The future of bariatric surgery: could surgical practice take advantage of in silico computational tools and...

In 2023, the 8th IFSO analysis reported 480 970 metabolic bariatric procedures worldwide, as an action against obesity, a pandemic affecting more than a billion people. Despite the well-documented risks associated with obesity and the potential health benefits after bariatric surgery (BS), many eligible patients avoid it, raising concerns about whether this is due to a lack of awareness or limitations in existing techniques. Indeed, this discrepancy prompts inquiries into how this trend can be reversed. Is this a lack of proper information to the eligible patients, or is it a conscious choice linked to the limitations of existing technology? This aspect highlights the urgent need for more patient-focused, advanced methodologies that enhance both surgical outcomes and accessibility. Bioengineering offers an innovative approach by personalising BS, encouraging patients to pursue a tailored care pathway. In the era of digital twins, artificial intelligence and virtual surgical planning, bioengineers could support both surgeons and patients, predicting individual success rates, with greater control over surgical outcomes. Some examples are reported in the scientific literature, offering additional information, such as the optimal reduction of stomach volume by varying the tube size in laparoscopic sleeve gastrectomy or adjusting the suture pattern in endoscopic sleeve gastroplasty. Computational models can also predict the mechanical stress and strain on the gastric wall, which is crucial for targeting the brain regions associated with satiety and thus facilitating the weight loss process. Moreover, emerging personalised virtual models are demonstrating significant potential to revolutionise BS, leading to more realistic and precise surgical planning. Therefore, how could these virtual approaches impact the evolution of BS? Which could be the next improvements provided by computational bioengineering in this field? This perspective underscores the importance of adopting and advancing computational bioengineering to address current limitations and enhance the global impact of BS.