Langenbeck's Archives of Surgery最新文献

{"title":"Versius surgical system: tips and tricks for OR setting and port placement for pelvic surgery, our experience in a multi-robotic referral centre.","authors":"Giorgia Gaia, Maria Chiara Sighinolfi, Margarita Afonina, Stefano Terzoni, Veronica Iannuzzi, Mauro Felline, Alessandro Morandi, Carlo Alboni, Antonio La Marca, Andrea Pisani Ceretti, Paolo Pietro Bianchi, Bernardo Rocco, Anna Maria Marconi","doi":"10.1007/s00423-025-03812-7","DOIUrl":"10.1007/s00423-025-03812-7","url":null,"abstract":"<p><strong>Background: </strong>The Versius surgical system (CMR Surgical, Cambridge, UK) is a new robotic platform introduced after the original patent of the DaVinci system expired; it has already been applied in different fields, including gynaecology. Unlike DaVinci, Versius has four independent bedside units (BSU), which must be individually positioned with adequate angles and distance to avoid collisions. Given this peculiarity and the shorter arm (30 cm) compared to the Da Vinci, investigating BSU positioning and port placement is mandatory. We aim to report technical tips and tricks for OR setup and port placement by analyzing our initial series with the Versius system for benign gynaecological conditions, thereby making the procedure easily reproducible.</p><p><strong>Materials and methods: </strong>We considered prospectively 19 patients undergoing robotic surgery for gynaecological diseases. Demographics, pre-surgical variables, intraoperative robotic events (number and characteristics of collisions, need for detaching instruments, and moving trays during surgery), and perioperative outcomes were collected. Factors impacting the occurrence of high-impact collisions (requiring the disconnection of instruments and restarting of the port training) were analyzed.</p><p><strong>Result: </strong>All surgeries were carried out uneventfully and without conversion. Collisions of any type occurred in 16 out of 19 operations, including 11 high impact collisions. The distance between the trocars and the target organ is a factor that impacts the necessity to restart the system.</p><p><strong>Conclusions: </strong>Versius appeared to be a safe option for benign gynaecological surgery. Our experience suggests that a minimum distance of 19 cm from the bipolar operative trocar and the target organ, as well as a minimum distance of 15 cm between the scissors operative trocar and the target organ, is recommendable to avoid any collisions, or 11 and 9 cm to avoid high impact collisions.</p><p><strong>Conclusions: </strong>Versius appeared to be a safe option for benign gynaecological surgery. Our experience suggests that a minimum distance of 19 cm from the bipolar operative trocar and the target organ, as well as a minimum distance of 15 cm between the scissors operative trocar and the target organ, is recommendable to avoid any collisions, or 11 and 9 cm to avoid high impact collisions.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"252"},"PeriodicalIF":1.8,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How-I-do-it: meso-caval shunt: a safe emergency option for venous reconstruction in pancreaticoduodenectomy.","authors":"Ruili Wei, Jia Huang, Yingjixing Luo, Ruyi Liu, Yue Qiu, Li Xu, Hanchun Huang, Wenying Zhou, Yongliang Sun, Zhiying Yang","doi":"10.1007/s00423-025-03826-1","DOIUrl":"10.1007/s00423-025-03826-1","url":null,"abstract":"<p><strong>Purpose: </strong>In pancreaticoduodenectomy, extensive involvement of the superior mesenteric vein (SMV) often complicates venous reconstruction, especially when artificial grafts are unavailable. In such cases, meso-caval shunt (MCS) emerges as a solution. This study aimed to evaluate the safety and efficacy of permanent MCS as both an emergency procedure and a planned surgical strategy.</p><p><strong>Methods: </strong>We retrospectively analyzed 8 consecutive patients undergoing pancreaticoduodenectomy with permanent MCS between July 2019 and January 2025 at our institution. Clinicopathological characteristics were identified using electronic medical records, and the same surgeon performed all surgeries.</p><p><strong>Results: </strong>The study included seven cases of pancreatic cancer and one ampullary carcinoma (6 male, 2 females; age 54-71 years). The mean operative duration was 510 min with 767 ml blood loss. All patients achieved R0 resection with minor complications (Clavien-Dindo grade I/II), no mortality, and preserved portal perfusion. Meso-caval shunt patency was confirmed postoperatively without hepatic dysfunction. Median survival reached 21 months.</p><p><strong>Conclusion: </strong>Permanent MCS is a reliable elective option for venous reconstruction in pancreaticoduodenectomy, especially when graft-based solutions are not available. Its success in achieving R0 resection while maintaining portal hemodynamics suggests its utility in complex pancreatic resections.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"250"},"PeriodicalIF":1.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical prognostic risk assessment of different pathological subtypes of papillary thyroid cancer: a systematic review and network meta-analysis.","authors":"Jiayi Zhao, Wanchen Zhang, Dongning Lu, Chengying Shao, Yiwei Chen, Xingyu Huang, Yining Zhang, Jiajie Xu","doi":"10.1007/s00423-025-03841-2","DOIUrl":"10.1007/s00423-025-03841-2","url":null,"abstract":"<p><p>There are multiple pathologic subtypes of papillary thyroid carcinoma (PTC), each with distinct clinical prognoses. However, the available data on the clinicopathologic risks associated with several common PTC subtypes are controversial and require more comprehensive evaluation. To address this, we conducted a systematic search of English-language databases, including PubMed, EMbase, Cochrane Library, and Web of Science, for studies on six PTC subtypes, including classic papillary thyroid carcinoma (CPTC), papillary thyroid microcarcinoma (PTMC), follicular variant of papillary thyroid carcinoma (FVPTC), tall cell variant of papillary thyroid carcinoma (TCVPTC), diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC), and columnar cell papillary thyroid carcinoma (CCVPTC). Our case-control study of clinicopathological prognostic analyses of six subtypes, with a search date of January 2000 to May 2024. Two researchers independently screened the literature, extracted data, and assessed quality and risk of bias according to set criteria. R software gemtc package, Stata 15.1 software were applied to perform reticulated Meta-analysis methods were applied to compare the clinicopathological features and prognostic assessment of classic papillary thyroid carcinoma and the other five subtypes in all the studies.The risk of distant metastasis was higher in patients with CCVPTC, TCVPTC, and DSVPTC than in CPTC.FVPTC and PTMC exhibit a lower risk of in situ tumor relapse compared to CPTC. The tumour size of TCVPTC was significantly larger than that of CPTC, while there was no significant difference in the tumour size of CCV, DSV, FVPTC, CPTC and PTMC. DSVPTC was significantly more multifocal than the other subtypes. This network meta-analysis confirms the aggressive biological behavior and poor prognosis associated with TCVPTC, DSVPTC, and CCVPTC. Therefore, these subtypes should be managed aggressively with total thyroidectomy and lymph node dissection if diagnosed preoperatively. In contrast, FVPTC and PTMC are less aggressive and have a better prognosis, suggesting that treatment and follow-up strategies for PTC should be tailored according to the histopathological subtype.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"251"},"PeriodicalIF":1.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between intraoperative hyperoxia and liver function in patients undergoing hepatectomy: a multicenter observational study.","authors":"Yumeng Fu, Ke Hao, Xiaohan Lin, Xiaojun Wu, Shuting Yang, Ziyi Cheng, Minghan Wang, Yongqian Yuan, Baoli Cheng","doi":"10.1007/s00423-025-03832-3","DOIUrl":"https://doi.org/10.1007/s00423-025-03832-3","url":null,"abstract":"<p><strong>Purpose: </strong>Oxygen (O₂) is recognized as both a \"friend and foe\" to various organs, with emerging evidence suggesting potential adverse effects of hyperoxia on the liver. This study aimed to evaluate whether a high intraoperative partial pressure of arterial oxygen (PaO₂ ≥ 300 mmHg) during hepatectomy is associated with postoperative liver injury.</p><p><strong>Methods: </strong>A comparative analysis was conducted on patients undergoing hepatectomy at a university hospital, stratified by intraoperative PaO₂ levels (≥ 300 mmHg vs. <300 mmHg). Primary outcomes included markers of liver function impairment, specifically elevated levels of alanine aminotransferase (ALT), aspartate transaminase (AST), and total bilirubin (Tbil), reduced plasma albumin levels, as well as increased international normalized ratio (INR), prothrombin time (PT). Secondary outcomes encompassed hospital length of stay (LOS) and postoperative complications (Clavien-Dindo classification). Subgroup analyses were performed based on Child‒Pugh score (≥ 7), age (≥ 65 years), surgical approach (laparoscopic), and surgery duration. Additionally, findings were validated in a prospective cohort of 76 patients.</p><p><strong>Results: </strong>The study included 292 patients who underwent hepatectomy between January 2021 and December 2021. All patients survived through hospital discharge. There were no cases diagnosed as post-hepatectomy liver failure. Postoperative changes in ALT, AST, Tbil, albumin levels, and INR, PT were comparable between the high and low PaO₂ groups. No significant differences were observed in hospital LOS and postoperative complications. Subgroup analyses yielded consistent results. These findings were further corroborated in the prospective validation cohort.</p><p><strong>Conclusions: </strong>The findings suggest that intraoperative high PaO₂ (≥ 300 mmHg) is not associated with adverse effects on postoperative liver injury in patients undergoing hepatectomy.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"249"},"PeriodicalIF":1.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Future demand for visceral surgeons in Switzerland: an empirical study.","authors":"Hans Grossen, Matthias Baechtold, Pia Antony, Pietro Renzulli, Fabian Hauswirth, Pascal Probst, Markus K Muller","doi":"10.1007/s00423-025-03833-2","DOIUrl":"10.1007/s00423-025-03833-2","url":null,"abstract":"<p><strong>Introduction: </strong>Switzerland's aging population and evolving healthcare demands are expected to increase the need for specialized surgeons. Meanwhile, ongoing discussions about reduced work hours for residents and a growing trend toward minimally invasive and outpatient procedures may influence training opportunities and inpatient procedural volumes. The aim of this study was to evaluate workforce, training, and procedural volumes in surgery to determine the future demand for visceral surgeons in Switzerland.</p><p><strong>Methods: </strong>This study analysed national datasets from 2009 to 2023 to assess trends in medical school enrolments, recognised medical diplomas, residency positions, and the availability of general and visceral surgeons. Additionally, surgical procedure volumes were evaluated with a particular focus on pancreatic surgery as a proxy for complex cases and appendectomies for simple procedures. Linear regression models projected developments up to 2040, incorporating Swiss population growth forecasts.</p><p><strong>Results: </strong>The number of medical diplomas - both Swiss-issued and foreign-recognized - showed an increase from 2,725 in 2011 to 4,647 in 2023. Projections indicate a further rise, reaching over 6,000 by 2040. Although total surgical residency positions declined slightly, spots dedicated to general surgery candidates grew by 8.7%. The overall pool of general surgeons increased from 1'127 in 2009 to 1'557 in 2023, with the proportion of women rising from 10.6 to 24.9% within the same interval. From 2013 to 2023, annual appendectomies increased from 11,529 to 12,412 (7.7% growth), and forecasts project a further rise of approximately 14% by 2040, although the procedures per surgeon are expected to decrease due to ongoing workforce expansion. Visceral surgeons numbered 303 by 2023 (11% female), and forecasts suggest a 50% increase to approximately 462 by 2040. Pancreatic surgery cases grew by 14.5% between 2016 and 2023 and are projected to increase by an additional 25% by 2040. However, the number of complex surgeries per visceral surgeon is projected to decline steadily over the next years.</p><p><strong>Conclusions: </strong>The expansion of the surgical workforce is projected to overcompensate for the growth of Switzerland's population. In combination with a shift towards outpatient care and reduced working hours, procedural exposure could become critical in general and visceral surgery. Ensuring that training pathways and practice models adapt to these evolving demands will be vital to maintaining high standards of surgical care.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"248"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Segmentectomy is associated with worse disease-free survival compared to lobectomy in patients with stage IA3 non-small cell lung cancer.","authors":"Kaman Hafsa, Stork Theresa, Okumus Özlem, Alnajdawi Yazan, Jemsi Mehran, Petrone Ana, Collaud Stéphane, Stéphane Collaud","doi":"10.1007/s00423-025-03835-0","DOIUrl":"10.1007/s00423-025-03835-0","url":null,"abstract":"<p><strong>Purpose: </strong>Segmentectomy has become the new standard of care for selected patients with stage IA1-2 non-small cell lung cancer (NSCLC). For stage IA3 NSCLC, lobectomy is indicated. This study aims to compare the outcome after segmentectomy and lobectomy in patients with stage IA3 NSCLC.</p><p><strong>Methods: </strong>We retrospectively reviewed all patients undergoing surgery for NSCLC in our center between 2013 and 2023. We identified all patients who underwent segmentectomy or lobectomy for pathological stage IA3 tumors. Survival was calculated from the date of surgery until last follow- up. Univariate analysis was performed to study the impact on overall survival (OS) and disease-free survival (DFS) of clinical variables.</p><p><strong>Results: </strong>We identified fifty-nine patients undergoing surgery for stage IA3 NSCLC. Twenty- seven (28%) patients underwent segmentectomy and sixty-eight (72%) patients underwent lobectomy. Median age was 68 years (47-85). Median FEV1 was 74% (39-140), median DLCO was 67% (28-128). Surgery was performed by VATS in most cases (91%). There was no difference in age and lung function between the lobectomy and segmentectomy groups. Five-year OS was 67%. 5-year DFS was 63%. Five-year DFS was significantly worse in patients who underwent segmentectomy compared to lobectomy (37% vs. 72%, p = 0.040). There was no difference in 5-year OS (56% vs. 69%, p = 0.56).</p><p><strong>Conclusion: </strong>Segmentectomy is associated with significantly worse disease-free survival compared to lobectomy in our cohort of patients with stage IA3 NSCLC.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"247"},"PeriodicalIF":1.8,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12354619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the relationship between hospital caseload and outcome in incisional hernia repair?-A registry-based analysis of 55,584 patients.","authors":"F Köckerling, R Schwab, K Zarras, B Lammers, D Adolf, B Stechemesser, F Mayer, W Reinpold, H Niebuhr, H Riediger","doi":"10.1007/s00423-025-03836-z","DOIUrl":"10.1007/s00423-025-03836-z","url":null,"abstract":"<p><strong>Introduction: </strong>There is an ongoing controversal debate about whether the hospital volume (hospital case load) or the surgeon volume has a greater influence on outcome. The implications of high surgeon volume for the outcome have been demonstrated for ventral and incisional hernia repair. This analysis of data from the Herniamed Registry now aims to assess the relationship between hospital volume/hospital case load and outcome in incisional hernia repair.</p><p><strong>Methods: </strong>To calculate the caseload all repairs carried out in the centers and which met the inclusion criteria were included. The annualized number (based on the time difference between the first and last entry for the respective center) of repairs per center was used for the following categories: < = 20 procedures per year, > 20 - < = 40 procedures per year, > 40 procedures per year. The association of confirmatory defined patient- and procedure-related characteristics to the outcome parameters (general, intraoperative and postoperative surgical complications, complication-related reoperations as well as recurrences, pain at rest, pain on exertion, and chronic pain requiring treatment on 1-year follow-up) was analyzed using logistic regression models.</p><p><strong>Results: </strong>Following patient selection, 55,584 patients were included in analysis of the relation of the hospital volume as well as of other potential confounders to the outcome parameters. In the caseload group with ≤ 20 incisional hernias per year, the mean number of surgeons was 6.8, whereas in the caseload group > 20 - ≤ 40 per year the mean number was 12.9 surgeons and in the caseload group > 40 incisional hernias per year, the mean number was 23.7 surgeons. The multivariable analysis of the data from the Herniamed Registry demonstrates that a lower case load is associated with a higher risk of postoperative surgical complications and recurrences, but with a lower risk of pain at rest, pain on exertion and chronic pain requiring treatment.</p><p><strong>Conclusion: </strong>In summary, this analysis of data from the Herniamed Registry demonstrates that a relatively large number of surgeons are involved in the repair of incisional hernias, regardless of the hospital caseload. High hospital volume comes with a price of more surgeons participating resulting in higher postoperative surgical complication and recurrence risk. Low-volume centers seem to manage less severe cases, whereas high-volume centers appear to act as referral centers, treating more complex cases, which might reflect influence of unobserved confounders.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"244"},"PeriodicalIF":1.8,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre- and postoperative pain management practices in fracture surgery: A bicentric prospective observational study in Ethiopia.","authors":"Mestawet Getachew, Anners Lerdal, Tsegaye Melaku, Maren Falch Lindberg","doi":"10.1007/s00423-025-03837-y","DOIUrl":"10.1007/s00423-025-03837-y","url":null,"abstract":"<p><strong>Background: </strong>Acute pain is common following orthopedic trauma and surgery. This study aims to evaluate the adequacy of pre- and postoperative pain management in traumatic fracture patients undergoing orthopedic surgery in Ethiopia.</p><p><strong>Methods: </strong>A prospective cohort study was conducted at two Ethiopian trauma centers from January 2019 to October 2021. Preoperatively, data was obtained on sociodemographic factors, substance use, type of injury, pain and psychological factors. Pain was assessed again 24 h following surgery. Pain management adequacy was evaluated using the Pain Management Index (PMI), based on the World Health Organization's pain treatment framework. The PMI was determined by subtracting the patient's pain intensity from the strength of the prescribed analgesic scores range from - 3 to + 3. Negative values indicate inadequate pain control.</p><p><strong>Results: </strong>Of the 220 patients enrolled, 218 completed the study. Preoperative pain was inadequately managed in 74.8% of patients, improving to 42.2% postoperatively. Most patients reported mild (23.3%), moderate (43.1%), or severe (30.8%) pain preoperatively, yet 56.4% received no analgesics. At 24 h post-surgery, the patients reported mild (5.0%), moderate (53.7%), and severe (41.3%) pain, with 99.1% receiving analgesics. Notably, no patients with severe pain were given strong opioids at any time point. Lower educational level was associated with inadequate preoperative pain management (AOR: 3.18; 95% CI: 1.19-8.54). Alcohol use (AOR: 2.80; 95% CI: 1.30-6.05), higher anxiety (AOR: 1.17; 95% CI: 1.05-1.30), and higher depression scores (AOR: 0.77; 95% CI: 0.68-0.88) were associated with inadequate pain management 24 h post-surgery.</p><p><strong>Conclusions: </strong>Most patients with traumatic fractures received inadequate perioperative pain management, especially before surgery. Strong opioids were not used even in cases of severe pain. Socio-demographic and psychological factors were significantly associated with inadequate pain management.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"246"},"PeriodicalIF":1.8,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12350506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating cruroplasty with laparoscopic sleeve gastrectomy: a strategy to mitigate GERD symptoms in obese patients. A randomized control trial.","authors":"Firdaus Che Ani, Guo Hou Loo, Richelle Huey Bing Chua, Kok-Yong Chin, Nik Ritza Kosai","doi":"10.1007/s00423-025-03827-0","DOIUrl":"10.1007/s00423-025-03827-0","url":null,"abstract":"<p><strong>Objective: </strong>Laparoscopic sleeve gastrectomy (LSG) is effective for weight loss but may exacerbate gastroesophageal reflux disease (GERD) in predisposed patients. This randomized controlled trial aimed to evaluate whether adding cruroplasty to LSG (Cr-LSG) improves postoperative GERD symptom control in patients with intraoperative evidence of hiatal laxity.</p><p><strong>Methods: </strong>A total of 100 patients undergoing LSG were randomized to either standard LSG or LSG with posterior cruroplasty (Cr-LSG). Patients with large hiatal hernias were excluded. GERD symptoms were assessed using the validated GERD-Health Related Quality of Life (GERD-HRQL) questionnaire at baseline, 3 months, and 6 months postoperatively. BMI changes were also recorded. Statistical analysis included mixed-design ANOVA for within- and between-group comparisons.</p><p><strong>Results: </strong>Of the 100 enrolled patients, 95 (95%) completed the 6-month follow-up (LSG: 47, Cr-LSG: 48). Both groups demonstrated significant BMI reductions over time, with no between-group differences. GERD symptoms improved significantly within both groups postoperatively. However, between-group comparisons showed significantly lower GERD-HRQL scores in the Cr-LSG group at both 3 and 6 months (p < 0.05), suggesting better symptom control. Postoperative PPI use was not systematically recorded and represents a limitation.</p><p><strong>Conclusion: </strong>Adding cruroplasty to LSG may enhance short-term reflux symptom control in selected patients with intraoperative hiatal laxity. However, given the study's reliance on subjective symptom reporting and limited follow-up, these findings should be interpreted with caution. Further studies using objective diagnostics and longer-term follow-up are warranted.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"243"},"PeriodicalIF":1.8,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of body mass index change on cholelithiasis after laparoscopic sleeve gastrectomy: a single center experience.","authors":"Serhat Doğan, Yunus Dönder","doi":"10.1007/s00423-025-03716-6","DOIUrl":"10.1007/s00423-025-03716-6","url":null,"abstract":"","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"245"},"PeriodicalIF":1.8,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12350442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}