Complications After Bariatric Surgery: Insights from a 14-Year Single-Institutional Study Without Fistula

<b>Background/Objectives</b>: Obesity imposes a significant and growing burden on healthcare systems worldwide. Bariatric surgery remains the most effective long-term treatment for morbid obesity, but its success depends heavily on the quality of perioperative management and institutional expertise. This study presents a comprehensive analysis of 14 years of bariatric surgical activity in a university-based Center of Excellence, emphasizing complication rates and safety outcomes. <b>Methods</b>: A cohort analysis was performed on a prospectively collected database including all bariatric procedures conducted between June 2012 and June 2025 in an Obesity Center, located in 'Saint Spiridon' Hospital' in Iasi, Romania. Eligibility was determined according to the American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) guidelines. All patients underwent standardized preoperative evaluation by a multidisciplinary team. <b>Results</b>: Over a 14-year period, 1010 patients underwent surgery and had a mean age of 39 years and 72% of them were females. A total of 68 patients (6.73%) experienced complications, including 28 (2.77%) within 30 days and 40 (3.96%) after first month. No postoperative fistulas or deaths were recorded during the entire study period. <b>Conclusions</b>: The long-term data from over one thousand consecutive bariatric cases confirm the high safety and effectiveness of a multidisciplinary, protocol-driven approach. The absence of postoperative fistulas and mortality underscores the value of institutional experience and standardized perioperative care.