Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Feasibility and safety of endoscopic resection for cardial submucosal tumors more than 30 mm in diameter.","authors":"Shao-Bin Luo, Zu-Qiang Liu, Li Wang, Yi-Qun Zhang, Ming-Yan Cai, Quan-Lin Li, Ping-Hong Zhou","doi":"10.1007/s00464-025-12189-z","DOIUrl":"https://doi.org/10.1007/s00464-025-12189-z","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic resection has emerged as a viable option for cardial submucosal tumors (SMTs), but existing evidence remains limited by small sample sizes. This study aimed to evaluate the efficacy and safety of endoscopic resection techniques for cardial SMTs more than 30 mm in diameter.</p><p><strong>Methods: </strong>Between January 2012 and October 2024, 107 patients with cardial SMTs larger than 30 mm were included in this study. Data on patient characteristics, clinical outcomes, and follow-up ‌were retrospectively analyzed.</p><p><strong>Results: </strong>Among 107 patients, 42 patients underwent submucosal tunneling endoscopic resection (STER), 34 patients underwent endoscopic full-thickness resection (EFTR), and 31 patients received endoscopic submucosal dissection (ESD). The mean lesion size was 4.2 ± 1.9 cm. The rate of en bloc resection and complete resection were 94.3% and 91.6%, respectively. Postoperative adverse events included delayed bleeding (2 cases), delayed perforation (2 cases), subcutaneous emphysema (2 cases) and pleural effusion (2 cases). One case of recurrence was detected during the mean follow-up period of 37.4 ± 22.5 months. Multivariate analysis showed irregular morphology (OR 2.076, 95% CI 0.513-6.274, P = 0.039) and invasion into the muscularis propria layer (OR 6.157, 95% CI1.160-7.602, P = 0.031) were independent risk factors for incomplete resection; lesion size ≥ 40 mm (OR 6.271, 95% CI 1.024-7.856, P = 0.027), irregular morphology (OR 4.734, 95% CI 1.489-6.052, P = 0.042), trans-cardia tumor (OR 5.526, 95% CI 1.160-7.602, P = 0.043) and invasion into the muscularis propria layer (OR 5.104, 95% CI 1.893-7.965, P = 0.030) were independent risk factors for long operative times.</p><p><strong>Conclusion: </strong>Endoscopic resection is an effective and safe treatment for cardial SMTs larger than 30 mm, particularly when performed by experienced endoscopists. Long-term surveillance remains crucial for early detection of recurrence.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070503","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":"Artificial intelligence-assisted scar visualization under intraoperative bleeding using CycleGAN and uncertainty fusion in laparoscopic cholecystectomy.","authors":"Tatsushi Tokuyasu, Subal Ikeda, Hiroki Orimoto, Teijiro Hirashita, Yuichi Endo, Masafumi Inomata","doi":"10.1007/s00464-025-12203-4","DOIUrl":"https://doi.org/10.1007/s00464-025-12203-4","url":null,"abstract":"<p><strong>Background: </strong>Accurate intraoperative identification of scar tissue is essential for preventing bile duct injury during laparoscopic cholecystectomy (LC), especially under visually impaired conditions caused by bleeding. This study aimed to develop an artificial intelligence (AI)-based framework to enhance scar region prediction in such challenging surgical environments.</p><p><strong>Methods: </strong>A hybrid approach was proposed, combining Cycle-Consistent Generative Adversarial Network-based image translation with uncertainty-aware fusion. Bleeding-contaminated laparoscopic images were translated into pseudo non-bleeding representations using unpaired domain adaptation. Segmentation results obtained from the original and translated images were then fused based on pixel-wise entropy to improve robustness.</p><p><strong>Results: </strong>The system was evaluated using 99 representative images from 20 surgical patients. Compared with conventional segmentation methods, the proposed framework significantly improved Dice coefficients across all three board-certified endoscopic surgeons who served as expert annotators, with all improvements demonstrating significance (P < 0.001). Subjective evaluations by the same surgeons confirmed high clinical utility, particularly in scar visibility and boundary delineation. The framework achieved near real-time inference speed (0.06 s per frame on an RTX A5000 GPU).</p><p><strong>Conclusion: </strong>This AI-assisted framework improved the accuracy and robustness of scar tissue detection during LC, even in bleeding-compromised fields. Its real-time capability and strong clinical validation indicate substantial potential for intraoperative application and enhancement of surgical safety.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070531","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 the stapler method on postoperative pancreatic fistula in robot-assisted pancreaticoduodenectomy: a retrospective study.","authors":"Kota Sugiura, Yoshihiro Ono, Kosuke Kobayashi, Atsushi Oba, Hiromichi Ito, Yosuke Inoue, Yu Takahashi","doi":"10.1007/s00464-025-12223-0","DOIUrl":"https://doi.org/10.1007/s00464-025-12223-0","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pancreatic fistula (POPF) remains a significant complication after pancreaticoduodenectomy. However, optimal techniques for pancreatic transection to minimize the risk of POPF have not been thoroughly elucidated. This study aimed to evaluate the impact of stapler-assisted pancreatic transection and reconstruction (stapler method) on the incidence of clinically relevant POPF (CR-POPF) and to present the technical details of the stapler method, accompanied by supplementary video footage.</p><p><strong>Methods: </strong>A retrospective review was conducted on patients who underwent robot-assisted pancreaticoduodenectomy (RPD) between October 2020 and December 2024. Patients were categorized into the stapler method group and the conventional method group, in which pancreatic transection was performed using a coagulation-based technique. The incidence and risk factors for CR-POPF were analyzed, and post-pancreatectomy acute pancreatitis (PPAP) was also evaluated.</p><p><strong>Results: </strong>A total of 134 patients who underwent RPD were included in this study, with 61 in the stapler method group and 73 in the conventional method group. The incidence of CR-POPF was significantly lower in the stapler method group compared to the conventional method group (13.1% vs. 31.5%, p = 0.014). In multivariate analysis, body mass index was independently associated with an increased risk of CR-POPF (OR, 1.34; 95% CI, 1.14-1.57; p < 0.001), while the stapler method was associated with a significantly reduced risk (OR, 0.31; 95% CI, 0.12-0.80; p = 0.016). Although postoperative serum amylase levels on postoperative day 1 were significantly higher in the stapler method group (578 U/L; IQR, 292-1107) than in the conventional method group (336 U/L; IQR, 242-830; p = 0.020), the incidence of PPAP did not significantly differ between the groups (stapler method: 1.6% vs. conventional method: 1.4%, p = 1.000).</p><p><strong>Conclusions: </strong>These findings suggest that the stapler method may reduce the incidence of CR-POPF in RPD without increasing the risk of PPAP.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070533","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":"Evaluating the evaluators: does C-SATS measure up?","authors":"Robert B Laverty, Charles H Chesnut, Joseph R Karam, Joseph C L'Huillier, Alexander Bonte, Julie M Clanahan, Jisuk Park, Brian Yoon, Robert W Krell","doi":"10.1007/s00464-025-12150-0","DOIUrl":"https://doi.org/10.1007/s00464-025-12150-0","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted surgery has increased in prevalence, particularly in general surgery. The number of cases required to achieve adequate proficiency in robotic surgery, however, and the training metrics that correlate best with proficiency remain unclear. We sought to better define proficiency-based benchmarks in robotic-assisted cholecystectomies (RAC) and inguinal hernia repairs (RIHR) using a commercial crowd source based on competency platform.</p><p><strong>Methods: </strong>Multi-institutional cohort study in which 48 surgeons (senior residents, fellows, and practicing physicians) submitted representative videos of themselves performing a RAC and/or RIHR. Subjects subsequently underwent blinded case video reviews using the C-SATS platform, which utilizes the Global Evaluative Assessment of Robotic Skills (GEARS) rubric. Participating surgeons self-reported surgical case volume. Primary outcome was correlation of GEARS scores with historic procedure case volume. Secondary outcomes included construct validity of GEARS scores as an operative proficiency metric.</p><p><strong>Results: </strong>Total GEARS scores and historical case volume showed positive correlation for both RAC (r = 0.65, p < 0.0001) and RIHR (r = 0.54, p = 0.001) among all performers. On subgroup analysis, no correlation was seen for resident/fellow physicians (r = 0.39, p = 0.11 for RAC; r = 0.22, p = 0.49 for RIHR) or those with < 50 historic case volume (r = 0.14, p = 0.55 for RAC; r = 0.21, p = 0.54 for RIHR). No difference in total GEARS scores was seen between resident/fellow and practicing physicians for either RAC (20.21 v 20.25, p = 0.82) or RIHR (20.45 v 20.46, p = 0.95), nor in those with < 50 or ≥ 50 historic case volume in RAC (20.16 v 20.33, p = 0.33) and RIHR (20.35 v 20.49, p = 0.48). GEARS scores by domain (bimanual dexterity, depth perception, efficiency, force sensitivity, and robotic control) and surgical step (exposure of triangle of calot, clipping and division of cystic artery/duct, and dissection of gallbladder; mobilizing peritoneal flap, hernia sac dissection, and mesh placement) were similar across both groups (p > 0.05).</p><p><strong>Conclusion: </strong>C-SATS-derived GEARS scores correlated to overall surgeon historical case volume for RA cholecystectomy and IHR, but not among novice performers. This methodology was unable to differentiate between novice and expert performers for these procedures. There remains a need for high-fidelity and discerning robotic skills evaluation platforms for trainees and novice surgeons.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070558","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":"Quality of bariatric surgery at Veterans Affairs versus community care hospitals.","authors":"Adnan S Syed, Krzysztof J Wikiel, Jake L Cotton, Edward L Jones","doi":"10.1007/s00464-025-12148-8","DOIUrl":"https://doi.org/10.1007/s00464-025-12148-8","url":null,"abstract":"<p><strong>Background: </strong>Under the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018, Veterans can obtain Veterans Health Administration (VHA)-funded care in the community; however, there are limited studies on Veteran outcomes following bariatric surgery.</p><p><strong>Methods: </strong>We performed a national retrospective study of Veterans undergoing bariatric surgery between fiscal years 2022-2023. Data were collected through VHA administrative databases. Differences in baseline characteristics and length of stay were assessed with two-sided t-tests or Wilcoxon Sign Rank tests for continuous variables and Pearson's Chi-square or Fisher's Exact tests for categorical outcomes. Differences in 30-day emergency room visit, 30-day readmissions and both 30-day and 1-year mortality were estimated with log binomial models adjusted for baseline characteristics and expressed as relative risk (RR).</p><p><strong>Results: </strong>Three thousand three hundred ninety Veterans met inclusion criteria, and 1730 (51%) underwent bariatric surgery within the VHA and 1660 (49%) within the community. VHA Veterans were younger (p = .035), comprised of fewer white (p < .001), more Hispanic (p < .001), more urban-residing individuals (p < .001), had less comorbidities (p = .026), lower BMI (p < .001), and shorter length of stay (p < .001) compared to community care Veterans. Compared to VHA, Veterans in the community were more likely to undergo Roux-en-Y (VHA: 46% vs. Community: 33%, p < .001) and less likely to undergo gastroplasty (VHA: 67% vs. Community: 54%, p < .001). Community care Veterans were less likely to have an emergency department visit within 30 days (Adjusted RR = 0.78, 95% Confidence Interval, 0.63-0.97, p < .001) but did not have statistically significant differences in 30-day readmissions and neither 30-day nor 1-year mortality.</p><p><strong>Conclusion: </strong>Despite the increased risk in 30-day emergency department visits among VHA Veterans following bariatric surgery, morbidity and mortality are comparable between VHA and community care Veterans. Further investigation accounting for consult timeliness and cost should be conducted to fully evaluate differences in quality and access to care.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070569","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 partially extracorporeal versus totally intracorporeal Roux-en-Y reconstruction in robotic surgery for gastric cancer.","authors":"Hiromi Nagata, Takahiro Kinoshita, Masaru Komatsu, Takumi Habu, Mitsumasa Yoshida, Masahiro Yura","doi":"10.1007/s00464-025-12171-9","DOIUrl":"https://doi.org/10.1007/s00464-025-12171-9","url":null,"abstract":"<p><strong>Background: </strong>Robotic surgery for gastric cancer has been increasingly performed globally. The ability to perform accurate dissection is recognized as a pivotal advantage. As for reconstruction, the debate remains as to whether it should be partially extracorporeal or totally intracorporeal with robotic manipulation.</p><p><strong>Methods: </strong>This retrospective study reviewed the clinical data of patients who underwent robotic radical gastrectomy with Roux-en-Y reconstruction (total gastrectomy or distal gastrectomy) for gastric cancer between January 2023 and October 2024. Patients were divided into two groups depending on how jejunal limb was created: extracorporeal via mini-laparotomy (Extra group, n = 50) or totally intracorporeal (Intra group, n = 58). Esophagojejunostomy in total gastrectomy or gastrojejunostomy in distal gastrectomy was done intracorporeally in all patients. Surgical outcomes were compared between the two groups.</p><p><strong>Results: </strong>The Intra group included more patients with high body mass index (BMI) (21.4 vs. 25.0 kg/m²; P < 0.001). In the entire cohort, the Intra group showed shorter reconstruction times (56.5 vs. 69 min). Multiple regression analysis showed distal gastrectomy (t = - 4.492, P < 0.001) and the totally intracorporeal reconstruction (t = - 2.607, P = 0.011) were significantly associated with shorter reconstruction time. Reconstruction time in the Intra group was little affected by patient's BMI. No anastomosis-related complications were recognized in either group.</p><p><strong>Conclusions: </strong>Totally intracorporeal Roux-en-Y reconstruction in robotic gastric cancer surgery may reduce reconstruction time because there is no need to undock the robotic system and there are no surgical interruptions. Furthermore, it has the advantage of not being affected by patient's BMI.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055573","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":"Do smokers deserve \"No\"? Management and outcomes of smokers undergoing elective ventral hernia repair.","authors":"Ryan Howard, Anne Ehlers, Brian Fry, Sean O'Neill, Dana Telem, Jenny Shao","doi":"10.1007/s00464-025-12206-1","DOIUrl":"https://doi.org/10.1007/s00464-025-12206-1","url":null,"abstract":"<p><strong>Introduction: </strong>Smoking has long been regarded as a contraindication to elective ventral hernia repair, however some have begun to question whether this practice is unnecessarily restrictive. In order to better understand the implications of more liberal patient selection for commonly encountered hernias, we evaluated outcomes among smokers and nonsmokers undergoing elective ventral hernia repair.</p><p><strong>Methods: </strong>We retrospectively reviewed a population-level registry to identify adults who underwent elective ventral hernia repair between 2021 and 2023. The primary explanatory variable was active smoking, which was defined as smoking within the month prior to surgery. Outcomes included 30-day complications, emergency department utilization (including reason for utilization), readmission, and reoperation. Multivariable logistic regression was used to assess the association of smoking with all outcomes while controlling for patient, hernia, and operative characteristics.</p><p><strong>Results: </strong>12,233 patients underwent elective ventral hernia repair during the study period. Mean age was 54.3 (14.3) years, 5151 (42.1%) patients were female, and mean hernia width was 3.3 (3.2) cm. 2059 (16.8%) patients smoked prior to surgery. Smokers were younger, had higher ASA classifications, and more pulmonary disease. Regarding management, smokers were less likely to have myofascial release, but there was no difference in surgical approach or mesh use. Smoking was not associated with increased odds of 30-day complications, readmission, or reoperation. Smoking was associated with increased odds of 30-day ED utilization (6.83% [95% CI 5.76-7.90%] vs. 4.87% [95% CI 4.45-5.30%], P < 001), however this was due to pain-related issues (43.3% vs. 32.9%, P = 0.017) and not infectious or wound-related issues.</p><p><strong>Conclusions: </strong>In this cohort of patients undergoing elective ventral hernia repair, management of smokers and nonsmokers was similar, and smokers did not have significantly worse short-term outcomes than nonsmokers. These findings may help inform patient selection and expectations, however long-term outcomes including recurrence require evaluation as well.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055613","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":"Artificial intelligence-supported system of surgical anatomy recognition may facilitate the understanding of gastrointestinal surgery for medical students.","authors":"Shintaro Okumura, Shigeru Tsunoda, Shigeo Hisamori, Shoichi Kitano, Kohei Ueno, Masazumi Sakaguchi, Yu Yoshida, Takashi Sakamoto, Takehito Yamamoto, Ryosuke Okamura, Keiko Kasahara, Masahiro Maeda, Nobuaki Hoshino, Yoshiro Itatani, Koya Hida, Kazutaka Obama","doi":"10.1007/s00464-025-12205-2","DOIUrl":"https://doi.org/10.1007/s00464-025-12205-2","url":null,"abstract":"<p><strong>Background: </strong>Although the high accuracy of artificial intelligence (AI) for recognizing surgical anatomy has been reported, its effective usage remains unclear. In this study, we investigated the utility of AI in surgical education for medical students.</p><p><strong>Methods: </strong>Fifth-grade medical students were recruited to investigate the educational utility of EUREKA™. After an introductory lecture, they watched a video of distal gastrectomy with or without the suggestion of the connective tissue and the pancreas by EUREKA™ and then drew dissection lines in still images captured from the video. The distance between the lines drawn by students and the optimal dissection line determined by an expert surgeon was integrated to evaluate how well the students appropriately recognized the dissection line. Students filled out questionnaires after the study. A total of 45 operative video frames from radical gastrectomies performed with three different robotic systems were analyzed. The accuracy of the EUREKA™ recognition of the connective tissue and the pancreas was assessed using Dice and Intersection over Union (IoU) as a measurement tool.</p><p><strong>Results: </strong>Twelve students participated in the study, and nine students drew dissection lines. All students completed questionnaires. The students could recognize dissection lines more appropriately with the EUREKA™ suggestion, and the deviations between the dissection lines drawn by the students and the optimal dissection lines were significantly reduced. From the questionnaires completed by the students, eight students agreed with the possibility of AI to facilitate their understanding of the operation, and two students agreed with the potential of AI to increase the number of medical students who choose gastrointestinal surgery as their career. There were no differences in the DICE and IoU scores of the connective tissue and the pancreas between the three robotic systems, suggesting the versatility of the EUREKA™ system.</p><p><strong>Conclusion: </strong>AI may facilitate students' understanding of surgery.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055567","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":"Obesity and short-term outcomes in blunt liver trauma with and without surgical repair: evidence from the United States Nationwide Inpatient Sample 2005-2020.","authors":"Sin-Yong Wee, Chi Li, Wei-Ti Su, Shih-Min Ying, Hao-Ping Wang","doi":"10.1007/s00464-025-12210-5","DOIUrl":"https://doi.org/10.1007/s00464-025-12210-5","url":null,"abstract":"<p><strong>Background: </strong>To determine the influence of obesity on short-term outcomes in patients with blunt liver trauma.</p><p><strong>Methods: </strong>The US Nationwide Inpatient Sample (NIS) database 2005-2020 was reviewed to identify patients ≥ 18 years old with blunt liver trauma. Patients were categorized based on body mass index (BMI) into morbidly obese (BMI > 40 kg/m²), obese (30 ≤ BMI ≤ 40 kg/m²), and non-obese (BMI < 30 kg/m²) groups.</p><p><strong>Results: </strong>A total of 4121 patients were included, representing an estimated 20,382 patients nationwide. The mean age was 46.4 years, and 51.0% were male. Both obese and morbidly obese patients had significantly increased risks of in-hospital mortality (obese: adjusted odds ratio [aOR] = 1.59, 95% confidence interval [CI] 1.05-2.14; morbidly obese: aOR = 2.43, 95% CI 1.61-3.65). Morbid obesity was associated with increased risks of acute kidney injury (AKI) (aOR = 1.90, 95% CI 1.50-2.41) and shock (aOR = 1.56, 95% CI 1.21-2.01). However, patients with non-morbid obesity had significantly lower risks of prolonged LOS (aOR = 0.61, 95% CI 0.50-0.75), non-routine discharge (aOR = 0.66, 95% CI 0.53-0.81), and complications (aOR = 0.69, 95% CI: 0.57-0.83) compared to non-obese individuals.</p><p><strong>Conclusion: </strong>Patients with morbid obesity who sustain blunt liver trauma are at increased risk of in-hospital mortality, AKI, and shock compared to non-obese individuals. Despite higher mortality risk, non-morbid obese patients have a lower risk of prolonged LOS, non-routine discharges, and complications.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055601","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":"Analysis of mesh-related factors associated with recurrence and treatment outcomes after laparoscopic inguinal hernia repair.","authors":"Fengru Jiang, Minggang Wang, Yilin Zhu, Fan Wang, Yuchen Liu","doi":"10.1007/s00464-025-12209-y","DOIUrl":"https://doi.org/10.1007/s00464-025-12209-y","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the factors associated with recurrence and treatment outcomes after laparoscopic inguinal hernia repair. Furthermore, to discuss how outcomes could be improved.</p><p><strong>Methods: </strong>This was a retrospective study of data of 41 patients who had undergone laparoscopic surgeries for recurrent inguinal hernias after laparoscopic inguinal hernia repair in the Hernia and Abdominal Wall Surgery Department of Beijing Chaoyang Hospital, Capital Medical University from January 2017 to December 2021. We collected and analyzed baseline characteristics, factors associated with recurrence, and outcomes of surgical treatment.</p><p><strong>Results: </strong>Of the 41 study patients, 31 (75.61%) had recurrences after transabdominal preperitoneal (TAPP) surgery, and 10 had recurrences after totally extraperitoneal surgery. The recurrent hernia was managed by TAPP in 11 of these patients and by the Lichtenstein procedure in the remaining 30 patients 30. Factors associated with recurrence were separated into four categories; namely, insufficient patch coverage in 23 cases (56.10%), folding of the patch in nine (21.95%), patch contraction in seven (17.07%), and incorrect patch fixation in two (4.88%). During follow-up after surgical treatment of the recurrence, there were no further recurrences, infection, chronic pain, or foreign body sensation occurred in any patient. There was no significant difference in the incidence of postoperative seroma between TAPP and the Lichtenstein procedure.</p><p><strong>Conclusions: </strong>Most recurrences after laparoscopic inguinal hernia repair are caused by insufficient patch coverage. Standardized surgical procedures should be performed. Both TAPP and the Lichtenstein procedure are effective treatments for recurrence.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055649","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}