Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Selective Management of Inguinal Canal Fat During TAPP Repair: Distinguishing True Lipoma from Preperitoneal Fat.","authors":"Sung Ryul Lee, Geon Young Byun, In Gyu Song","doi":"10.1177/10926429261458122","DOIUrl":"10.1177/10926429261458122","url":null,"abstract":"<p><strong>Background: </strong>Inguinal canal fat encountered during inguinal hernia repair is frequently described as a lipoma, although many lesions are continuous with preperitoneal fat (PPF) rather than true neoplasms. The lack of clear intraoperative criteria has led to controversy regarding routine excision versus conservative management. This study aimed to determine whether intraoperative differentiation between true lipomas and PPF can guide selective surgical management.</p><p><strong>Methods: </strong>We retrospectively reviewed 2465 adult patients (aged ≥20 years) who underwent transabdominal preperitoneal (TAPP) repair between January 2019 and December 2023. Among them, 271 patients with fatty tissue in the inguinal canal were analyzed. Intraoperative fatty tissue was classified as either true lipoma or PPF based on encapsulation and continuity with the preperitoneal space. True lipomas were excised, and PPF was managed with reduction alone.</p><p><strong>Results: </strong>The presence of inguinal canal fat was not associated with differences in the demographic or hernia-related clinical characteristics. Recurrence was rare in both groups (0.3% versus 0.4%), with no significant difference between the patients with and without fatty tissue. Operative time was longer in patients with fatty tissue (35.6 ± 8.2 versus 28.9 ± 5.8 minutes, <i>P</i> < .001). Within the fat group, lipoma excision required longer operative time (41.8 ± 9.5 versus 34.9 ± 7.8 minutes, <i>P</i> = .001) and was associated with a higher complication rate (10.0% versus 1.2%, <i>P</i> = .005) than was PPF reduction, while recurrence and metachronous contralateral inguinal hernia were rare in both subgroups. Other postoperative outcomes were comparable between the strategies.</p><p><strong>Conclusions: </strong>Most fatty protrusions encountered in the inguinal canal during TAPP repair were continuous with the PPF layer rather than discrete encapsulated lipomas. In appropriately selected cases, reduction of PPF without excision appeared feasible and safe, with favorable short- and long-term outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"896-903"},"PeriodicalIF":1.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning Curves and Proficiency Milestones in Robotic Ventral Hernia Repair: A Systematic Review by Surgical Technique.","authors":"Gabriela Lyons, Vitor Dos Santos Neves, Maria Clara Morais, Denise Padilha Abs de Almeida, Raquel Nogueira, Leandro Totti Cavazzola, Flavio Malcher, Diego L Lima","doi":"10.1177/10926429261449956","DOIUrl":"10.1177/10926429261449956","url":null,"abstract":"<p><strong>Aim: </strong>Robotic ventral hernia repair (VHR) has enabled minimally invasive management of complex abdominal wall hernias. As robotic procedures involve distinct technical demands and require progressive skill acquisition, understanding learning curves (LCs) is essential to define proficiency thresholds, optimize surgical training, and ensure safe implementation of these techniques. This systematic review compared LCs in robotic VHR across surgical techniques.</p><p><strong>Methods: </strong>A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of major medical databases (PubMed/MEDLINE, EMBASE, Web of Science, Lilacs, and the Cochrane Library) was performed through August 2025, including cohort studies on adult patients undergoing elective robotic VHR.</p><p><strong>Results: </strong>Seven retrospective cohort studies were included, comprising six single-surgeon series: one robotic intraperitoneal underlay mesh (rIPUM), one robotic transversus abdominis release (rTAR), one robotic transabdominal preperitoneal (rTAPP), three robotic enhanced-view totally extraperitoneal (r-eTEP), and one population-based analysis including 12,609 cases. The single-surgeon series predominantly involved patients with class I obesity (mean body mass index range: 31.0-33.0 kg/m²). LC assessment was heterogeneous, employing cumulative sum (CUSUM), risk-adjusted CUSUM (RA-CUSUM), chronological case grouping, and multivariable regression modeling. Across single-surgeon studies, operative efficiency improved earlier than complication-adjusted or technical quality outcomes. Operative-time (OT) proficiency thresholds were reported at 26 cases for rIPUM, 29-38 for r-eTEP, 46 for rTAPP, and 49 cases for rTAR. However, stabilization of complication-adjusted performance required higher volumes, ranging from 51 to 64 cases. Prior experience substantially shortened the LC, reducing OT proficiency for r-eTEP to just 8 cases. In contrast, population-level analysis suggested that 16-19 robotic cases were required to achieve recurrence-related reoperation rates comparable to open or laparoscopic repair.</p><p><strong>Conclusion: </strong>LCs in robotic VHR follow a two-phase, technique-dependent pattern. While operative efficiency is achieved earlier, optimal patient outcomes require higher case volumes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"904-913"},"PeriodicalIF":1.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Robotic Surgery: From Observation to Autonomy in a Motion-Based Assessment of Learning Curve Using a Dual-Console System.","authors":"Vincenzo Coppola, Claudia Di Mento, Francesca Carraturo, Maria Sofia Caracò, Giovanni Esposito, Francesco Tedesco, Fulvia Del Conte, Maria Escolino, Ciro Esposito","doi":"10.1177/10926429261466991","DOIUrl":"10.1177/10926429261466991","url":null,"abstract":"<p><strong>Introduction: </strong>Objective data quantifying the trend of the robotic-assisted learning process remains limited. The aim of this study is to evaluate the efficiency and progression of surgical skill acquisition during robotic-assisted pyeloplasty by comparing performance parameters between expert and non-expert surgeons using a dual-console system over a 3-year period.</p><p><strong>Methods: </strong>A total of 25 robotic-assisted pyeloplasties were retrospectively analyzed; all were performed by a <i>Da Vinci Xi</i> robotic platform equipped with dual operative consoles, operated simultaneously by a robotic expert (C1) and a non-expert surgeon (C2). The procedures were divided into five standardized phases. Surgical performance was assessed using <i>Tracker^®</i> motion analysis software, which measured operative times, console utilization, instrument collisions, and motion efficiency. Trends across years were assessed using one-way analysis of variance (<i>P</i> < .05).</p><p><strong>Results: </strong>A total of 25 cases were analyzed. The total operative time decreased significantly from 210 minutes in year 1 to 185 minutes in year 3 (<i>P</i> = .008). The expert surgeon's console time ratio decreased from 90.0% in year 1 to 14.5% in year 3 (<i>P</i> < .001), with a corresponding increase in non-expert surgeon's console time. A significant reduction in the number of instrument collisions (from 1457 in year 1 to 97 in year 3, <i>P</i> < .001) and a marked increase in motion efficiency (from 14% to 88%, <i>P</i> < .001) were observed for the non-expert surgeon. Phase-specific analysis revealed a steady improvement in the non-expert surgeon's performance across all phases.</p><p><strong>Conclusions: </strong>Robotic-assisted pyeloplasty significantly accelerates skill acquisition for non-expert surgeons, as evidenced by improvements in operative time, instrument collisions, and motion efficiency. The dual-console approach provides a valuable educational framework, facilitating real-time supervision and progressive task delegation. These findings support integrating dual-console systems and objective motion analysis into structured robotic training programs to enhance surgical proficiency and safety in pediatric surgery.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"926-930"},"PeriodicalIF":1.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraperitoneal Onlay Mesh Plus Repair Versus Transabdominal Preperitoneal Mesh Plus Repair in Patients with Primary Midline Ventral Hernia: A Prospective Randomized Controlled Study.","authors":"Varnik Goel, Devender Singh, Yashwant Rathore, Kamal Kataria, Sunil Chumber, Piyush Ranjan","doi":"10.1177/10926429261460683","DOIUrl":"10.1177/10926429261460683","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic intraperitoneal onlay mesh repair with defect closure (intraperitoneal onlay mesh repair with fascial defect [IPOM Plus]) is widely practiced for ventral hernia repair but remains associated with significant postoperative pain and intraperitoneal mesh-related complications. Transabdominal preperitoneal mesh repair with defect closure (vTAPP Plus) offers an anatomical, extraperitoneal alternative that may reduce postoperative pain along with reduced mesh-related complications. High-quality randomized evidence directly comparing these techniques is limited.</p><p><strong>Methods: </strong>This prospective, single-center, randomized controlled trial was conducted at a tertiary care institute. Adults with small-to-medium primary ventral hernias (2-4 cm) were randomized to undergo laparoscopic IPOM Plus or vTAPP Plus repair. The primary outcome was mean postoperative pain score (Visual Analogue Scale [VAS]) within the first 24 hours. Secondary outcomes included serial pain scores up to 6 months, operative duration, length of hospital stay, postoperative complications, and recurrence. Statistical analysis was performed using appropriate statistical tests.</p><p><strong>Results: </strong>In total, 68 patients were analyzed (IPOM Plus: <i>n</i> = 36; vTAPP Plus: <i>n</i> = 32). Baseline demographic and clinical variables were comparable between groups. vTAPP Plus demonstrated significantly lower postoperative pain at 6, 12, 24, and 48 hours, as well as at 14 and 30 days (<i>P</i> < .001). Differences diminished at 3 months and were not significant at 6 months. Operative time was marginally longer for vTAPP Plus, the hospital stay was significantly lower. Postoperative complication rates were comparable. No mesh infection or hernia recurrence was observed during follow-up.</p><p><strong>Conclusion: </strong>vTAPP Plus repair significantly reduces early and intermediate postoperative pain compared with IPOM Plus, without compromising safety or short-term efficacy. Thus, vTAPP Plus represents a better option for selected primary midline ventral hernias.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"872-880"},"PeriodicalIF":1.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Holmium Laser Enucleation of the Prostate Versus Robot-Assisted Simple Prostatectomy for Benign Prostatic Obstruction: A Systematic Review and Meta-Analysis with Trial Sequential Analysis.","authors":"Giulia Luiza Garcia, Bernardo Fontel Pompeu, Gabriel Leal Barone, Giovanna Barbaroto Pilon, Camila Tur de Arruda Ribeiro, Michel Azzem Goes, Claudia Theis, Leonardo Borges","doi":"10.1177/10926429261461101","DOIUrl":"10.1177/10926429261461101","url":null,"abstract":"<p><strong>Background: </strong>Holmium laser enucleation of the prostate (HoLEP) has emerged as an alternative for benign prostatic obstruction (BPO), with fewer perioperative and functional complications. However, its comparative performance relative to robot-assisted simple prostatectomy (RASP) remains debated, requiring updated evaluation.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of studies comparing HoLEP and RASP was performed using PubMed, Scopus, and Cochrane databases through August 2025. Outcomes were pooled using mean differences (MDs) and odds ratios (ORs) with random-effects models. Risk of bias assessment and trial sequential analysis were conducted to evaluate the robustness of evidence.</p><p><strong>Results: </strong>Thirteen studies, including 1993 patients, were analyzed. HoLEP was associated with shorter operative time (MD = -32.05 minutes), lower transfusion rates (OR = 0.34), fewer Clavien-Dindo grades III and IV complications (OR = 0.39), and earlier catheter removal (MD = -3.84 days). Postoperative International Prostate Symptom Score modestly favored RASP (MD = 0.96). No significant differences were observed in quality of life, maximum urinary flow rate, International Index of Erectile Function, prostate-specific antigen reduction, postvoid residual volume, estimated blood loss, specimen weight, hospital stay, minor complications, trifecta achievement, or postoperative urge and stress incontinence.</p><p><strong>Conclusion: </strong>HoLEP provides improved perioperative safety with largely comparable functional outcomes compared with RASP. Further high-quality comparative studies are needed to confirm long-term effectiveness.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"881-895"},"PeriodicalIF":1.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periarterial Divestment in Locally Advanced Pancreatic Cancer: Systematic Review and Single-Arm Meta-Analysis.","authors":"Philipe Franco do Amaral Tafner, Júlia Paiva Behs, Fernanda de Moraes Nava, Mateus Lima Ulisses Trindade, Claudia Theis, Sergio Mazzola Poli de Figueiredo, Leonardo Del Grande, Fábio Israel Lima Castelo Branco Marques, Alexsander Kuroiwa Bressan, Bernardo Fontel Pompeu","doi":"10.1177/10926429261458126","DOIUrl":"10.1177/10926429261458126","url":null,"abstract":"<p><strong>Background: </strong>Periarterial divestment has emerged as an artery-preserving alternative to formal arterial resection for borderline resectable and locally advanced pancreatic cancer. However, the available evidence remains limited. This study aimed to evaluate the perioperative and oncologic outcomes of periarterial divestment in pancreatic cancer.</p><p><strong>Methods: </strong>A systematic review was conducted using PubMed, Scopus, Web of Science, and the Cochrane Central Register to identify studies' data published up to March 2026. Continuous outcomes were pooled as means with 95% confidence intervals (CIs), and binary outcomes were pooled as proportions using random-effects models. Heterogeneity was assessed using the <i>I</i>² statistic and the Cochrane Q test. Sensitivity analyses were performed using leave-one-out methods. All analyses were conducted in R version 4.4.2.</p><p><strong>Results: </strong>Five retrospective observational studies comprising 474 patients were included, of whom 92.8% had locally advanced pancreatic cancer and 64.8% received neoadjuvant therapy. The pooled operative time was 333.0 minutes (95% CI: 232.6-433.4; <i>I² =</i> 99%), estimated blood loss was 620.6 mL (95% CI: 292.4-948.7; <i>I² =</i> 97%), and length of hospital stay was 12.4 days (95% CI: 9.1-15.6; <i>I² =</i> 99%). The pooled incidence of intraabdominal infection, postoperative pancreatic fistula, postpancreatectomy hemorrhage, delayed gastric emptying, reoperation, major complications (Clavien-Dindo grade ≥ III), and 90-day mortality was 10.57%, 8.72%, 8.56%, 14.13%, 3.36%, 11.27%, and 4.18%, respectively. The pooled rates of venous resection, arterial resection, and R0 resection were 36.18%, 3.56%, and 43.33%, respectively. The pooled 1-year and 3-year disease-free survival rates were 50.42% and 17.77%, respectively, while the corresponding overall survival rates were 75.99% and 29.11%.</p><p><strong>Conclusion: </strong>Periarterial divestment has been applied in selected patients, with reported perioperative and oncologic outcomes across studies. However, the current evidence remains descriptive and does not allow comparative inference.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"861-871"},"PeriodicalIF":1.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Side-to-Side Duodeno-Ileostomy with the MagDI System: A Technical Description of the Initial Experience in Argentina.","authors":"Mariano Palermo, Edgardo Serra, Facundo Serra, Mauricio Fuster, Guillermo Duza, Michel Gagner","doi":"10.1177/10926429261464826","DOIUrl":"10.1177/10926429261464826","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic complications remain the principal source of morbidity in metabolic and bariatric surgery. Bleeding, leakage, and stricture are most often related to the anastomosis itself and to the permanent hardware left behind by staplers and sutures. Magnetic compression anastomosis has been proposed as an incisionless, sutureless alternative that avoids retained foreign material.</p><p><strong>Objective: </strong>To describe the surgical technique for the creation of a side-to-side duodeno-ileal anastomosis using the Magnet Anastomosis System (MagDI) and to summarize early clinical outcomes.</p><p><strong>Technique: </strong>Two linear neodymium magnets are positioned on opposite intestinal walls-one in the proximal duodenum and one in the ileum, 250 cm from the ileocecal valve. The magnets self-align and apply sustained compression to the interposed tissue. Over the following weeks the entrapped tissue undergoes controlled necrosis, a patent anastomosis is formed, and the magnets detach and are eliminated through the gastrointestinal tract, leaving no retained material.</p><p><strong>Results: </strong>In early clinical experience, magnet placement and anastomotic patency were achieved in all cases, with no device-related leaks, obstructions, or deaths. When combined with sleeve gastrectomy, the procedure produced substantial weight loss and improvement of type 2 diabetes.</p><p><strong>Conclusion: </strong>Magnetic side-to-side duodeno-ileostomy is a feasible and reproducible technique that may reduce anastomotic morbidity in bariatric and metabolic surgery. Longer-term, larger studies are warranted to confirm durability.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"914-917"},"PeriodicalIF":1.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Management of Pediatric Noncommunicating Hydrocele: A Comparative Study of Hydrocelectomy Versus Aspiration.","authors":"Sung Ryul Lee, Yun Choi","doi":"10.1177/10926429261461807","DOIUrl":"10.1177/10926429261461807","url":null,"abstract":"<p><strong>Background: </strong>Pediatric noncommunicating hydrocele (NCH) requires surgical treatment when spontaneous resolution does not occur. Although communicating hydrocele is typically treated with high ligation alone, NCH traditionally requires hydrocelectomy with high ligation. Evidence comparing laparoscopic hydrocelectomy and simple aspiration in children remains limited.</p><p><strong>Methods: </strong>We retrospectively analyzed 2500 children under 10 years who underwent laparoscopic management for NCH between 2016 and 2024. Patients were categorized into scrotal hydrocele (SH) and encysted spermatic cord hydrocele (ESCH), and surgical methods were classified as hydrocelectomy or aspiration, both combined with high ligation. Operative outcomes and recurrence were compared between subtypes and surgical techniques.</p><p><strong>Results: </strong>Among 2500 patients (SH: 862; ESCH: 1638), ESCH had a significantly higher association with inguinal hernia (13.6% versus 9.2%; <i>P</i> < .001). Most patients underwent hydrocelectomy (<i>n</i> = 2449, 98%), while 51 (2%) underwent aspiration. Recurrence was markedly higher after aspiration than hydrocelectomy (5.9% versus 0.3%, <i>P</i> < .001). Complications were infrequent and comparable between groups.</p><p><strong>Conclusion: </strong>Laparoscopic hydrocelectomy with high ligation is a highly effective and safe treatment for pediatric NCH, with an exceptionally low recurrence rate. Aspiration showed inferior and inconsistent outcomes, suggesting that it should be reserved for very select cases. These findings support complete laparoscopic hydrocelectomy as the preferred minimally invasive technique for pediatric NCH.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"918-925"},"PeriodicalIF":1.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mesh Fixation Strategy and Recovery Trajectories after Unilateral Totally Extraperitoneal Inguinal Hernia Repair: A Defect-Size-Stratified Analysis.","authors":"Kanan Ismayilzada, Koray Topgul, Babek Tabandeh","doi":"10.1177/10926429261450042","DOIUrl":"10.1177/10926429261450042","url":null,"abstract":"<p><strong>Background: </strong>Mesh fixation strategy is a modifiable intraoperative factor that may influence postoperative recovery following totally extraperitoneal (TEP) inguinal hernia repair. Although self-fixating meshes were developed to avoid penetrating fixation and potentially reduce pain, their effect on multidimensional recovery trajectories remains unclear.</p><p><strong>Methods: </strong>This retrospective cohort study included consecutive adults undergoing elective unilateral TEP repair at a tertiary referral center. Patients were grouped according to fixation strategy: self-fixating mesh or polypropylene mesh secured with absorbable tacks. The primary outcome was early quality of recovery measured using the Quality of Recovery-15 (QoR-15) questionnaire at postoperative week 1. Secondary outcomes included longitudinal QoR-15 and visual analog scale (VAS) pain scores at postoperative months 1 and 3, analgesic consumption, and time to functional recovery. Recovery trajectories were analyzed using linear mixed-effects models, with additional stratification by defect size (<20 mm versus ≥20 mm).</p><p><strong>Results: </strong>A total of 134 patients were included (56 tack fixation, 78 self-fixating mesh). Early recovery at week 1 was comparable between groups. Mixed-effects modeling demonstrated significant improvement over time in both groups, without an independent association between fixation strategy and overall QoR-15 trajectory. However, in defects ≥20 mm, self-fixating mesh was associated with higher QoR-15 scores. Pain scores improved over time in both groups, with small but statistically significant differences favoring self-fixating mesh.</p><p><strong>Conclusions: </strong>In unilateral TEP repair, fixation strategy does not substantially influence overall early and short-term recovery. However, in larger defects (≥20 mm), self-fixating mesh may provide modest recovery advantages, suggesting a context-dependent rather than uniform effect.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"819-827"},"PeriodicalIF":1.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pleomorphic Implications in Gastrointestinal Stromal Tumors.","authors":"Lila Brody, Fatima Khambaty, Amanda Karatchoun, Parini Shah, Victor Nava","doi":"10.1177/10926429261473329","DOIUrl":"10.1177/10926429261473329","url":null,"abstract":"<p><p>Minimally invasive partial gastrectomies for incidentally identified gastrointestinal stromal tumors (GISTs) are increasingly more common, and most patients have an uneventful perioperative course. The surgical resection is not technically demanding, especially when a wedge resection is performed. Although the majority of relatively small- or intermediate-sized GISTs have low mitotic rates, postoperative surveillance intervals should be shorter for GISTs with higher mitotic rates. Although pleomorphism has not dictated metastatic potential, the addition of dedifferentiation may alter postoperative management. This perspective article details a patient with a pleomorphic gastric GIST that was successfully resected via a wedge resection. The pleomorphic lesion did not show dedifferentiation, so a longer surveillance interval was instituted. This case reaffirms that surgeons should actively review their patients' pathology results in conjunction with oncology, as subtle findings may alter patient surveillance.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"840-843"},"PeriodicalIF":1.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}