CRP and obesity due to melanocortin 4 receptor deficiency: Previous studies have identified several independent risk factors for DSL, including preoperative pyloric obstruction leading to duodenal inflammation [23], elevated preoperative C-reactive protein (CRP) [24], obesity [24], lack of reinforcement at the duodenal stump [24], afferent loop obstruction [23, 25], and D2 lymph node dissection combined with subtotal gastrectomy [26].