Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Short- and long-term outcomes after minimally invasive spleen-preserving distal pancreatectomy with and without preservation of the splenic vessels: splenic vessel-preserving procedure is a \"double-edged sword\" in left-sided portal hypertension.","authors":"Yusuke Watanabe, Kohei Nakata, Toshiya Abe, Noboru Ideno, Naoki Ikenaga, Masafumi Nakamura","doi":"10.1007/s00464-025-12167-5","DOIUrl":"https://doi.org/10.1007/s00464-025-12167-5","url":null,"abstract":"<p><strong>Background: </strong>Spleen-preserving distal pancreatectomy (SPDP) involves splenic vessel preservation (Kimura procedure) and splenic vessel resection (Warshaw procedure). This study evaluated the short- and long-term outcomes of the minimally invasive (MI) Kimura and Warshaw SPDP.</p><p><strong>Methods: </strong>Medical records of 137 consecutive patients scheduled to undergo MI-SPDP (Kimura group, n = 72; Warshaw group, n = 65) between 2012 and 2024 were retrospectively reviewed.</p><p><strong>Results: </strong>The completion rate of the planned procedures was significantly lower in the Kimura group than in the Warshaw group (78% vs. 92%, P = 0.03). However, the patients experienced no major disadvantages due to procedural conversion. Most short-term outcomes were comparable between groups, with the exception of splenic infarction. The prevalence of radiological splenic infarction was significantly lower in the Kimura group than in the Warshaw group (5% vs. 38%, P < 0.01), although the splenic infarctions were clinically harmless. The incidence of perigastric and gastric intramural venous dilatation confirmed on computed tomography during follow-up was significantly lower in the Kimura group than in the Warshaw group (46% vs. 87%, P < 0.01; 21% vs. 39%, P = 0.04, respectively). The postoperative changes in splenic volume were significantly smaller in the Kimura group than in the Warshaw group (median, 17% vs. 28%, P = 0.04). However, 41% of patients in the Kimura group developed postoperative splenic venous stenosis during follow-up, most of whom had left-sided portal hypertension (LSPH), and postoperative splenic volume changes were significantly greater than those in patients who underwent the Warshaw procedure (median, 42% vs. 28%, P = 0.01).</p><p><strong>Conclusions: </strong>In clinical practice, the short- and long-term outcomes of patients after both procedures were comparable. The Kimura procedure carries the potential risk of postoperative splenic venous stenosis during the follow-up period, which causes LSPH. Establishing the patient selection criteria and suitable surgical procedures to prevent splenic venous stenosis after the MI Kimura procedure is required.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076229","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":"Primary umbilical hernia repair: does suture type matter?","authors":"Alex Finn, Kristin Hawes, Tien Hua, Madi Mangione, Elizabeth Martin, Stephen Kuselias, Giuseppe Zambito, Amy Banks-Venegoni","doi":"10.1007/s00464-025-12212-3","DOIUrl":"https://doi.org/10.1007/s00464-025-12212-3","url":null,"abstract":"<p><strong>Background: </strong>Umbilical hernias are a common surgical pathology. Umbilical hernias 2 cm or less are generally treated with open primary suture repair with associated risk of recurrence up to 27 percent. A variety of suture and repair techniques are used with little evidence to suggest which provides the lowest risk of recurrence. The primary goal of our study is to evaluate recurrence rates between primary umbilical hernia repairs with braided and monofilament suture.</p><p><strong>Methods: </strong>We conducted a retrospective review of primary umbilical hernia repairs in patients over the age of 18 performed at a single institution by a group of ten surgeons from November 2018 to November 2023. The primary outcome was comparison of recurrence rates between braided and monofilament suture. Secondary outcomes include recurrence rate of monofilament absorbable versus permanent repair, recurrence rate by repair method, rates of wound infection and suture granulomas.</p><p><strong>Results: </strong>We evaluated 797 patients that met inclusion criteria with a mean age of 50.9 years, mean BMI 29.6, mean CCI 1.64, and 77% male. We had a 46-month average follow-up via chart review. Mean hernia size was 1.11 cm. 86.4% were repaired with braided (Ethibond) and 13.6% with monofilament (PDS or Prolene) suture. Recurrence rate was 3.9% versus 5.6% for braided and monofilament, respectively, with no significant difference. The incidence of wound complications was not significant between the two groups. There was an increased recurrence rate using the pants over vest repair technique.</p><p><strong>Conclusion: </strong>Our study indicates that the type of suture used in primary umbilical hernia repairs does not significantly impact the rates of recurrence, wound infection, or suture granuloma formation. However, the pants-over-vest technique is associated with a higher recurrence rate.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076266","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":"Preoperative factors influence technique selection in surgical management of small bowel obstruction: findings from the SnapSBO multinational prospective observational study.","authors":"Isidro Martinez-Casas, Lewis J Kaplan, Carlos Javier Garcia Sánchez, Felipe Pareja Ciuró, Matteo Cimino, Hayato Kurihara, Matthew J Lee, Shahin Mohseni, Gary A Bass","doi":"10.1007/s00464-025-12226-x","DOIUrl":"https://doi.org/10.1007/s00464-025-12226-x","url":null,"abstract":"<p><strong>Objectives: </strong>Laparoscopic surgery is a standard approach for many elective gastrointestinal procedures but remains underutilized for emergent small bowel obstruction (SBO) resolution. This study evaluates how preoperative factors influence the initial choice of laparoscopic versus open surgery for SBO, and how intra-operative events may modify the initial operative approach and impact outcomes.</p><p><strong>Methods: </strong>Prospective, multicenter, multinational time-bound observational study of SBO patients. Preoperative data and operative details were collected. Primary outcome was initial surgical approach (laparoscopic or open). Secondary outcomes included conversion to open and post-operative complications. Uni- and multivariable analyses identified predictors of approach selection and conversion.</p><p><strong>Results: </strong>Of 1737 patients, 876 (50.4%) underwent surgery with 172 (19.6%) initially explored using laparoscopy; 60 (34.8%) of those cases converted to open. Laparoscopy was initially pursued in younger patients (mean 60.9 ± 18.2 vs. 66.5 ± 17.5 years, p < 0.001), with fewer comorbidities (66.3% vs. 75.1%, p = 0.018), and less frequent prior abdominal surgery (43.6% vs. 29.8%, p < 0.001) or multiple previous operations (mean 1.5 ± 1 vs. 1.9 ± 1.3, p = 0.03). Presumed etiology influenced approach: laparoscopy was more frequently utilized for adhesive single-band obstructions (60.5% vs. 45.2%), whereas open surgery was more common for hernias (24.4% vs. 38.1%). Both abdominal malignancy (OR = 4.74, p = 0.015) and free intraperitoneal fluid on CT (OR = 6.79, p < 0.001) surfaced as independent predictors of conversion. Laparoscopy was associated with fewer complications (surgical: 13.9% vs. 23.1%, p = 0.009; medical: 9.8% vs. 20.7%, p = 0.001) and lower mortality (0.6% vs. 8.3%, p < 0.001) than open surgery.</p><p><strong>Conclusions: </strong>Preoperative patient factors and disease etiology are associated with initial operative technique selection, while intraoperative events and findings appear to adjust the probability of conversion to open. Preoperative assessment combined with flexibility in intraoperative decision-making appears to be associated with optimal outcomes in SBO management.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081560","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":"Preoperative splenic artery embolization in moderate splenomegaly undergoing elective laparoscopic splenectomy: a randomized controlled trial.","authors":"Jyoti Sharma, Yashwant Singh Rathore, Devender Singh, Ankita Singh, Piyush Ranjan, Sunil Chumber, Kamal Kataria, Chandan J Das","doi":"10.1007/s00464-025-12198-y","DOIUrl":"https://doi.org/10.1007/s00464-025-12198-y","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic splenectomy (LS) for moderate splenomegaly remains technically demanding due to limited working space and increased vascularity. Pre-operative splenic artery embolization (SAE) has shown benefits in massive splenomegaly, but its role in moderate cases is unclear.</p><p><strong>Methods: </strong>This open-label randomized controlled trial was conducted at a tertiary care center. Patients aged 15 years and above with moderate splenomegaly undergoing elective LS were randomized into two groups: Group A (pre-operative SAE + LS) and Group B (LS alone). Primary outcomes included intra-operative blood loss, conversion to open surgery, mean operative time, and post-operative length of stay. Secondary outcomes included short-term post-operative complications and post-splenectomy hematological changes.</p><p><strong>Results: </strong>A total of 40 patients were randomized (20 per group). The intraoperative blood loss was comparable between Group A [100(50-550)] ml and Group B [100(50-2000)] ml, p < 0.228). The conversion rates were similar across both groups (5% in Group A vs. 10% in group B). Operative time was slightly longer in Group B (79.9 ± 19.2 min) compared to Group A (90.5 ± 32.0 min; p = 0.210), but not statistically significant. Mean post-operative hospital stay was similar (4.35 ± 0.8 days in Group A vs. 4.75 ± 1.4 days in Group B) Post-operative complications, including pancreatic leak and atelectasis, were similar across both the groups.</p><p><strong>Conclusion: </strong>The results of preoperative SAE with LS are equivocal to LS alone in patients undergoing elective LS for moderate splenomegaly. While SAE resulted in reduced intraoperative blood loss, the results were not statistically significant. Randomized trials with larger sample sizes and multicentric studies are required to achieve a consensus.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076241","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":"Machine learning-derived predictive model for post-ERCP pancreatitis in patients with common bile duct stones: a retrospective multicenter study.","authors":"Kangjie Chen, Linpei Wang, Xianfeng Wang, Liang Yang, Xiaodong Zhang, Yonghua Lin, Linping Cao","doi":"10.1007/s00464-025-12169-3","DOIUrl":"https://doi.org/10.1007/s00464-025-12169-3","url":null,"abstract":"<p><strong>Background: </strong>Common bile duct stones (CBDS) are the primary indication for endoscopic retrograde cholangiopancreatography (ERCP), yet post-ERCP pancreatitis (PEP) remains a significant complication due to its multifactorial etiology. This study aimed to identify core predictors and develop an optimized predictive model for PEP.</p><p><strong>Methods: </strong>We retrospectively enrolled patients who underwent ERCP in three centers between March 2019 and March 2024. Potential predictors and their importance were evaluated with four machine learning (ML) algorithms. Predictive models were developed using logistic regression and assessed for discrimination, calibration, and clinical utility.</p><p><strong>Results: </strong>A total of 1758 patients were included in the training (n = 917), testing (n = 392), validation 1 (n = 366), and validation 2 (n = 83) cohorts. The incidences of PEP were 6.7%, 6.6%, 10.1%, and 12.0%, respectively, with no significant difference among them (p = 0.063). Using ML, eight critical predictors were identified: age, direct bilirubin, serum calcium, γGT, cannulation attempts, transpancreatic precut, pancreatic guidewire passage, and endoscopic papillary balloon dilation (EPBD) duration. Model 3, incorporating serum calcium (OR: 2.50, p = 0.002), transpancreatic precut (OR: 4.61, p < 0.001), pancreatic guidewire passage (OR: 3.62, p < 0.001), and EPBD duration (OR: 2.25, p = 0.009), exhibited the highest AUC (0.845) and superior sensitivity (83.2%). Internal and external validations confirmed robustness and generalizability of the model, demonstrating excellent predictive performance and clinical utility.</p><p><strong>Conclusion: </strong>We established and validated an optimized predictive model for PEP using four key predictors, enhancing early identification and intervention after ERCP for patients with CBDS.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081656","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":"Long-term 10-year outcomes of biliopancreatic diversion with duodenal switch (BPD/DS) and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S): a comparative multicenter cohort study.","authors":"Nour El Ghazal, Graziella Galvao Goncalves, Muhammad A Jawad, Michael L Kendrick, Andre F Teixeira, Omar M Ghanem","doi":"10.1007/s00464-025-12170-w","DOIUrl":"https://doi.org/10.1007/s00464-025-12170-w","url":null,"abstract":"<p><strong>Background: </strong>With the recent endorsement of the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) as a modification of the biliopancreatic diversion with duodenal switch (BPD/DS), long-term data regarding their comparison is scarce. This study aimed to compare the 10-year efficacy and safety outcomes of BPD/DS and SADI-S.</p><p><strong>Methods: </strong>A retrospective review of patients undergoing BPD/DS and SADI-S as primary procedures was conducted at two centers. Outcomes assessed were weight loss, remission of obesity-related medical conditions and early and late complications. Chi-squared tests, t-tests for parametric data and Mann Whitney U tests for nonparametric data, and a linear fixed effects model were used for statistical analysis.</p><p><strong>Results: </strong>101 patients underwent BPD/DS and 32 underwent SADI-S between 2008 and 2014. Mean preoperative body mass index (57.5 ± 9.5 kg/m² in BPD/DS vs 59.9 ± 9.7 kg/m² in SADI-S, p = 0.208) and age (46.9 ± 11.0 years in BPD/DS vs 43.3 ± 11.3 years in SADI-S, p = 0.102) were comparable between both groups. The mean percentage total weight loss (%TWL) at all time points, the maximum % TWL (45.7 ± 9.6% in BPD/DS vs 47.3 ± 10.1% in SADI-S, p = 0.418), and remission rates of obesity-related medical conditions were similar. The SADI-S group experienced more intraoperative complications (n = 3 vs n = 0 in BPD/DS, p = 0.013) and longer hospital length of stay (4 vs 3 days in BPD/DS, p < 0.001). More nutritional complications were seen after BPD/DS (53.5% vs 15.6% in SADI-S, p < 0.001). Rates of early and late complications were comparable between both cohorts.</p><p><strong>Conclusions: </strong>Although SADI-S is a relatively newer technique, long-term results seem promising, especially when compared to the traditional DS, which is known to raise safety and nutritional concerns. More long-term comparative studies are needed to contribute to this growing data.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081619","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":"Comparison of robotic-assisted and laparoscopic-assisted anorectal pull-through for anorectal malformations: a single-center retrospective study.","authors":"Daiwei Zhu, Zebing Zheng, Chengyan Tang, Xingrong Xia, Yuan Gong, Lu Huang, Qing Du, Wankang Zhou, Zeping Li, Yu Liao, Yuanmei Liu, Zhu Jin","doi":"10.1007/s00464-025-12175-5","DOIUrl":"https://doi.org/10.1007/s00464-025-12175-5","url":null,"abstract":"<p><strong>Objective: </strong>In this study, we aimed to compare the efficacy of robotic-assisted anorectal pull-through (RAARP) and laparoscopic-assisted anorectal pull-through (LAARP) in treating children with anorectal malformations (ARMs).</p><p><strong>Methods: </strong>Sixty five children with ARMs who underwent surgical treatment in our department between 2018 and 2023 were retrospectively enrolled. Patients were divided into two groups based on surgical approach: 27 cases in the RAARP group and 38 in the LAARP group. The collected data included age and weight at surgery, operation time,intraoperative blood loss,postoperative hospital stay,postoperative complications and postoperative defecation function.</p><p><strong>Results: </strong>No significant differences were observed in age at surgery, weight at surgery, operative time, or postoperative hospital stay (P > 0.05). the intraoperative blood loss in the RAARP group were significantly lower than that in the LAARP group (P < 0.05). No statistically significant difference was observed in the complication rates between the two groups (P > 0.05). The total hospitalization cost in the RAARP group were significantly higher than LAARP group (P < 0.05). The RAARP group demonstrated significantly better postoperative defecation function, including voluntary bowel control and soiling, compared to the LAARP group (P < 0.05), However, no significant difference was observed in the incidence of constipation (P > 0.05).</p><p><strong>Conclusion: </strong>The application of RAARP in the treatment of intermediate/high-type anorectal malformations with rectourethral bulbar fistula demonstrates safety and efficacy, effectively reducing intraoperative blood loss while maintaining postoperative defecation function comparable to or better than LAARP, with satisfactory early-term outcomes.RAARP also represents a safe and feasible option for the treatment of low-type fistulous anorectal malformations, warranting consideration for clinical application.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076209","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":"Advancing laparoscopic surgery in low- and middle-income countries (LMICs): pilot implementation of the Global Laparoscopic Advancement Program (GLAP) with Fundamentals of Laparoscopic Surgery (FLS) certification in Ethiopia.","authors":"Fatmata Bah, Jesse Asiedu, Tulio Pacheco, Linda Zhang, Maria Marcela Bailez, Ana Carasquilla, Rohan Joseph","doi":"10.1007/s00464-025-12149-7","DOIUrl":"https://doi.org/10.1007/s00464-025-12149-7","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic surgery adoption in low- and middle-income countries (LMICs) faces significant challenges due to limitations of resources and trained professionals. The Global Laparoscopic Advancement Program (GLAP) of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), through the Global Affairs Committee (GAC), aims to overcome these barriers through sustainable collaborative training in LMICs. Building on GLAP's success in Mexico, Costa Rica, and Namibia, this study aims to evaluate the feasibility of GLAP training combined with FLS certification for surgeons in Ethiopia.</p><p><strong>Methods: </strong>In December 2023, the GAC collaborated with the Surgical Society of Ethiopia and the College of Surgeons of East, Central, and Southern Africa to conduct two GLAP sessions. These sessions focused on simulation-based education, Fundamentals of Laparoscopic Surgery (FLS), and other SAGES fundamental courses. Participants completed surveys assessing their surgical backgrounds, simulation experience, and curriculum development interest. Participants took the FLS exam at completion of the program.</p><p><strong>Results: </strong>The GLAP Ethiopia course trained 47 general, pediatric, urologic, and gynecologic surgeons with diverse training backgrounds in laparoscopic surgery-of those trained, 20.8% received formal training in residency and 8.3% in fellowship, whereas 23.4% had no experience. While most (70.2%) learned laparoscopy through observation, 60.4% rarely or had never practiced on simulators, and 36.1% lacked laparoscopic mentors. At the end of the training, 23 participants took the FLS exam; 65% passed both the cognitive and skills portions.</p><p><strong>Conclusion: </strong>Laparoscopy adoption in Ethiopia remains limited by insufficient structured formal training programs, a shortage of expert trainers, and inadequate equipment. The implementation of GLAP has proven feasible and provides valuable additional training opportunities for the region. Furthermore, the GLAP curriculum and training platform may improve participant performance and success in FLS certification.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076226","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":"Efficacy and safety of endoscopic submucosal dissection for pyloric neoplasms.","authors":"Shao-Bin Luo, Zu-Qiang Liu, Li Wang, Yi-Qun Zhang, Ming-Yan Cai, Quan-Lin Li, Ping-Hong Zhou","doi":"10.1007/s00464-025-12061-0","DOIUrl":"https://doi.org/10.1007/s00464-025-12061-0","url":null,"abstract":"<p><strong>Background and aims: </strong>Although endoscopic resection is widely accepted for pyloric lesions, endoscopic submucosal dissection (ESD) of pyloric neoplasms remains technically challenging. The study aimed to assess the efficacy and safety of ESD for pyloric neoplasms.</p><p><strong>Methods: </strong>From June 2011 to August 2024, we retrospectively analyzed 103 patients with pyloric neoplasms who underwent ESD at the Endoscopy Center of Zhongshan Hospital. Clinical data,‌ including patient demographics, procedural outcomes, and follow-up results, were collected.</p><p><strong>Results: </strong>Among 103 lesions, there were 36 prepyloric neoplasms, 49 pyloric neoplasms and 18 postpyloric neoplasms. The median lesion size was 31 mm (range 10-85 mm). The postpyloric group showed longer procedure duration (32 min vs. 39 min vs. 46 min, P = 0.029) and lower rate of en bloc resection (100.0% vs. 95.9% vs. 83.3%, P = 0.026) compared with the prepyloric group and pyloric group. No patients required conversion to open surgery. After procedure, delayed bleeding occurred in ‌one patient each‌ from the prepyloric and pyloric groups. During a median follow-up of 25 months (range: 6-81 months), only ‌one recurrence‌ (pyloric group) was observed. Post-ESD pyloric stenosis developed in 5 patients, all of whom achieved ‌symptomatic relief‌ through endoscopic balloon dilation (EBD) without complications.</p><p><strong>Conclusions: </strong>ESD is a feasible and safe treatment for pyloric neoplasms. Additionally, EBD appears to be a safe and effective ‌therapeutic approach for post-ESD pyloric stenosis.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076261","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":"Surgical synergy or complication catalyst? Evaluating a meta-analysis of concomitant bariatric surgery and ventral hernia repair.","authors":"Carlos A Balthazar da Silveira, Ana C D Rasador, Laura Vidotto, Raquel Nogueira, W Scott Melvin, Diego Camacho, Diego L Lima","doi":"10.1007/s00464-025-12207-0","DOIUrl":"https://doi.org/10.1007/s00464-025-12207-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Obesity has become a global comorbidity with increasing prevalence over the last decade. It is associated with an elevated risk for the development of ventral hernias. Bariatric surgery aims to address obesity through surgical intervention, which has become increasingly safe over time. However, a comparative meta-analysis with a double-arm evaluation of concomitant ventral hernia repair (VHR) and weight loss surgery is not yet available in the literature. Hence, we performed a systematic review and meta-analysis of simultaneous VHR and bariatric surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;Cochrane, Embase, Scopus, Scielo, and PubMed were systematically searched for studies comparing concomitant bariatric surgery and VHR with bariatric surgery alone or staged repair. Outcomes assessed for comparative meta-analysis were surgical site infection (SSI), dehiscence, readmission and reoperation, deep venous thrombosis (DVT) and pulmonary embolism (PE), overall mortality, operative time, and length of hospital stay (LOS). SSI was also analyzed separately as a superficial or deep infection. We also performed a single-arm meta-analysis of incarceration within the staged repair groups with a bariatric surgery as the first procedure and a single-arm meta-analysis of recurrence following concomitant bariatric surgery and VHR. Statistical analysis was performed with R Studio.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;805 studies were screened and 26 were thoroughly reviewed. Six studies were included, comprising a total of 131,323 patients, of whom 3002 (2.3%) underwent simultaneous bariatric and VHR procedures. Simultaneous repair was associated with an increase of 39.4 min (95% CI 26.17 to 52.63; p &lt; 0.01) in the operative time. We found an increased readmission rate for the concomitant procedures (OR 1.48; 95% CI 1.1 to 1.99; p &lt; 0.01), but no differences were found in reoperation rates (OR 2.97; 95% CI 1.0 to 8.84; p = 0.05). Concomitant procedures were also associated with higher DVT (OR 2.54; 95% CI 1.36 to 4.72; p &lt; 0.01) and PE rates compared to separated procedures (OR 3.08; 95% CI 1.57 to 6.05; p &lt; 0.01). No differences were found in overall SSI (OR 1.1; 95% CI 0.59 to 2.12; p = 0.74) and superficial (OR 0.94; 95% CI 0.48 to 1.84; p = 0.86) or deep (OR 7.02; 95% CI 0.36 to 136.1; p = 0.2) SSI. No statistically significant differences were found in dehiscence rates between the groups (OR 0.2; 95% CI 0.01 to 4.16; p = 0.3). Concomitant procedures were associated with an increase of 0.35 days in LOS (95% CI 0.1 to 0.59; p = 0.004) and with increased mortality odds (OR 3.99; 95% CI 1.92 to 8.3; p &lt; 0.01). The proportional meta-analysis found an incarceration rate of 22.95 (95% CI 10.9 to 42) for the patients who delayed the VHR and a recurrence rate of 7.61 per 100 patients (95% CI 1.6 to 29.6) for the patients who underwent concomitant surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our systematic review and meta-analysis fou","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075987","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}