;, Obesity Reviews. 2021; 22: e13296.\u003c/li\u003e\n\u003cli\u003eHansen, D., Decroix, L., Devos, Y., Nocca, D., Cornelissen, V., Dillemans, B. and Lannoo, M. \u0026apos;Towards optimized care after bariatric surgery by physical activity and exercise intervention: a review\u0026apos;, \u003cem\u003eObesity Surgery\u003c/em\u003e. 2020; 30: 1118-1125.\u003c/li\u003e\n\u003cli\u003eHerring, L.Y., Stevinson, C., Carter, P., Biddle, S.J., Bowrey, D., Sutton, C. and Davies, M.J. (\u0026apos;The effects of supervised exercise training 12\u0026ndash;24 months after bariatric surgery on physical function and body composition: a randomised controlled trial\u0026apos;, International \u003cem\u003eJournal of Obesity\u003c/em\u003e. 2017; 41(6): 909-916.\u003c/li\u003e\n\u003cli\u003eEdwards, M.A., Powers, K., Vosburg, R.W., Zhou, R., Stroud, A., Obeid, N.R., Pilcher, J., Levy, S., McArthur, K., Basishvili, G. and Rosenbluth, A. (2025) \u0026apos;American Society for Metabolic and Bariatric Surgery: Postoperative Care Pathway Guidelines for Roux-en-Y Gastric Bypass\u0026apos;, Surgery for Obesity and Related Diseases.. Available at: https://asmbs.org/resources/american-society-for-metabolic-and-bariatric-surgery-postoperative-care-pathway-guidelines-for-roux-en-y-gastric-bypass/. (Accessed 1\u003csup\u003est\u003c/sup\u003e March 2025).\u003c/li\u003e\n\u003cli\u003eFinks, J.F., English, W.J., Carlin, A.M., et al. (2012) \u0026apos;Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative\u0026apos;, \u003cem\u003eAnnals of Surgery\u003c/em\u003e. 2012; 255(6): 1100\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eAminian, A., Vosburg, R.W., Altieri, M.S., Hinojosa, M.W. and Khorgami, Z. \u0026apos;The American Society for Metabolic and Bariatric Surgery (ASMBS) updated position statement on perioperative venous thromboembolism prophylaxis in bariatric surgery\u0026apos;, \u003cem\u003eSurgery for Obesity and Related Diseases.\u003c/em\u003e 2022; 18(2): 165-174.\u003c/li\u003e\n\u003cli\u003eHamad, G.G. and Choban, P.S. \u0026apos;Enoxaparin for thromboprophylaxis in morbidly obese patients undergoing bariatric surgery: findings of the prophylaxis against VTE outcomes in bariatric surgery patients receiving enoxaparin (PROBE) study\u0026apos;, \u003cem\u003eObesity Surgery\u003c/em\u003e. 2005; 15(10): 1368-1374.\u003c/li\u003e\n\u003cli\u003eGuzman-Pruneda, F.A., Garcia, A., Crum, R.W., Chen, T., Krikhely, A. and Bessler, M. \u0026apos;Extended Post Discharge Prophylaxis for Venous Thromboembolism Prevention After Bariatric Surgery\u0026apos;. \u003cem\u003eObesity Surgery\u003c/em\u003e. 2024; 34(4): 1217-1223.\u003c/li\u003e\n\u003cli\u003eGiannopoulos, S., Motamedi, S.M.K., Athanasiadis, D.I., Clapp, B., Lyo, V., Ghanem, O., Edwards, M., Puzziferri, N., Stefanidis, D. and ASMBS Research Committee. \u0026apos;Venous thromboembolism (VTE) prophylaxis after bariatric surgery: a national survey of MBSAQIP director practices\u0026apos;, \u003cem\u003eSurgery for Obesity and Related Diseases\u003c/em\u003e. 2023; 19(8): 799-807.\u003c/li\u003e\n\u003cli\u003eYing, V.W., Kim, S.H., Khan, K.J., et al. \u0026apos;Prophylactic PPI help reduce marginal ulcers after gastric bypass surgery: a systematic review and meta-analysis of cohort studies\u0026apos;, \u003cem\u003eSurgical Endoscopy\u003c/em\u003e. 2015; 29(5): 1018-1023.\u003c/li\u003e\n\u003cli\u003eGiannopoulos, S., Athanasiadis, D.I., Clapp, B., Lyo, V., Ghanem, O., Puzziferri, N., Stefanidis, D. and Bariatric Surgery Research Committee \u0026apos;Proton pump inhibitor prophylaxis after Roux-en-Y gastric bypass: a national survey of surgeon practices\u0026apos;, \u003cem\u003eSurgery for Obesity and Related Diseases.\u003c/em\u003e 2023; 19(4): 303-308.\u003c/li\u003e\n\u003cli\u003eChiappetta, S., Stier, C., Ghanem, O.M., Dayyeh, B.K.A., Bo\u0026scaron;koski, I., Prager, G., LaMasters, T. and Kermansaravi, M. \u0026apos;Perioperative interventions to prevent gastroesophageal reflux disease and marginal ulcers after bariatric surgery\u0026mdash;An international experts\u0026rsquo; survey\u0026apos;, Obesity Surgery. 2023; 33(5):1449-1462.\u003c/li\u003e\n\u003cli\u003eMalfertheiner, P., Kandulski, A. and Venerito, M. \u0026apos;Proton-pump inhibitors: understanding the complications and risks\u0026apos;, \u003cem\u003eNature Reviews Gastroenterology \u0026amp; Hepatology\u003c/em\u003e. 2017; 14(12): 697-710.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Bariatric and metabolic surgery, postoperative care, follow-up","lastPublishedDoi":"10.21203/rs.3.rs-6779565/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6779565/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e With over 1 billion individuals affected globally, obesity and obesity related diseases is now a leading cause of death. Metabolic and bariatric surgery (MBS) has emerged as a cornerstone intervention for severe obesity and its associated comorbidities. Despite its efficacy, postoperative care and follow-up after MBS remains highly variable worldwide.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e The PARTNER study aimed to evaluate global clinical practices in the postoperative management following MBS by surveying multidisciplinary healthcare professionals\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This study was an international online survey conducted between October 2024 and January 2025. A multidisciplinary team developed the questionnaire based on existing literature and international guidelines. The survey assessed five domains: follow-up care, postoperative treatment, dietary management, patient support, and measurement of surgical outcomes. Responses were analysed descriptively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 262 responses were received from 62 countries. Most respondents were bariatric surgeons (72.1%) working in public healthcare systems (73.3%). While 78.7% reported conducting three-month postoperative reviews, only 23.7% offered indefinite follow-up. Hybrid models of care (virtual and in-person) were common (56.9%). VTE prophylaxis and postoperative PPI use were recommended by 64.1% and 84.3% respectively. Nearly all respondents (98.1%) provided dietary advice, with protein and micronutrient supplementation widely endorsed. Only 56.1% routinely referred patients for psychological follow-up. Definitions of surgical success and failure varied widely, with inconsistent objective outcome measures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The PARTNER study reveals significant international variation in postoperative management practices following MBS. These findings underscore the need for more standardized, evidence-based guidelines to improve long-term outcomes and equity of care worldwide.\u003c/p\u003e","manuscriptTitle":"Global Variations in Practices After Bariatric and Metabolic Surgery; the PARTNER study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 14:35:25","doi":"10.21203/rs.3.rs-6779565/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-10-22T01:06:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-12T21:28:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-08T09:17:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-01T17:55:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30163016305515940636879586187584314683","date":"2025-09-30T01:19:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210640601002565618800024722707611724287","date":"2025-09-29T06:34:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"264240188266377342288096685614622402966","date":"2025-09-23T17:08:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-29T04:01:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76065628788096634342542698222803243765","date":"2025-08-18T17:43:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"279539125572751314693722489050448974200","date":"2025-08-16T18:56:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-04T15:53:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-12T12:38:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-06T03:32:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2025-05-29T22:06:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"40740833-9883-43aa-be1f-2e041835afda","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T16:06:52+00:00","versionOfRecord":{"articleIdentity":"rs-6779565","link":"https://doi.org/10.1007/s11695-025-08356-9","journal":{"identity":"obesity-surgery","isVorOnly":false,"title":"Obesity Surgery"},"publishedOn":"2025-11-11 15:58:38","publishedOnDateReadable":"November 11th, 2025"},"versionCreatedAt":"2025-08-06 14:35:25","video":"","vorDoi":"10.1007/s11695-025-08356-9","vorDoiUrl":"https://doi.org/10.1007/s11695-025-08356-9","workflowStages":[]},"version":"v1","identity":"rs-6779565","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6779565","identity":"rs-6779565","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}