Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

{"title":"Management of Mirizzi Syndrome Type II.","authors":"Ivan Mamontov, Tamara Tamm, Kostiantyn Kramarenko, Valentyn Nepomniashchyi, Erika Bilousova, Daryna Pryimak","doi":"10.1097/SLE.0000000000001496","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001496","url":null,"abstract":"<p><strong>Background: </strong>Mirizzi syndrome (MS) with cholecystobiliary fistula (type II McSherry classification) is a rare complication of cholelithiasis. Accurate diagnosis is important in the management of MS type II. ERCP provides biliary decompression, and in some cases, endoscopic lithoextraction can be achieved. Surgery is the primary method in the management of MS type II. The aim of this study was to report and assess our experience of MS type II management in terms of different treatment modalities, such as endoscopic lithoextraction, open surgery, and laparoscopy.</p><p><strong>Methods: </strong>A retrospective review of a prospectively maintained database of 30 patients with MS type II between January 2009 and May 2025 was performed. Demographic, clinical, laboratory, visualization, operative, and postoperative data were recorded.</p><p><strong>Results: </strong>ERCP was done in all 30 cases. Complete endoscopic stone removal was achieved in 9 (30%). Endoscopic decompression was not successful in 1 (3.3%) case. Adverse events after ERCP occurred in 4 (13.3%) cases. Nineteen patients were operated on, 8 (42%) by laparoscopy. Partial cholecystectomy with choledochoplasty by remaining gallbladder tissue in 8 cases; cholecystofistulolithotomy in 8; partial cholecystectomy with choledocholithotomy in 2; partial cholecystectomy with fistulolithotomy in 1. Minor adverse events were reported in 3 (15.6%) cases: wound infection in 2 after open procedures and pneumonia in 1 after laparoscopy.</p><p><strong>Conclusion: </strong>Precise visualization data are the key to MS type II management. ERCP allows restoration of the bile outflow, and in a subset of patients, complete endoscopic stone extraction can be achieved. Surgical management of MS type II consists of stone removal through the gallbladder and/or fistula incision. With sufficient experience, laparoscopy can be applied. Cholecystofistulolithotomy without gallbladder removal may be a procedure of choice in MS type II management.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Robotic Surgery on Esophagogastric Gap During Modified Side Overlap With Fundoplication by Yamashita Reconstruction After Proximal Gastrectomy.","authors":"Mao Tsuru, Yusuke Taki, Erina Nagai, Masato Nishida, Shinsuke Sato, Masaya Watanabe, Ko Ohata, Hideyuki Kanemoto","doi":"10.1097/SLE.0000000000001500","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001500","url":null,"abstract":"<p><strong>Introduction: </strong>Modified side overlap with fundoplication by Yamashita (mSOFY) reconstruction is an antireflux procedure after proximal gastrectomy. Precise alignment between the esophageal and gastric entry holes is important for maintaining an appropriate anastomotic configuration. We evaluated the impact of robotic surgery on the esophagogastric gap (EGG), a novel intraoperative parameter reflecting anastomotic alignment.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 42 patients who underwent proximal gastrectomy with mSOFY reconstruction between June 2019 and August 2025. EGG was defined as the distance between the esophageal and gastric entry holes during stapled anastomosis and was measured retrospectively from the recorded surgical videos (Supplemental Digital Content 1, https://links.lww.com/SLE/A563). Outcomes were compared between laparoscopic (L, n=23) and robotic (R, n=19) approaches. The association between EGG and anastomotic stricture was evaluated as an exploratory analysis.</p><p><strong>Results: </strong>Patient characteristics were generally comparable, although the proportion of male patients was higher in the L group (82.6% vs. 52.6%, P=0.049). EGG was significantly smaller in the R group (0 vs. 8 mm, P<0.001). The number of retrieved lymph nodes was significantly higher in the R group (31 vs. 22, P=0.022). Operative time, blood loss, anastomosis time, and postoperative outcomes were comparable. EGG tended to be larger in patients with stricture (8.5 vs. 3.0 mm, P=0.174).</p><p><strong>Conclusions: </strong>Robotic surgery was associated with a significantly smaller EGG during mSOFY reconstruction after proximal gastrectomy. EGG may serve as a novel intraoperative parameter reflecting anastomotic alignment, although its association with anastomotic stricture requires further validation.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological Considerations and Statistical Concerns Regarding the Use of Laparoscopic-Assisted TAP Block in Laparoscopic Cholecystectomy.","authors":"Ruiying Huang, Li Zhou","doi":"10.1097/SLE.0000000000001499","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001499","url":null,"abstract":"","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified SCOLA Repair for Large Incisional Hernia With Rectus Diastasis.","authors":"Moshe Dudai, Marah Ganiem, Rut Meruham","doi":"10.1097/SLE.0000000000001494","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001494","url":null,"abstract":"<p><strong>Background: </strong>Postoperative incisional ventral hernias (POIH) can sometimes be avoided and are challenging to repair. If the underlying rectus diastasis (RD) is left untreated, the attenuated linea alba predisposes to hernia formation and recurrence. Guidelines recommend concomitant repair of hernia and RD using mesh, but data on endoscopic subcutaneous onlay techniques for large or complex POIH defects remain scarce. This study reports long‑term outcomes of a modified subcutaneous onlay endoscopic approach (SCOLA) combined with bilateral rectus fascia release (RFR), triple‑action seroma prevention (TASP), and preoperative Botulinum toxin A (BOTOX) injection when needed for large POIH combined with RD.</p><p><strong>Materials and methods: </strong>A retrospective review included adults undergoing SCOLA‑RFR between 2016 and 2024. Forty-five patients met the eligibility criteria for POIH with concomitant RD. Forty-two patients (93.3%) completed the structured telephone survey and constituted the analytic cohort. Endoscopic subcutaneous dissection, bilateral relaxing incisions in the anterior rectus sheath, midline plication, and onlay mesh glue reinforcement were performed. Quilting sutures, hypertonic saline irrigation, and fibrin sealant limited seroma. BOTOX was injected preoperatively for wide or rigid defects. Functional outcomes and satisfaction were assessed by telephone survey with 6 to 108 months of follow‑up.</p><p><strong>Results: </strong>The cohort (24 males, 18 females; mean age: 55±12 y) had hernia widths of 2 to 12.5 cm and RD widths of 6 to 13.5 cm. Nearly half of hernias (47.6%) followed minimally invasive surgery, and 52.4% followed open surgery. Functional level improved in 88.1%, core strength was preserved or improved in 95.2%, and 95.2% reported no residual pain or urinary/bowel symptoms. The overall complication rate was 21.4% and was limited to seromas occurring before the introduction of the triple‑action protocol; no seromas were noted thereafter. Recurrence occurred in one patient (2.4%). High satisfaction was reported by 88.1%.</p><p><strong>Conclusions: </strong>Untreated RD may contribute to POIH, including after minimally invasive surgery. SCOLA-RFR combined with TASP and selective BOTOX use may provide a durable, minimally invasive extraperitoneal approach for large POIH with RD, avoiding peritoneal re-entry and muscle transection, with low recurrence and high patient satisfaction.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomaterials in Tissue Regeneration Following Surgically Induced Bile Duct Injuries: A Systematic Review.","authors":"Héctor González Rosas, Luis de J Márquez Bohor Rugerio, Carlos J Solis-Oviedo, Fernando Pérez-Escamirosa","doi":"10.1097/SLE.0000000000001498","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001498","url":null,"abstract":"<p><strong>Objective: </strong>Bile duct injury (BDI) following cholecystectomy represents a significant surgical complication, often associated with hepatobiliary dysfunction, increased morbidity, and the need for complex reconstruction. Advances in tissue engineering and biomaterials have introduced novel strategies aimed at bile duct regeneration. This systematic review evaluates current evidence on biomaterial-based approaches for the treatment of BDI in experimental animal models.</p><p><strong>Methods: </strong>A systematic search was conducted between October 2025 and January 2026 in PubMed, Web of Science, and Ovid, following the PRISMA 2020 checklist. The selected studies explored a range of regenerative strategies applied to experimental animal models, including polymeric scaffolds, decellularized grafts, bioabsorbable stents, hydrogels, and bioactive systems incorporating growth factors or stem cells.</p><p><strong>Results: </strong>A total of 1141 records were identified from Web of Science (578), PubMed (459), and Ovid (104). After removal of 413 duplicates, 667 records were excluded during title and abstract screening. Fifty-eight articles underwent full text assessment, and 20 studies met the inclusion criteria for data extraction. These studies explored diverse biomaterial-based strategies aimed at promoting biliary regeneration and functional repair in experimental models. These approaches include decellularized and autologous grafts, polymeric scaffolds, bioactive systems, stents, and other natural materials, each with a unique set of advantages.</p><p><strong>Conclusion: </strong>Current evidence highlights the growing potential of biomaterial-based and bioactive platforms for bile duct regeneration in experimental models, underscoring the importance of continued research to optimize these strategies and facilitate their future translation to clinical approaches.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Patient-Controlled Analgesia Using Ropivacaine (0.25%) Through Transversus Abdominis Plane Versus Epidural Route for Postoperative Pain Relief Following Midline Laparotomy.","authors":"Ruiying Huang, Li Zhou","doi":"10.1097/SLE.0000000000001495","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001495","url":null,"abstract":"","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Transmural Drainage of Walled-off Necrosis: Comparative Outcomes of EUS-guided Versus Conventional Approaches.","authors":"Bülent Ödemiş, Nazmi Gökhan Ünver, Mustafa Özdemir, Kerem Kenarli, Alper Macif, Batuhan Başpinar, Dilara Turan Gökçe","doi":"10.1097/SLE.0000000000001497","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001497","url":null,"abstract":"<p><strong>Background: </strong>Walled-off necrosis (WON) is a complex sequela of acute pancreatitis that often necessitates interventional management. Endoscopic transmural drainage has emerged as the preferred first-line approach, especially with the increasing availability of endoscopic ultrasonography (EUS) guidance. This study aimed to evaluate endoscopic management of WON and identify factors associated with technical and clinical success.</p><p><strong>Methods: </strong>Patients who underwent endoscopic transmural drainage for symptomatic WON were analyzed retrospectively. Two different techniques-conventional and EUS-guided-were used as endoscopic drainage modalities. Baseline characteristics, procedural details, and outcomes were collected, and the impact of drainage modality and anatomic factors-including paracolic extension, disconnected pancreatic duct syndrome (DPDS), and colonic fistula-on clinical outcomes and adverse events was analyzed.</p><p><strong>Results: </strong>A total of 73 patients (mean age: 54.6±13.9 y; 46.6% male) underwent a total of 76 transmural drainage procedures. The median size of WON collections was 14 cm (IQR: 11-17 cm), and the most common indication was infection (62.5%). Colonic fistula and DPDS were identified in 5 (6.8%) and 38 (52.1%) patients, respectively. Technical success was assessed per procedure. Overall technical success was 97.4% (74/76), with 100% (36/36) success in the conventional group and 95.0% (38/40) in the EUS group. Clinical success was achieved in 84.9% (62/73) of patients, with similar outcomes between conventional (83.3%) and EUS-guided (86.5%) drainage (P=0.961). Reintervention was required in 67.1%, and direct endoscopic necrosectomy was performed in 31.5%. Complications occurred in 28.7% of patients, most commonly bleeding (15.1%), generally managed endoscopically.</p><p><strong>Conclusions: </strong>Endoscopic transmural drainage is an effective and safe intervention for the management of WON, with high technical and clinical success. EUS-guided drainage offers significant advantages by allowing intervention in patients without luminal bulging and in those with smaller collections, thereby expanding treatment eligibility to a broader patient population.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating ERCP Within UK Higher Surgical Training: A Structured, Curriculum-Embedded Model.","authors":"Javed Latif, John Isherwood, Imran Bhatti, Ashley Dennison","doi":"10.1097/SLE.0000000000001459","DOIUrl":"10.1097/SLE.0000000000001459","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is integral to hepatopancreatobiliary (HPB) surgical practice, yet structured access to ERCP training within UK higher surgical training (HST) remains limited. Barriers include rota commitments, competing operative priorities, and restricted access to endoscopy lists. This study describes a structured, curriculum-integrated ERCP training model and examines the systemic factors influencing surgical trainee exposure.</p><p><strong>Methods: </strong>A structured ERCP training model embedded within UK HST is described and evaluated using a longitudinal case-study exemplar using prospectively logged data. Procedural volume, key performance indicators (KPIs), and levels of supervision were analyzed using data from the Joint Advisory Group (JAG) Endoscopy Training System (JETS) e-portfolio. Variation in annual case exposure was examined in relation to rota commitments, endoscopy list availability, and center-specific training infrastructure.</p><p><strong>Results: </strong>Over a 33-month period, 365 ERCP procedures were completed, consistent with and exceeding the JAG-reported median of ∼300 supervised procedures required for certification. Procedural exposure varied across training rotations, reflecting differences in service configuration and access to ERCP lists. KPIs improved progressively in keeping with recognized ERCP learning curves, with native papilla cannulation rates exceeding 90% early within the structured training pathway, following an initial learning phase and sustained achievement of therapeutic benchmarks for stone clearance and biliary stenting.</p><p><strong>Conclusion: </strong>This study demonstrates that ERCP competence can be achieved within UK higher surgical training when exposure is intentionally integrated into HPB rotations and supported by structured planning, longitudinal mentorship, and access to high-volume endoscopy services. The training model highlights transferable strategies to overcome systemic barriers to surgical ERCP training and may inform future curriculum development to support sustainable ERCP service provision.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Risk Factors and Construction of Risk Prediction Model for Patients With First Recurrence After Initial Curative Resection for Hepatocellular Carcinoma.","authors":"Nan Ye, Yunxiao Lv, Bin Wang, Sicong Zhao, Jing Zhao","doi":"10.1097/SLE.0000000000001466","DOIUrl":"10.1097/SLE.0000000000001466","url":null,"abstract":"<p><strong>Objective: </strong>To investigate treatment strategies and relevant clinical indicators for patients with first recurrence after initial curative resection for hepatocellular carcinoma (HCC), and to construct a nomogram model for predicting the risk of survival and disease progression, as well as to validate its predictive performance.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 200 patients who experienced their first recurrence after initial curative resection for HCC in our hospital between January 2018 and July 2025. Patients were randomly divided into a training cohort and a validation cohort at a ratio of 7:3. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors affecting survival and disease status. On the basis of these factors, nomogram prediction models were established respectively for overall survival (OS) and progression-free survival (PFS). The prognostic capabilities were assessed by calibration curves and receiver operating characteristic (ROC) curves. The prediction models derived from the training cohort were validated in the validation cohort to assess their accuracy and feasibility.</p><p><strong>Results: </strong>Multivariate analysis revealed that independent factors influencing OS included alpha-fetoprotein (AFP) level, maximum tumor area, lymph node metastasis, histologic grade of the tumor at initial resection, and microvascular invasion (MVI). Independent factors affecting PFS included age, AFP level, and histologic grade of the tumor at initial resection. On the basis of these factors, individualized risk prediction models were constructed respectively for OS and PFS in patients with first postoperative recurrence. In the training cohort, the area under the curve (AUC) values for OS at 1-year, 2-year, and 3-year were 0.872, 0.919, and 0.831, respectively; for PFS, the corresponding AUC values were 0.740, 0.746, and 0.748. Calibration curves and ROC curves demonstrated good consistency between model predictions and actual observations. Different treatment strategies did not significantly affect the OS or PFS.</p><p><strong>Conclusion: </strong>AFP level, maximum tumor area, lymph node metastasis, histologic grade of the tumor at initial resection, and MVI are independent risk factors for OS in patients with first recurrence after initial curative resection for HCC. Age, AFP level, and histologic grade of the tumor at initial resection are independent risk factors for PFS. The risk prediction models developed in this study effectively predict 1-year, 2-year, and 3-year risks of OS and PFS, demonstrating strong predictive performance and providing valuable insights for clinical medical professionals in patients with first recurrence after initial curative resection for HCC.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Hiatal Hernia Repair in Over 65-Year-Old Population: Feasibility, Technique, and Early Results.","authors":"Mattia Di Benedetto, Jérome R Lechien, Lorenzo Casali, Andrea Locatelli, Giovanni Dapri","doi":"10.1097/SLE.0000000000001465","DOIUrl":"10.1097/SLE.0000000000001465","url":null,"abstract":"<p><strong>Background: </strong>The incidence of hiatal hernia (HH) and associated comorbidities increases with age, which contributes to a higher perioperative risk in elderly patients. As life expectancy rises, general surgery must increasingly confront the challenge of treating this benign yet symptomatic condition in the elderly, where the primary goal is functional improvement and enhanced quality of life. We aimed to evaluate the safety and efficacy of laparoscopy for HH repair in this high-risk patient cohort.</p><p><strong>Methods: </strong>In a prospective database, we enrolled all consecutive elderly (65-year-old or older) patients who underwent laparoscopic HH repair (hernia reduction, cruroplasty, and fundoplication). Data analyzed included demographic and anthropometric, intra-operative and post-operative results and complications, mortality, length of stay (LOS), and clinical results during follow-up.</p><p><strong>Results: </strong>We enrolled a total of 28 patients, of whom 8 were males (28.6%), and 20 were females (71.4%). All patients came to consultation because of strong symptoms and were studied with esophagogastroduodenoscopy, x-ray oral swallow/oral contrast CT-scan, 24-hour pH-Impedance testing, and high-resolution esophageal manometry. Median age at the time of surgery was 73 (IQR 68-77) years, mean body mass index (BMI) was 24.5±2.3 Kg/m 2 , and median Charlson Comorbidity Index was 3.5 (IQR 3-4.75), corresponding to an estimated mean 10-year survival of 57.7%. Intraoperatively, a total of 3 complications (10.7%) were observed (2 cases of pneumothorax requiring placement of a chest drain, and 1 case of gastric perforation managed with laparoscopic suture); mean operative time was 162±79 minutes, and mean intraoperative blood loss was 42.5 mL (range: 0 to 200). A total of 14 Toupet fundoplications (50%) and 14 Nissen fundoplications (50%) were performed. A mesh was positioned in 1 patient (3.6%). No conversions to open surgery occurred.</p><p><strong>Postoperatively: </strong>three patients (10.7%) were transferred to the intensive care unit for monitoring; 4 complications occurred (14.3%): 3 radiologic pneumothoraxes (Clavien-Dindo score 1) and 1 cruroplasty disruption following extubation (Clavien-Dindo score 3). The mean LOS was 4.3±1.4 days. Peri-operative mortality was 0%, and there was one 90-day readmission (3.6%). During a mean follow-up period of 20±15 months, no HH recurrences or wrap stenosis were observed.</p><p><strong>Conclusions: </strong>Despite the ongoing debate regarding upper gastrointestinal minimally invasive surgery in elderly patients with multiple comorbidities, this study shows that a laparoscopic approach for symptomatic HH in an elderly population is feasible and safe, with no severe complications and no mortality, with favorable outcomes during follow-up. Advanced age alone should not be a limiting factor for the surgical decision-making, especially in experienced centers.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}