ObjectiveTo systematically review the research progress in the selection of metabolic bariatric procedures, efficacy, safety, complication prevention, and long-term management for elderly patients, so as to provide references for surgical decision-making and perioperative management in future metabolic and bariatric surgery for elderly obese patients. MethodA review of recent domestic and international literature on metabolic and bariatric surgery in elderly patients was conducted. ResultsWith the intensification of societal aging, the incidence of obesity and related metabolic diseases among the elderly population has significantly increased. Metabolic and bariatric surgery has been proven to effectively reduce weight and improve obesity-related metabolic diseases in elderly patients. Current guidelines no longer consider age an absolute contraindication for surgery. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly used procedures internationally. SG is superior to RYGB in terms of surgical safety, while RYGB has greater advantages in improving metabolic diseases. Although the postoperative mortality and complications risks in elderly obese patients are higher than those in younger obese patients, strict preoperative assessment and individualized procedure selection can significantly reduce these risks. ConclusionsMetabolic and bariatric surgery can serve as an effective treatment for elderly obese patients, offering comprehensive benefits in weight loss and metabolic improvement. Procedure selection requires individualized assessment, balancing the patient’s baseline condition and metabolic needs. Postoperative success hinges on systematic long-term follow-up and management to ensure sustained benefits and safety. Future efforts should focus on clarifying the definitions or standards of “elderly” and “obesity,” followed by more large-sample, long-term follow-up randomized controlled studies to validate the safety and efficacy of metabolic and bariatric surgery.
ObjectiveTo compare the safety of the incision along the upper umbilical margin (referred to as the “upper incision”) versus the transverse umbilical incision (referred to as the “transverse incision”) for single-port bariatric surgery, and to assess their effects on postoperative scar appearance and patient’s psychological adaptation. MethodsThis study was designed as a multi-center retrospective analysis. The patients who underwent bariatric surgery via the upper incision and transverse incision at the Third People’s Hospital of Chengdu, Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, and the First Affiliated Hospital of Jinan University from December 2024 to April 2025. The incidence of postoperative complications and the pionts of scar appearance (evaluated using the POSAS 3.0 scale) and psychological adaptation (measured with the BODY-Q scale) between the two incision methods were compared. Furthermore, multiple linear regression model was employed to evaluate the impact of different incision methods on points of scar appearance and psychological adaptation. ResultsA total of 194 patients who underwent single-port bariatric surgery were included, with 134 in the transverse incision group and 60 in the upper incision group. There was no statistically significant difference in the total incidence of incision complications between the transverse and upper incision groups [11.9% (16/134) vs. 18.3% (11/60), χ2=0.930, P=0.335]. The transverse incision group showed significantly better outcomes than the upper incision group in the overall points of BODY-Q scale [(39.86±1.02) points vs. (37.63±4.70) points, t=–6.090, P<0.001] and POSAS scale [(17.60±2.35) points vs. (21.25±6.00) points, t=5.239, P<0.001]. After adjusting for potential confounding factors such as history of diabetes mellitus, education level, smoking status, alcohol consumption status, keloid tendency, and use of scar improvement products in the multiple linear regression model, the advantage of the transverse incision remained significant [β(95%CI)=–1.81 (–2.84, –0.78), P<0.001]. Conclusions This study demonstrates that the transverse incision significantly improves the overall appearance of the postoperative scar and enhances patient’s psychological adaptation compared to the upper incision in single-port bariatric surgery. This advantage persists independently after adjusting for multiple confounding factors. Therefore, the transverse incision could be considered a more favorable approach in terms of cosmetic outcomes and patient’s psychological adaptation.