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Background <p>Roux-en-Y gastric bypass (RYGB) is a widely performed metabolic and bariatric surgery (MBS) procedure with proven efficacy. However, significant variability exists in its technical execution. This study aimed to evaluate global practice patterns among surgeons affiliated with the International Federation for the Surgery and Other Therapies for Obesity (IFSO), identifying key variations and factors influencing intraoperative decision-making.</p> Methods <p>A cross-sectional survey was distributed between January and November 2025 to active IFSO members performing RYGB. The survey explored techniques related to the gastric pouch configuration, intestinal limb lengths, gastrojejunostomy, ring augmentation, and adjunct use. Responses from 245 surgeons across 47 countries were analyzed using descriptive statistics, subgroup comparisons, and multivariable logistic regression.</p> Results <p>Technical variability was widespread. Only 53.5% routinely measured gastric pouch length; 67.3% described their pouches as “short” or “small,” with variable anatomical endpoints. Bougie sizes ranged from 28 to 46 Fr, with 36 Fr being most common (41.2%). Only 21.6% of respondents reported routinely measuring total bowel length. Ring-augmentation was used by 20.4%, with significant regional and experiential variation. Linear stapling was preferred for gastrojejunostomy (81.2%), but stoma size and suture materials varied. Routine closure of both Petersen’s space and the jejunojejunal mesenteric defect was common (69%) yet non-uniform. High-volume surgeons had shorter hospital stays and longer follow-up, but technical patterns were similar.</p> Conclusion <p>Global RYGB practice exhibits heterogeneity in several key operative steps. Improved reporting of intraoperative technical variables may help clarify which differences are most relevant to perioperative, long-term, and registry-based outcomes, and may support future consensus-building in areas where standardization is clinically justified.</p>

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Global Technical Variations in Roux-en-Y Gastric Bypass: A Worldwide Survey Among IFSO Members

  • 期刊论文

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  • 发表日期：

    2026年5月23日

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  • Mohamed Hany,
  • Mohamed H. Zidan,
  • Hashem Altabbaa,
  • Ahmed Amgad,
  • Hazem Al-Momani,
  • Ahmed Mosaad,
  • Aya Bessa,
  • Fouad Hanna,
  • Nour Zayed,
  • Ahmed Youssef Hassan,
  • Omar Badawy,
  • Omar Heih,
  • Hassan El-Masry,
  • Shorouk Mourad,
  • Ahmed El-Shamarka,
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  • Anwar Ashraf Abouelnasr,
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  • Bart Torensma,
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  • Ahmed Abokhozima,
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  • Abdelrahman M. Tawfik,
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  • Hisham Sharaf,
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  • Mohamed Al Sayed,
  • Menahtallah Mohsen,
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  • Almoatazbellah Anwar Attalla,
  • Nour Eldein Saad,
  • Nour Lebda,
  • Nouran Keshk,
  • Yousef Romia,
  • Abd-Elfattah Kalmoush,
  • Abdullah Almunifi,
  • Abdelrahman Nimeri,
  • Adel Abou-mrad,
  • Admar concon-Filho,
  • Adrianus Luijten,
  • Ahmed Guirat,
  • Ala Wafa,
  • Aleksandr Neimark,
  • Aleksei A. Botov,
  • Alex Craven,
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  • Alexandre Haumann,
  • Alexandre Henrard,
  • Alvaro Gonzalez,
  • Amanda Belluzzi,
  • Ana Carolina da Costa Mello Moreira,
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  • André Lázaro,
  • Andres Alban Rivas,
  • Andrés Hanssen,
  • Andrés Muñoz Mora,
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  • Andrew G. Robertson,
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  • Anna Casajoana,
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  • Arshad Ali,
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  • Benjamin Clapp,
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  • Caio Cesar Lopes Borga,
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  • Carlo Nagliati,
  • Carlos A. Casalnuovo,
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  • Cristian Eugeniu Boru,
  • Daniel Gero,
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  • David Moszkowicz,
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  • Frédéric Borel,
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  • Frits Berends,
  • Georgios Peros,
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  • Gil Faria,
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  • Giuliano Sarro,
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  • Hamilton Barbosa,
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  • Hernando Javier Forero,
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  • Jean Pierre Vergnaud,
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  • Jesús Vakl,
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  • Johanan David Davila Castro,
  • Johannes Zacherl,
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  • Julio Cezar Cechinel Filho,
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  • Klaus Erich Gerauer,
  • Koba Sakhechidze,
  • Kurt Devroe,
  • Laurent Genser,
  • Leonardo Bortolotti,
  • Leopa Nicoleta,
  • Levon N. Grigoryan,
  • Lourenilson Jose de Souza,
  • Lucas Bojanini Acevedo,
  • Luis Rafael Level Córdova,
  • Luiz Alfredo D’ Almeida,
  • Mahdi Alemrajabi,
  • Maksims Mukāns,
  • Manish Khaitan,
  • Manuel Garcia,
  • Marc J. Legrand,
  • Marc J. Van Det,
  • Maria Antonieta Barrera,
  • María Asunción Acosta Mérida,
  • Mariano Palermo,
  • Mario Alfonso-Blaschke,
  • Marjori Román,
  • Marta Cuadrado-Ayuso,
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  • Masoud Rezvani,
  • Massimiliano Di Paola,
  • Matthieu Poussier,
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  • Michel Vix,
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  • Mirto Foletto,
  • Misha Luyer,
  • Mohamed Mosaad Kandel,
  • Mohamed Omar Fathi Ammar,
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  • Montse Adell Trapé,
  • Mostafa Mohamed Gamal,
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  • Muhammed Taha Demirpolat,
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  • Oktyabr Teshaev,
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  • Patwinder Gill,
  • Paula Franczak,
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  • Romano Schneider,
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  • Santiago Gomez,
  • Samer Mattar,
  • Sergio Carandina,
  • Sergio Sitta,
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  • Sjaak Pouwels,
  • Sofie Viskens,
  • Sonja Chiappetta,
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  • Suhaib Ahmad,
  • Suleiman Naji,
  • Javier T. Birriel ,
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  • Therese Reinstaller,
  • Thomas W Frick,
  • Tom Wiggins,
  • Tristan Greilsamer,
  • Umut Riza Gunduz,
  • Valdemir José Alegre Salles,
  • Valerio Girardi,
  • Vasileios Charalampakis,
  • Victor Lunau Barcellos,
  • Vincenzo Borrelli,
  • Wah Yang,
  • Yi Chen,
  • Yves Borbély,
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摘要

Background

Roux-en-Y gastric bypass (RYGB) is a widely performed metabolic and bariatric surgery (MBS) procedure with proven efficacy. However, significant variability exists in its technical execution. This study aimed to evaluate global practice patterns among surgeons affiliated with the International Federation for the Surgery and Other Therapies for Obesity (IFSO), identifying key variations and factors influencing intraoperative decision-making.

Methods

A cross-sectional survey was distributed between January and November 2025 to active IFSO members performing RYGB. The survey explored techniques related to the gastric pouch configuration, intestinal limb lengths, gastrojejunostomy, ring augmentation, and adjunct use. Responses from 245 surgeons across 47 countries were analyzed using descriptive statistics, subgroup comparisons, and multivariable logistic regression.

Results

Technical variability was widespread. Only 53.5% routinely measured gastric pouch length; 67.3% described their pouches as “short” or “small,” with variable anatomical endpoints. Bougie sizes ranged from 28 to 46 Fr, with 36 Fr being most common (41.2%). Only 21.6% of respondents reported routinely measuring total bowel length. Ring-augmentation was used by 20.4%, with significant regional and experiential variation. Linear stapling was preferred for gastrojejunostomy (81.2%), but stoma size and suture materials varied. Routine closure of both Petersen’s space and the jejunojejunal mesenteric defect was common (69%) yet non-uniform. High-volume surgeons had shorter hospital stays and longer follow-up, but technical patterns were similar.

Conclusion

Global RYGB practice exhibits heterogeneity in several key operative steps. Improved reporting of intraoperative technical variables may help clarify which differences are most relevant to perioperative, long-term, and registry-based outcomes, and may support future consensus-building in areas where standardization is clinically justified.