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Sánchez et al. Mini-invasive Surg 2024;8:36 https://dx.doi.org/10.20517/2574-1225.2024.72 Page 3 of 9

Operational definitions:
Diabetes mellitus: Defined as type 2 diabetes (T2D) on oral medication or insulin therapy.
High blood pressure (HBP): Confirmed clinical hypertension on medication.
Depression: Clinical depression on medication as an indication for MBS.
Sleep apnea: Confirmed sleep apnea with the usage of continuous positive airway pressure (CPAP).
Dyslipidemia: Confirmed dyslipidemia on medication.
GERD: Defined as gastro-esophageal reflux disease on medication.

Statistical analysis was performed using IBM SPSS Statistics v 26 and Microsoft Excel for iMac v 16.46.
Descriptive and inferential statistics were applied based on the original scaling of every included variable.
Nominal or categorical comparisons were made with Chi-square and Fisher’s exact tests, Kendall’s tau-b,
Gamma, Spearman correlation, and Pearson’s for ordinal and two-way analysis of variance (ANOVA) for
repeated (time series), and continuous measures of multiple independent groups (LATAM vs. Mexico) were
contrasted based on the type of MBS [Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG)]. Any
P-value of ≤ 0.05 (or 5% for the type I error) was considered as statistically significant for two-tailed
hypothesis testing.

Ethics statement:
The data reported in the manuscript were collected from retrospective blinded databases and reported in
counts and percentages such that participants are not able to be identified from the results. The protocol
was approved by the ABC Medical Center Institutional Review Board, with approval No: ABC-17-11.

RESULTS
In Mexico, a total of 13 surgeons working in five institutions participated in the registry. The rest of
LATAM included 30 surgeons working in ten institutions.

In the five years of data collection, the 3,344 patients included in the Mexican registry were contrasted with
the 10,384 corresponding to the other LATAM institutions. In Mexico, there were 2,522 females (75%) and
822 males (25%), and in LATAM, the percentage of females vs. males was 73% and 27%, respectively. The
mean age of patients in Mexico and LATAM was very similar, 39 and 41 years, respectively. The mean body
mass index (BMI) was 43.4 ± 7.9 kg/m in Mexico and 40.1 ± 6.57 kg/m in LATAM. Patient distribution by
2
2
the degree of obesity and gender is shown in Figure 1. The obesity degree in males and females was
statistically different in both Mexico and LATAM (Kendall’s tau = 0.14, P < 0.0001). In Mexico, there was an
increasing trend of the obesity degree in both genders, higher in males (Spearman correlation = 0.15, P <
0.0001) and in LATAM, the trend was decreasing with a lesser association (Spearman correlation = 0.09, P <
0.0001).

In Mexico, the most frequently performed surgical procedure was the RYGB followed by SG, whereas in
LATAM, the most common surgical procedure was SG followed by RYGB. Figure 2 shows the distribution
of surgical procedures in both groups. From the total number of surgical procedures, 91% were primary and
9% revisional in Mexico, whereas percentages of primary and revisional procedures in LATAM were 89.4%
and 10.6%.

In Mexico, surgical morbidity occurred in 6% of the patients at 30 days and 2% of patients had an additional
complication at 90 days. Complications at 30 and 90 days in LATAM were 4% and 2%. There was one
surgical mortality in Mexico. The most common surgical complications are shown in Table 1.