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Abstract Background Bariatric surgery is the most effective long-term intervention for severe obesity and its metabolic complications. However, the influence of chronic hypobaric hypoxia at high altitude (HA) on surgical outcomes remains inadequately characterized. This systematic review synthesizes available evidence on HA as a potential risk modifier and provides mechanistic insights and clinical management guidance. Methods A systematic search was conducted across PubMed, Embase, Cochrane Library, CNKI, and Wanfang Data from inception to October 25, 2025. Studies comparing postoperative outcomes between HA (≥ 2000 m) and low-altitude (LA, < 1000 m) patients undergoing primary bariatric surgery were included. Data were synthesized narratively by procedure type and outcome domain. Results Six studies comprising 476 patients met eligibility criteria, predominantly examining laparoscopic sleeve gastrectomy (LSG) with limited data on Roux-en-Y gastric bypass (RYGB). LSG complication rates at HA ranged from 4.35% to 15.3% across studies, consistently exceeding typical LA benchmarks. Staple-line complications and pulmonary events were most frequently reported. Early postoperative weight loss was often attenuated at HA, although medium-term outcomes at 12–24 months became comparable between groups. Evidence for RYGB remains restricted to a single small study without internal LA comparator, precluding definitive conclusions. Conclusions High-altitude residence is associated with elevated perioperative risks for LSG, supported by consistent multi-study evidence. Whether altitude independently affects RYGB outcomes cannot be reliably determined from current data. Healthcare system factors and altitude-associated comorbidities likely contribute substantially to observed differences. Procedure-specific, altitude-adapted perioperative protocols are warranted, with LSG representing the better-studied option in HA settings. Future prospective studies with concurrent low-altitude controls are urgently needed to isolate the true altitude effect.
Zhou et al. (Wed,) studied this question.