Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Recurrent emergent hernia repairs: who is at risk?","authors":"Erin E Isenberg, Joshua Sinamo, Michael A Rubyan, Annie Ehlers, Dana A Telem","doi":"10.1007/s00464-025-11914-y","DOIUrl":"https://doi.org/10.1007/s00464-025-11914-y","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing recurrent emergent hernia repairs may represent some of the most vulnerable patients in the healthcare system. However, this population has not been adequately characterized to date, limiting identification of opportunities for intervention.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study of Medicare beneficiaries who underwent an index emergent or urgent ventral hernia repair between 2011 and 2021. We performed a multivariable risk-adjusted Royston-Parmar survival analysis for cumulative recurrent emergent hernia repair incidence within 10 years, accounting for patient comorbidities, demographics, and repair characteristics. We assessed patient, provider, and community factors associated with an increased risk of recurrent emergent hernia repair. We used the Social Vulnerability Index, a publicly available score from the CDC reflecting 15 sociodemographic factors, to measure social risk.</p><p><strong>Results: </strong>Among 120,227 Medicare beneficiaries who underwent emergent hernia repair during the study period, the mean (SD) age was 71 (12) and 58% were female. At 10 years, the cumulative incidence of recurrent emergent hernia repair was 6.4% (95% CI 6.2-6.7). Median time to recurrent repair was 1.6 years [IQR 0.8-3.2]. Risk-adjusted factors associated with increased risk for recurrent emergent repair include female sex (10-year Hazard Ratio [HR] 1.58, 95% CI [1.24-2.02]), Hispanic ethnicity (10-year HR 1.19, 95% CI [1.01-1.41]), and patients in the highest quintile of social vulnerability (10-year HR 1.33, 95% CI [1.03-1.71]). Hernias repaired via open approach (10-year HR 1.44, 95% CI [1.03- 2.01) and at for-profit hospitals (10-year HR 1.16, 95% CI [1.06-1.26]) also experienced increased risk.</p><p><strong>Conclusion: </strong>Female, Hispanic, and socially vulnerable patients are at increased risk of recurrent emergent hernia repairs, as well as patients receiving an open index repair and care at for-profit hospitals. Our study highlights opportunities for intervention, including consideration of index repair approach and populations that may benefit from closer follow-up and earlier elective intervention for hernia recurrence.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing advanced stapling technique using objective performance indicators in robotic-assisted sleeve gastrectomy: a retrospective cohort study.","authors":"Sarah Choksi, Bishaka Hirachan, Mattia Ballo, Jon Winalski, Kavita Jain, Ruben Salas-Parra, Craig Profant, Dimitre Stefanov, Max Berniker, Mitchell S Roslin, Vikrom Dhar, Andrew Yee, Marc Bessler, Filippo Filicori","doi":"10.1007/s00464-025-11862-7","DOIUrl":"https://doi.org/10.1007/s00464-025-11862-7","url":null,"abstract":"<p><strong>Background: </strong>Although multiple studies have described the association between the sleeve shape and clinical outcomes, limited objective metrics exist to characterize the creation of the optimal sleeve shape and staple line formation. This study offers a novel, objective method for deconstructing robotic sleeve gastrectomies utilizing advanced stapler-specific metrics with the goal of improving patient outcomes.</p><p><strong>Methods: </strong>Robotic sleeve gastrectomies were performed using the da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA) at our tertiary referral center. This system and the Intuitive data recorder (IDR) were used to collect procedure-specific data. These data included metrics for technique (pitch and yaw during staple fire) and staple line formation [cartridge height (color), staple fire total duration, and pause for compression]. All patients who underwent robotic sleeve gastrectomy in an operating room with an IDR one of the four board-certified, fellowship trained minimally invasive surgeons were included. Postoperative complications including outflow obstructive complications (leaks and PO intolerance) and bleeding were the primary outcomes analyzed. Univariate and multivariate analysis was used to analyze stapler metrics and postoperative outcomes. This is a retrospective cohort study from November 2020 to April 2023.</p><p><strong>Results: </strong>Of the 344 patients, 15 had obstructive complications which included postoperative PO intolerance and leaks. Logistic regression demonstrated a ten degree increase in absolute pitch for the first staple fire was associated with an 89% higher risk of obstructive complications (OR = 1.89, 95% CI = 1.33-2.70, p < 0.001). While staple height and pause for compression were not associated with bleeding, there may be associations with leaks while examining the last staple fires.</p><p><strong>Conclusion: </strong>This is one of the first studies associating objective stapler-specific metrics used to characterize stapling technique with clinical outcomes in robotic sleeve gastrectomy. Further evaluation of postoperative complications using objective metrics will help standardize technique and improve clinical outcomes.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of sex differences on risk factors for postoperative complications in transanal endoscopic surgery for rectal cancer: a large-scale Japanese multicenter cohort study.","authors":"Toru Miyake, Takeru Matsuda, Ichiro Takemasa, Masatsune Shibutani, Hirokazu Suwa, Shiro Terai, Masaji Tani, Yoshihiro Kakeji, Seiichiro Yamamoto, Takeshi Naitoh","doi":"10.1007/s00464-025-11878-z","DOIUrl":"https://doi.org/10.1007/s00464-025-11878-z","url":null,"abstract":"<p><strong>Background: </strong>Transanal total mesorectal excision (TaTME) is a novel, minimally invasive surgery for the treatment of rectal cancer. Sex-based anatomical differences such as pelvic morphology may influence surgical difficulty and outcomes. This study aimed to investigate the correlation between sex differences and postoperative complications for patients who have undergone TaTME.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted across 26 Japan Society of Laparoscopic Colorectal Surgery centers and included 702 patients who underwent TaTME for the treatment of primary rectal cancer between January 2012 and December 2019. Patients who underwent pelvic exenteration, had recurrent or multiple cancers, or ulcerative colitis were excluded. The primary end point of this study was major postoperative complications (Clavien-Dindo [CD] grade III or higher) within 30 days of surgery. Patient characteristics, operative details, and short-term outcomes were analyzed.</p><p><strong>Results: </strong>This study included 484 men (68.9%) and 218 women (31.1%), of whom 310 (44.2%) underwent preoperative therapy. A total of 88 patients (12.5%) had CD grade III or higher complications, with a higher incidence in men (14.7%) than women (7.8%) (P = 0.010). In 532 patients with lower rectal tumors located within 5 cm from the anal verge, male sex remained associated with a higher rate of postoperative complications (40.8 vs. 25.4%, P = 0.001). Multivariate analysis identified the following as independent risk factors for major complications: male sex (hazard ratio [HR] = 2.13, 95% confidence interval [CI] 1.200-3.800, P = 0.010), circumferential tumor (HR = 1.82, 95% CI 1.130-2.950, P = 0.014), operative time > 479 min (HR = 1.64, 95% CI 1.010-2.670, P = 0.046), and intraoperative complications during TaTME (HR = 2.17, 95% CI 1.010-4.670, P = 0.048).</p><p><strong>Conclusions: </strong>Male sex was a significant risk factor for postoperative complications in TaTME for rectal cancer.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing environmental sustainability in a resource-limited surgical setting: the design of Kyabirwa surgical center.","authors":"Grace Travers, Saul Kibirango, Linda Zhang, Anna Kalumuna, Winfred Nannozi, Ronard Tusiime, Joseph Damoi, Angellica Giibwa, Reetwan Bandyopadhyay, George George, Michael Marin","doi":"10.1007/s00464-025-11893-0","DOIUrl":"https://doi.org/10.1007/s00464-025-11893-0","url":null,"abstract":"<p><strong>Background: </strong>The healthcare industry is a leading contributor to climate change and resource depletion and its footprint is growing given efforts to improve healthcare access worldwide. Low- and middle-income countries (LMICs) are most vulnerable to this environmental degradation due to their relatively weaker infrastructure and lack of resources. This case study describes the infrastructure and procedures that drive environmental sustainability at Kyabirwa Surgical Center (KSC), an ambulatory surgery facility in rural Uganda that has cared for over 25,000 patients since its 2019 inception.</p><p><strong>Methods: </strong>KSC was architecturally designed with the goal of zero carbon footprint, exemplifying how environmental sustainability can be achieved in low-resource settings. In collaboration with a New York-based institution, Ugandan stakeholders constructed the original 8500 ft² center with local materials, leveraging natural resources such as sunlight and natural ventilation to minimize energy required. The center also prioritized operational independence from the local power grid and water supply, nearly exclusively using solar power and rainwater. Specific treatment and storage protocols, like environmentally conscious anesthesia regimens, were also implemented to minimize environmental footprint.</p><p><strong>Results: </strong>From 2021 to 2023, KSC obtained only 0.4% of its power and 25% of its water from the town. Excluding installation, this saves KSC an estimated $6,121 in annual operating costs-greater than annual maintenance costs estimated at $5,040. KSC also conserved 11% of solar power produced and 93% of rainwater collected from 2021 to 2023 for future use. Lastly, 71% of procedures were completed under environmentally friendly alternatives to general anesthesia.</p><p><strong>Conclusion: </strong>Integrating sustainability into LMIC surgical care is essential for improving healthcare resilience and accessibility. KSC shows that sustainable surgical models are feasible with innovative design, renewable energy, and potentially cost-effective practices. Scaling these efforts requires global collaboration, particularly support from high-income countries (HICs), to build resilient health systems in the face of climate change and resource limitations.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent hiatal hernia repair and gastric bypass as an adjunct in the treatment of hiatal hernia in populations with obesity.","authors":"Leon Siegel, Rory Carroll, Dakota T Thompson, Ryan Lehmann, Jessica Smith, Peter Nau","doi":"10.1007/s00464-025-11854-7","DOIUrl":"https://doi.org/10.1007/s00464-025-11854-7","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive hiatal hernia repair with fundoplication (HHR) is the standard of care for hiatal hernias but has a high risk of recurrence even in populations without obesity. Concomitant roux-en-y gastric bypass (RYGB) with HHR may mitigate the increased risk of hiatal hernia recurrence in patients with obesity while also addressing obesity-related comorbidities. There is a paucity of data on this procedure. It is hypothesized that a concomitant RYGB with HHR is safe and effective in patients with obesity.</p><p><strong>Methods: </strong>This is a single institution retrospective review of adult patients who underwent concomitant RYGB with HHR from 2014-2023. Patient charts were reviewed to collect data on complications, weight loss, GERD symptom resolution, and improvement in other obesity-related comorbidities. Outcomes were measured at one-, three-, and five-year follow-up.</p><p><strong>Results: </strong>Sixty-four patients met inclusion criteria. Fifty-three patients had primary and eleven patients had revisional surgery. There was one (2%) perioperative complication that required intervention, three (4%) unplanned readmissions for PO intolerance, and four patients (8%) treated for marginal ulcer. Resolution of heartburn/reflux symptoms was 86% at one year, 70% at 3 year, and 59% at 5 year follow-up. Improvement in diabetes (80%), hypertension (75%), and hyperlipidemia (33%) were noted at 5 years. The change in BMI and %TWL at 5 years for primary procedures was -11.5 kg/m² and 37.7%, respectively. For revisional procedures, change in BMI was -2.4 kg/m² and %TWL was 3.6%.</p><p><strong>Conclusion: </strong>Durability of a HHR in the setting of obesity is poor. Concomitant RYGB with HHR is safe and effective for treating GERD while also improving obesity and obesity-associated comorbidities.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peroral endoscopic myotomy: a Danish single center 10-year follow-up study.","authors":"Martin H Pedersen, Niels Christian Bjerregaard, Frederik Hvid-Jensen, Daniel W Kjaer","doi":"10.1007/s00464-025-11832-z","DOIUrl":"https://doi.org/10.1007/s00464-025-11832-z","url":null,"abstract":"<p><strong>Introduction: </strong>Achalasia is a rare esophageal motility disorder that in many cases can be treated effectively with Peroral Endoscopic Myotomy (POEM). However, long-term outcomes regarding clinical efficacy, patient satisfaction, and the prevalence of post-POEM gastro-esophageal reflux disease (GERD) remains elusive and thus require further investigation.</p><p><strong>Methods: </strong>This retrospective cohort study followed 63 patients treated for achalasia with POEM. Clinical success (Eckardt-score ≤ 3, and no subsequent treatments), GERD prevalence (GerdQ-score ≥ 8), and patient satisfaction were assessed via medical record reviews and telephone interviews. Statistical analyses identified risk factors for treatment failure, lower levels of satisfaction, and GERD.</p><p><strong>Results: </strong>At a median follow-up of 10 years, clinical success was 74%. The average Eckardt-score improved from 7,6 pre-POEM to 2,16 (p < 0.0001). The majority of treatment failures occurred within three months post-POEM, with no new failures after 5 years. GERD symptoms were reported by 33% of patients. Patient satisfaction was high with 91% reporting to be satisfied or very satisfied. Treatment-naïve patients had higher success rates (85%) compared to those with prior Heller's myotomy (40%, p < 0.0001). No other risk factors for clinical failure were found. RePOEM showed superior outcomes for salvage treatment compared to balloon dilation, botulinum toxin injections, and Heller's myotomy.</p><p><strong>Conclusion: </strong>POEM has a good and lasting efficacy at a median follow-up of 10 years. Clinical failure was not observed beyond 5 years post-POEM. The majority of patients were satisfied with POEM at follow-up. Symptomatic GERD was a highly experienced side effect at follow-up, however, not associated with lower levels of satisfaction.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of reduced intraoperative mean arterial pressure on postoperative hemorrhage in bariatric surgery.","authors":"Arturo Estrada, Yeisson Rivero-Moreno, Jasson Xia, Diego Zamata-Ovalle, Karen Velez, Jorge Humberto Rodriguez-Quintero, Jenny Choi, Erin Moran-Atkin, Diego Camacho","doi":"10.1007/s00464-025-11841-y","DOIUrl":"https://doi.org/10.1007/s00464-025-11841-y","url":null,"abstract":"<p><strong>Background: </strong>Postoperative hemorrhage (POH) is a life-threatening complication, occurring in 1.3-1.7% of bariatric surgeries and still constitutes a recognized challenge. This study examined the effect of intraoperative mean arterial pressure (MAP) on the development of POH.</p><p><strong>Methods: </strong>A retrospective observational study with a case-control design was conducted on adult patients who underwent bariatric surgery between 2015 and 2023 at a high-volume academic center. Intraoperative MAP (including MAP in the last 10 and 30 min) was collected in patients who developed POH. Cases were matched with controls by sex, gender, type of procedure, and ASA classification.</p><p><strong>Results: </strong>From 204 participants, 102 patients with POH were matched with 102 controls. The most common procedure performed was Roux-en-Y gastric bypass (n = 98, 48%), followed by sleeve gastrectomy (n = 77, 37.7%). Patients with POH had statistically significant lower intraoperative MAP during the last 10 min (92.41 ± 14.25 vs 97.44 ± 14.64, p = 0.014) and 30 min (87.93 ± 12.32 vs 91.93 ± 11.26, p = 0.016) of surgery compared to controls. An intraoperative MAP lower than 90 mmHg in the last 10 min (OR = 2.067, 95% CI = 1.156-3.695), 30 min (OR = 2.231, 95% CI = 1.27-3.919), and whole procedure (OR = 1.834, 95% CI = 1.024-3.285) was associated with increased risk of POH. No significant differences were found in comorbidities, smoking, preoperative laboratory results, history of antiplatelet therapy or anticoagulation use, and operative time between the two groups.</p><p><strong>Conclusion: </strong>Our study demonstrates that patients with POH had lower intraoperative MAP during the last 10 and 30 min of surgery. An intraoperative MAP < 90 mmHg was identified as a risk factor for developing POH.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Devices for minimally invasive liver parenchyma transection: the SICE (Italian Society of Endoscopic Surgery) Italian and International survey.","authors":"Graziano Ceccarelli, Pasquale Avella, Edoardo Maria Muttillo, Maria Conticchio, Giovanni Domenico Tebala, Gaetano Piccolo, Lucia Romano, Riccardo Memeo, Aldo Rocca","doi":"10.1007/s00464-025-11769-3","DOIUrl":"10.1007/s00464-025-11769-3","url":null,"abstract":"<p><strong>Backgrounds: </strong>Minimally Invasive Liver Surgery (MILS), encompassing laparoscopic (L-MILS) and robotic (R-MILS) approaches, has revolutionized liver surgery, offering reduced morbidity, shorter hospital stays, and improved outcomes while maintaining oncological efficacy. Despite the widespread use of L-MILS, parenchyma liver transection techniques and devices remain debated. This study investigates the adoption of transection devices (TDs) in MILS among 86 hospitals, focusing on surgical practices, device utilization, and outcomes.</p><p><strong>Methods: </strong>The Italian Society of Endoscopic Surgery (SICE) endorsed a cross-sectional internet-based survey targeting general and Hepato-Pancreato-Biliary surgeons.</p><p><strong>Results: </strong>Responses from 86 centers revealed that 77% of institutions is available a robotic platform, with an adoption rate of 87.50% in high-volume centers. L-MILS remains the predominant technique for liver resections, also in case of major hepatectomies, although R-MILS is increasingly utilized. For minor L-MILS, more than 50% of respondents use ultrasonic shears and electrosurgical pencil and advanced bipolar devices, while about 40% of surgeons adopt Cavitronic Ultrasonic Surgical Aspirator (CUSA) in major resections. R-MILS procedures predominantly used Maryland bipolar forceps and vessel sealers, with hybrid techniques (30%) integrating laparoscopic devices (e.g., CUSA) to address robotic device limitations.</p><p><strong>Conclusion: </strong>The minimally invasive approach to liver parenchymal transection is a key component of this surgical procedure. For major hepatectomies, the CUSA device remains the most effective tool, whereas ultrasonic shears, electrosurgical pencil, and advanced bipolar devices are more suited for minor resections. Despite limited access to specialized instruments, R-MILS achieves favorable outcomes in liver transection by employing the crash-clamp technique or hybrid strategies.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of simultaneous endoscopic transoral outlet reduction and gastric bypass distalization for the management of weight loss failure after Roux-en-Y gastric bypass.","authors":"Jorge Cornejo, Agustina A Pontecorvo, Dilhana Badurdeen, Victoria Gomez, Vivek Kumbhari, Enrique F Elli","doi":"10.1007/s00464-025-11846-7","DOIUrl":"https://doi.org/10.1007/s00464-025-11846-7","url":null,"abstract":"<p><strong>Background: </strong>There are numerous revisional surgery options for weight loss failure after Roux-en-Y Gastric Bypass. To date, there are no studies that assess the weight loss outcomes of single-stage endoscopic revision of the gastrojejunostomy (GJ) (TORe) in biliopancreatic (BP) limb distalization. We aimed to report our experience with single-stage TORe and distalization.</p><p><strong>Methods: </strong>Sixteen patients (5 TORe and distalization, 6 TORe alone, 5 distalization alone) from 2021 to 2023 were included and retrospectively reviewed. The minimum follow-up time was 24 months. The alimentary limb was distalized to allow for a total common channel length of about 150 cm and the endoscopic suturing was used to bring the diameter of the GJ between 10 and 20 mm.</p><p><strong>Results: </strong>The average preoperative BMI was 44.25 ± 8.8 kg/m² with an average excess body weight of 54.16 ± 23.6 kg. The mean operative time for patients who had distalization with and without TORe was 128.4 ± 30.3 min. The mean total alimentary limb length (TALL) was 300 + 45.6 cm. Single-stage TORe and distalization showed higher mean %TWL (23.67 vs 19.92 vs 15.02) and %EWL (37.20 vs 30.72 vs 27) compared to TORe and distalization alone at 24-month follow-up, respectively. One patient required distalization reversal due to malnutrition. The rest of patients who underwent distalization showed minor nutritional deficiencies (Hemoglobin, Hematocrit, Vitamin A, and Copper) at the last follow-up. Preoperative comorbidities were reduced by 33.2%.</p><p><strong>Conclusions: </strong>Endoscopic and surgical techniques for the management of weight loss failure after Roux-en-Y Gastric Bypass seem to be safe and effective. Single-stage TORe and distalization showed higher weight loss at 24-month follow-up.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopy-assisted magnetic foreign body removal using a magnetic instrument-a clinical review.","authors":"Jonas Rowald Petersen, Jes Sefland Vogt","doi":"10.1007/s00464-025-11860-9","DOIUrl":"https://doi.org/10.1007/s00464-025-11860-9","url":null,"abstract":"<p><strong>Background: </strong>Children often ingest foreign bodies by accident. Ingestion in adolescents is often intentional. Ingested magnets and button batteries can be life-threatening and require endoscopic removal. Magnetic instruments may increase the rate of successful removal of ferromagnetic foreign bodies. The aim is to investigate if foreign body removal using magnetic instruments is superior to conventional removal.</p><p><strong>Methods: </strong>A literature search of PubMed was conducted. Ten studies were included and compared in terms of type of ingested foreign body, symptoms, complications, and methods and effectiveness of retrieval.</p><p><strong>Results: </strong>Studies mainly included children and adolescents. A variety of foreign bodies had been ingested and were retrieved from the upper gastrointestinal tract. Use of magnetic instruments was superior to conventional endoscopy. The rate of successful foreign body removal increased, and procedures were more efficient. No adverse events were noted.</p><p><strong>Conclusion: </strong>Endoscopy-assisted foreign body removal using a magnetic instrument may be superior to conventional endoscopic removal. Further development and research are needed.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}