Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Efficacy and determinants of success in a structured ERCP training program: a retrospective cohort study from a national training center in China.","authors":"Can Sun, Rui Cheng, Xiu-Jing Sun, Yong-Qiu Wei, Xing-Hua Zhang, Yong-Jun Wang, Shu-Tian Zhang","doi":"10.1007/s00464-026-13413-0","DOIUrl":"https://doi.org/10.1007/s00464-026-13413-0","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure, and there is a significant shortage of trained practitioners in China.</p><p><strong>Aim: </strong>To evaluate effectiveness of a structured ERCP training program at a national training center and identify key determinants of success.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted among 68 graduates (response rate 62.5%) of the ERCP training program at Beijing Friendship Hospital (2017-2024). Data on demographics, training content, and post-training ERCP practice were collected via questionnaire. Primary competence was defined as performing > 10 ERCPs annually with a cannulation success rate ≥ 70% (entry-level). A secondary analysis used the > 90% cannulation rate (advanced mastery) to align with international benchmarks. Multivariate logistic regression identified factors associated with competence.</p><p><strong>Results: </strong>Most trainees (83.8%) successfully performed ERCP post-training; 63.2% achieved entry-level competence, while only 25.0% reached the advanced ≥ 90% standard. Subgroup analysis showed that 3-month and 6-month groups achieved higher entry-level competence (69.6% and 67.7%, respectively) than the 12-month group (42.9%), attributed to greater weekly hands-on density. Multivariate analysis identified longer training duration (OR 1.32, P = 0.011), greater weekly hands-on opportunities (OR 2.05, P = 0.013), and sufficient mentor guidance (OR 3.49, P = 0.016) as independent predictors.</p><p><strong>Conclusion: </strong>The structured ERCP training program effectively establishes entry-level competence for most trainees, but achieving international mastery remains challenging. Success is associated with adequate training duration, frequent hands-on experience, and quality mentorship. We propose a tiered accreditation system and post-training remediation pathways to safely address the national shortage of ERCPists.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224830","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":"Association between pregnancy and delivery mode and long-term pouch function in women with prior ileal pouch-anal anastomosis: a systematic review and meta-analysis.","authors":"Christopher Lopez, Samantha Sipe, Abel Abraham, James Burns, Cameron Perrone, Anjelli Wignakumar, Steven D Wexner, Sameh Hany Emile","doi":"10.1007/s00464-026-13515-9","DOIUrl":"https://doi.org/10.1007/s00464-026-13515-9","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review and meta-analysis aimed to evaluate the association between pregnancy and delivery mode and long-term pouch function after ileal pouch-anal anastomosis (IPAA).</p><p><strong>Methods: </strong>A systematic review (CRD420251076660) was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, Scopus, Cochrane Library, and Google Scholar were searched through June 2025 for studies reporting pouch-related outcomes among women with prior IPAA who became pregnant. Outcomes included continence, stool frequency, urgency, pouchitis, and pouch failure. Random-effects meta-analysis was performed to generate pooled estimates, with narrative synthesis where appropriate.</p><p><strong>Results: </strong>Eight studies, including 1350 women who had previously undergone IPAA, were evaluated. The median age was 32 years, and the mean follow-up after delivery was 79.2 months. Proportional meta-analysis of pouch function during pregnancy demonstrated a pooled incontinence and pad usage rates of 39.4% (95% CI 25-53%) and 21.8% (95 %CI 16.5-27%), respectively. Pouchitis during pregnancy was reported in 8% (95% CI 2-30%) of patients, while pouch outlet obstruction occurred in 10.9% (95% CI 2-20%). Pairwise meta-analysis demonstrated increased risk of incontinence after pregnancy (OR = 1.61, 95% CI 1.09; 2.38, p = 0.017), with non-significant changes in either daytime stool frequency (WMD = 0.56, 95% CI 0.19; 1.12, p= 0.358, I² = 73%) or nocturnal (WMD = 0.17, 95% CI - 0.43; 0.78, p = 0.575, I² = 77%), respectively. Cesarean section was associated with a significant reduction in nighttime bowel movements (WMD: -0.22, 95% CI: -0.41, -0.02, p=0.028), with no significant differences in other outcomes.</p><p><strong>Conclusions: </strong>Pouch function remains largely stable during and after pregnancy, although fecal incontinence is common and may worsen postpartum. Mode of delivery does not meaningfully impact long-term pouch outcomes, supporting individualized, preference-sensitive decision-making. Heterogeneity in outcome reporting and the predominance of older studies highlight the need for contemporary research.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224782","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":"Enhanced recovery after surgery (ERAS) for endoscopic resection of upper gastrointestinal lesions ≤ 2 cm: a single-center, 1:2 randomized, controlled, non-inferiority trial.","authors":"Guoyao Sun, Wen Jia, Zhixin Liu, Yanan Sun, Feng Gao, Yong Sun, Jianfeng Huo, Kaiqiang Xu, Zhuo Yang, Jiangning Gu","doi":"10.1007/s00464-026-13383-3","DOIUrl":"https://doi.org/10.1007/s00464-026-13383-3","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to preliminarily evaluate the non-inferiority of ERAS-based perioperative management in endoscopic resection for upper gastrointestinal lesions.</p><p><strong>Methods: </strong>A total of 165 patients with upper gastrointestinal lesions ≤ 2 cm undergoing endoscopic resection (STER, ESD, ESE, or EFTR) were randomized 1:2 to the ERAS group (n = 55) or the conventional recovery after surgery (CRAS) group (n = 110). The primary outcome was postoperative complication rate, with a non-inferiority margin of 5%. Secondary outcomes included postoperative pain, recovery indicators, length of stay, and hospitalization costs.</p><p><strong>Results: </strong>The risk difference in postoperative complications between the ERAS group and the CRAS group was - 0.91% (90% CI [- 3.97% to 3.83%]), meeting the prespecified criterion for non-inferiority. The ERAS group also showed significantly lower VAS pain scores (0.0 [0.0-3.0] vs. 2.0 [0.0-3.3]; p = 0.020), shorter nasogastric tube duration (3.0 [2.0-3.0] vs. 4.0 [3.0-4.0] days; p < 0.001), and earlier time to first oral water (23.9 [18.5-32.5] vs. 64.7 [56.2-77.0] hours; p < 0.001), first oral feeding (33.2 [22.5-38.5] vs. 70.3 [59.2-79.8] hours; p < 0.001), and first ambulation (36.8 [27.0-45.5] vs. 76.1 [62.0-86.0] hours; p < 0.001). Postoperative length of stay, total length of stay, and hospitalization costs were also significantly reduced (all p < 0.001).</p><p><strong>Conclusion: </strong>In this single-center trial involving selected patients with upper gastrointestinal lesions ≤ 2 cm, ERAS met the prespecified criterion for non-inferiority to CRAS with respect to postoperative complications. ERAS was also associated with shorter hospital stays and lower hospitalization costs.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224756","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":"Implementing single-port robotic platform into your colorectal surgery practice: a SAGES colorectal committee task force review of evolving robotic technology and innovations-Part II.","authors":"Ankit Sarin, Justin Dourado, Christopher M Seffren, Upinder S Sidhu, Elisabeth C McLemore, Nawar A Alkhamesi, Sherief Shawki, Brooklyn Williams, Alison Wenholz, Patricia Sylla, Laila Rashidi","doi":"10.1007/s00464-026-13332-0","DOIUrl":"https://doi.org/10.1007/s00464-026-13332-0","url":null,"abstract":"<p><strong>Background: </strong>Transanal surgery has advanced significantly since the introduction of transanal endoscopic microsurgery (TEM) in 1983. The single-port (SP) robotic system marks the latest technological advancement in minimally invasive transanal surgery, combining single-site access with full robotic articulation through a single 25 mm port. This is the first video dynamic manuscript and 2nd document of a four-part SAGES Colorectal Committee series outlining the foundational application of SP technology in colorectal surgery, specifically transanal minimally invasive surgery (SP-TAMIS).</p><p><strong>Methods: </strong>The SAGES Colorectal Committee SP Task Force performed a structured review of the da Vinci SP system, assessing platform features, instrumentation, and workflow considerations for transanal surgery. Task force members (subject matter experts with early experience with single-port robotic platforms) analyzed technical details, patient selection, operative workflows, and early outcomes. Representative procedural video-based techniques were detailed with emphasis on instrumentation, docking, and key operative steps specific to the SP transanal procedure.</p><p><strong>Results: </strong>The SP platform appears to offer several technological advantages for transanal surgery: (1) natural hand-eye coordination in an inverted field, (2) enhanced visualization with an articulating cobra camera, and (3) a third arm for retraction and exposure. These features appear to improve precision, reduce collision risk and fatigue, and shorten operative time. Published early clinical data suggest low positive margin rates (≈ 4-5%) and acceptable morbidity for multiport robotic TAMIS/SP-TAMIS in selected patients. However, direct comparative evidence versus conventional TAMIS remains limited, and many comparisons are indirect across heterogeneous cohorts. Current limitations include high cost, limited distal reach, lack of dedicated energy devices, and learning curve. The learning curve appears to be shorter than for laparoscopic TAMIS. Peritoneal entry during full-thickness excision of upper rectal and anterior lesions is a recognized event in transanal surgery; the SP platform offers several features that may facilitate its management, though SP-specific incidence data are not yet available.</p><p><strong>Conclusions: </strong>SME early experience with SP-TAMIS suggests that it can provide a safe, effective, and ergonomically superior method for local rectal excision. Mastery of this foundational application builds the skills needed for more complex SP colorectal procedures, with the potential for single-port robotics expansion into minimally invasive colorectal surgery through enhanced precision, reduced invasiveness, and improved surgeon ergonomics.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224877","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":"Laparoscopic-guided transversus abdominis plane block with low-pressure versus standard-pressure pneumoperitoneum versus port site infiltration with standard-pressure pneumoperitoneum for postoperative pain management in laparoscopic cholecystectomy: randomized controlled trial.","authors":"Puneeth Thalasta, Anita Dhar, Sunil Chumber, Rajinder Parshad, Jyotsna Punj, Kamal Kataria, Mani Kalaivani, Thirugnanasambandam Nelson, Uttam Thakur","doi":"10.1007/s00464-026-13510-0","DOIUrl":"https://doi.org/10.1007/s00464-026-13510-0","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain remains a significant challenge following laparoscopic cholecystectomy, influencing recovery, opioid consumption, and hospital stay. Laparoscopic-guided transversus abdominis plane (TAP) block and low-pressure pneumoperitoneum have independently demonstrated analgesic benefits. This study compared three predefined perioperative analgesic strategies: low-pressure pneumoperitoneum with laparoscopic-guided TAP block (L-TAP), standard-pressure pneumoperitoneum with TAP block (S-TAP), and standard-pressure pneumoperitoneum with port-site infiltration (S-PS).</p><p><strong>Methods: </strong>A prospective, open-label, three-arm randomized controlled trial was conducted at a tertiary care center (October 2022-June 2024). One hundred and eighty patients undergoing elective laparoscopic cholecystectomy for cholelithiasis were randomized equally (n = 60 each). The principal outcome was postoperative pain assessed using the Visual Analogue Scale (VAS) at 1 h, 6 h, 24 h, 7 days, and 30 days in four positions: lying, turning, coughing, and standing; standing was not assessed at 1 h. No single timepoint-position combination was designated as a standalone primary endpoint, and comparisons were interpreted as multiple outcomes. Standard analgesia comprised intravenous paracetamol 1 g QID. Rescue analgesia with intravenous tramadol 50 mg was administered when VAS ≥ 4. Secondary outcomes included shoulder-tip pain, PONV, early mobility, morphine consumption, surgical difficulty, conversion rate, and hospital stay.</p><p><strong>Results: </strong>Both TAP groups demonstrated lower VAS pain scores than S-PS at several early time points. L-TAP showed significantly lower pain scores than S-TAP during coughing and lying at 6 h (p = 0.009 for both). Shoulder-tip pain was lower in L-TAP than S-PS (3.3% vs 20.0%; p = 0.008). Rescue tramadol requirement was lower in L-TAP and S-TAP than S-PS (8.3% and 13.3% vs 41.7%; p < 0.001). Day-1 discharge rates were 96.7%, 95.0%, and 86.7%, respectively.</p><p><strong>Conclusion: </strong>TAP-based strategies were associated with lower early postoperative pain and reduced rescue analgesic requirements than S-PS. L-TAP suggested additional analgesic benefit over S-TAP, although differences in local anesthetic dose, volume, and timing limit attribution to individual components.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207971","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":"Operating under pressure: a scoping review of the effects of climate change on general surgery.","authors":"Kimberly P Woo, Ali Alipouriani, Jenny H Chang, William C Bennett, Abby Gross, Divya Deverakonda, Nikhila Yerabandi, Mary Schleicher, Alberto Arezzo, Marina Yiasemidou, Maggie Hodges, Vittoria Bellato, Myrthe M M Eussen, Patricia Sylla, Shaneeta M Johnson, Ilyssa O Gordon, Sofya Asfaw, Benjamin T Miller","doi":"10.1007/s00464-026-13407-y","DOIUrl":"https://doi.org/10.1007/s00464-026-13407-y","url":null,"abstract":"<p><strong>Introduction: </strong>Climate change adversely impacts human health; however, its effect on surgical diseases remains poorly understood. We conducted a scoping review to elucidate the current understanding of climate change's role in general surgical care and care delivery.</p><p><strong>Methods: </strong>A comprehensive search of Medline, Embase, Cochrane, and CINAHL was supplemented by manual searches. Broad terms for climate change in general surgery and its subspecialties were used. Climate-related effects were defined as daily or seasonal temperature anomalies and extreme weather events (e.g., hurricanes, floods, wildfires). Full-text articles were reviewed for relevance to treatment of surgical diseases, postoperative outcomes, and access to surgical care attributable to climate change. Thematic analysis identified recurring themes among included studies.</p><p><strong>Results: </strong>Of 5110 studies, 28 met inclusion criteria. Three themes were identified: access to surgical care, shifts in surgical disease burden, and postoperative outcomes. Five studies described decreased access to care following extreme weather events, including one reporting increased breast cancer mortality after Hurricane Katrina. Eleven studies highlighted shifts in surgical disease patterns. Temperature anomalies correlated with higher rates of traumatic injuries, skin and soft tissue infections, and complicated appendicitis. Extreme weather events were associated with increased surgical trauma and emergency case volume. Five articles found temperature anomalies associated with higher postoperative surgical site infection rates, while two did not. Four articles examined outcomes after extreme weather events, including one associating wildfire smoke exposure with worse overall survival after lung resection and another identifying longer hospital stays in wildfire-exposed facilities.</p><p><strong>Conclusion: </strong>High-level evidence regarding climate change's impact on general surgery remains limited. Emerging evidence suggests that extreme weather events and temperature fluctuations may increase demand for surgical services, disrupt timely access to treatment, and worsen postoperative outcomes. These effects may further strain healthcare systems and resources, requiring targeted mitigation and future research in this important evolving field.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208002","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":"Clinical significance of intraoperative dissection time and machine learning-based prediction in laparoscopic distal gastrectomy for gastric cancer.","authors":"Ahao Wu, Chao Lai, Guoxue Fu, Zhanhang Yu, Pan Huang, Wenbo Du, Qingwen Zeng, Zongfeng Feng, Tengcheng Hu, Yuao Tan, Zhengrong Li, Guosen Wang","doi":"10.1007/s00464-026-13369-1","DOIUrl":"https://doi.org/10.1007/s00464-026-13369-1","url":null,"abstract":"<p><strong>Background: </strong>Establishing a clinically meaningful cutoff value for intraoperative dissection time and developing predictive models for this metric among patients with distal gastric cancer.</p><p><strong>Methods: </strong>This retrospective multicenter study included 849 patients with distal gastric cancer who underwent laparoscopic distal gastrectomy between November 2020 and May 2025 at three tertiary centers. Using postoperative complications as the status variable, determine the optimal cutoff value for intraoperative dissection time. Patients were subsequently classified into short intraoperative dissection time (SIDT) and long intraoperative dissection time (LIDT) groups. Six machine learning predictive models were developed and validated.</p><p><strong>Results: </strong>An intraoperative dissection time of 133 min was identified as the optimal cutoff value. Compared with patients in the SIDT group, patients in the LIDT group had a higher incidence of postoperative complications and worse overall survival and recurrence-free survival. Although the LIDT group showed worse OS and RFS in the unadjusted analyses, intraoperative dissection time was not independently associated with prognosis in the multivariable Analysis. The LIDT group was also characterized by a higher body mass index, larger tumors, a more advanced clinical stage, and a higher proportion of patients who received neoadjuvant chemotherapy. Among the evaluated models, logistic regression achieved the highest area under the curve (AUC) in the test cohort (0.770), whereas random forest achieved the highest AUC in the validation cohort (0.759).</p><p><strong>Conclusions: </strong>For patients undergoing laparoscopic radical gastrectomy for distal gastric cancer, an intraoperative dissection time of 133 min was identified as a critical threshold, beyond which there was a higher incidence of complications. Although there were differences in prognosis, intraoperative dissection time was not an independent risk factor. Among the evaluated models, the random forest model showed the most stable predictive performance and may offer additional value for the preoperative evaluation of patients at risk of prolonged intraoperative dissection time.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207955","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":"Thoracoscopic versus endoscopic resection for esophageal leiomyoma: a propensity score-matched retrospective cohort study.","authors":"Shaoyuan Zhang, Zihan Geng, Yunfan Hu, Xinyu Yang, Dongxian Jiang, Jun Yin, Miao Lin, Hao Wang, Pinghong Zhou, Lijie Tan","doi":"10.1007/s00464-026-13314-2","DOIUrl":"https://doi.org/10.1007/s00464-026-13314-2","url":null,"abstract":"<p><strong>Introduction: </strong>Esophageal leiomyoma is the most common benign mesenchymal tumor of the esophagus. Minimally invasive management is performed by thoracoscopic surgery or endoscopic resection, but comparative evidence remains limited. This study evaluated perioperative outcomes and treatment-selection patterns for thoracic and endoscopic resection.</p><p><strong>Methods: </strong>Patients with pathologically confirmed leiomyoma who underwent resection between January 2015 and September 2023 were retrospectively reviewed. Patients with malignant components, biopsy/fine-needle aspiration only, or incomplete data were excluded. A 1:1 propensity score matching analysis was performed using nearest-neighbor matching with a caliper of 0.1, matching age, sex, tumor location, and maximal tumor diameter.</p><p><strong>Results: </strong>A total of 1,348 patients were included in the primary analysis: 132 underwent minimally invasive thoracic surgery and 1,216 underwent endoscopic resection. In the endoscopic group, 54.5% underwent endoscopic submucosal dissection and 45.5% underwent submucosal tunneling endoscopic resection. In the MIS group, 62 patients (47.0%) received intraoperative endoscopic assistance. Endoscopic resection was associated with shorter operative duration (41.9 ± 39.9 vs 114.8 ± 71.0 min, p < 0.001) and shorter postoperative hospital stay (median 2.0 vs 5.0 days, p < 0.001), whereas minimally invasive thoracic surgery was used for larger tumors (median 5.0 vs 1.3 cm, p < 0.001). After matching, 113 pairs were analyzed. Endoscopic resection remained associated with shorter operative duration (73.7 ± 62.9 vs 111.6 ± 61.5 min, p = 0.009) and shorter postoperative hospital stay (median 3.0 vs 5.0 days, p < 0.001). In the matched cohort, nasogastric tube placement and delayed stay of 5 days or longer were less common after endoscopic resection.</p><p><strong>Conclusions: </strong>Endoscopic resection was associated with faster postoperative recovery in patients with esophageal leiomyoma, whereas thoracic surgery remained important for larger tumors and complex lesions. These findings support a size- and location-oriented treatment strategy rather than a universal preference for either approach.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207969","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":"Laparoscopic adhesiolysis for small bowel obstruction in patients with abdominal surgical history: what makes it technically challenging?","authors":"Kana Ishikawa, Siyuan Yao, Taiki Omura, Kanon Hoshimaru, Tatsuhi Ushikubo, Takashi Takashima, Takashi Kumode, Shinichi Hosokawa, Teppei Murakami, Sanae Nakajima","doi":"10.1007/s00464-026-13514-w","DOIUrl":"https://doi.org/10.1007/s00464-026-13514-w","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic adhesiolysis (LA) has increasingly been adopted as a treatment option for small bowel obstruction (SBO). However, repeated operations and the resulting dense adhesions can make adhesiolysis technically challenging. Although LA generally yields better short-term outcomes than open adhesiolysis (OA), its benefits in patients with prior abdominal surgery, who often present with complex adhesions, remain unclear. Moreover, the pathophysiological characteristics and surgical pitfalls in such patients have not been sufficiently discussed.</p><p><strong>Methods: </strong>This single-center retrospective study included 373 consecutive patients who underwent surgery for adhesive SBO between 2009 and 2024. Particularly among the 301 patients with a history of prior abdominal surgery, postoperative outcomes between LA and OA were compared, and risk factors for technically difficult cases and complications were analyzed.</p><p><strong>Results: </strong>The impact of prior abdominal surgery was more pronounced in patients treated with LA than with OA. In the propensity score-matched cohort, LA resulted in faster bowel recovery, fewer complications, and shorter hospitalization compared with OA (p < 0.05). Conversion to OA occurred in 15.8% of LA-attempted cases, mainly due to dense adhesions (68.4%), and was associated with complication rates comparable to those of OA. Higher BMI (odds ratio (OR): 1.15, p = 0.003) and prior malignancy surgery (OR: 2.29, p = 0.014) independently predicted dense adhesions, whereas a 15-min increase in operative time (OR: 1.40, p < 0.001) was a significant risk factor for complications. As the operative time of LA increased, complication rates rose markedly, approaching those of OA.</p><p><strong>Conclusions: </strong>LA completion demonstrates overall advantages even in patients with prior abdominal surgery; however, in technically demanding cases with prolonged operative times or the need for conversion, complication rates approximate those of OA, warranting prudent case selection.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207948","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":"Bayesian network meta-analysis comparing efficacy of surgical gastrojejunostomy, endoscopic stenting, and EUS-guided gastroenterostomy for malignant gastric outlet obstruction.","authors":"Zhixin Xie, Zhiyu Yan, Yunlu Feng, Aiming Yang, Wen Shi, Qiang Wang","doi":"10.1007/s00464-026-13468-z","DOIUrl":"https://doi.org/10.1007/s00464-026-13468-z","url":null,"abstract":"<p><strong>Background and aims: </strong>Malignant gastric outlet obstruction (GOO) substantially impairs quality of life in patients with advanced malignancies. Surgical gastrojejunostomy (S-GJ), endoscopic stenting (ES), and EUS-guided gastroenterostomy (EUS-GE) are the principal palliative options. We performed a Bayesian network meta-analysis to compare their efficacy and safety.</p><p><strong>Methods: </strong>PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were searched through April 13, 2026. Randomized controlled trials and eligible comparative cohort studies comparing at least two interventions in adults with malignant GOO were included. Bayesian network meta-analysis was performed, and treatments were ranked using the surface under the cumulative ranking curve (SUCRA).</p><p><strong>Results: </strong>Fifteen studies (7 RCTs and 8 cohort studies; 827 patients) were included. EUS-GE achieved higher clinical success than S-GJ (risk ratio [RR] 1.38, 95% credible interval [CrI] 1.15-1.88; SUCRA 0.98), and ES was also superior to S-GJ (RR 1.18, 95% CrI 1.01-1.49). Reintervention was more frequent with ES than with S-GJ (RR 3.61, 95% CrI 1.43-14.51) or EUS-GE (RR 7.56, 95% CrI 2.02-38.14), whereas EUS-GE ranked highest for durability (SUCRA 0.93). Both endoscopic approaches shortened time to oral intake and hospital stay compared with S-GJ. No statistically significant between-treatment differences were identified for adverse events, 30-day mortality, or overall survival.</p><p><strong>Conclusions: </strong>EUS-GE was associated with a favorable balance of efficacy, durability, and recovery and may represent a promising minimally invasive alternative in centers with appropriate expertise. ES provides rapid recovery but is associated with more frequent reintervention, whereas S-GJ remains an established option. Additional direct randomized comparisons are needed to define the optimal palliative strategy.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207963","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}