Improvement of the surgical procedure and patient related outcomes in bariatric and metabolic surgery

This thesis aims to improve surgical procedures and patient-related outcomes in bariatric surgery. Part I explores markers for early detection of postoperative complications, by using a checklist and using parameters such as the Neutrophil-to-Lymphocyte Ratio (NLR), and compares outcomes between sleeve gastrectomy and Roux-en-Y gastric bypass. The SleeveBypass Trial evaluates the long-term effectiveness of both procedures. After five years, both showed comparable excess BMI loss, but Roux-en-Y gastric bypass resulted in better outcomes for dyslipidemia and GERD, although with a higher rate of minor complications. Part II focuses on preventing complications. The GINSBY trial investigates the Nissen-sleeve procedure as an alternative for patients with GERD and morbid obesity who are not candidates for Roux-en-Y gastric bypass. Additionally, the thesis examines the use of tranexamic acid (TXA) to reduce perioperative bleeding. While TXA showed no significant reduction in major complications, it improved postoperative hemoglobin and reduced minor bleeding-related issues, supporting further investigation in a randomized trial.