Surgeons should be alert to significant issues in the implementation of non-standard metabolic bariatric surgeries.

• 57 studies analyzed involved 10,754 patients; median from first operation to publication was 5 years.
• Only 11% had prospective trial registration; 26% reported outcomes at 3 years or more.

These findings point to systemic failures in monitoring experimental procedures, emphasizing the need for stronger regulations to safeguard patient safety and ensure solid evidence for new surgical techniques.