Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Single Anastomosis Sleeve Ileal Bypass Could Be the Future of Redo Surgery? A Single-Center Cohort Study.","authors":"Davide Moioli, Giovanni Cesana, Francesca Ciccarese, Matteo Uccelli, Adelinda Angela Giulia Zanoni, Riccardo Giorgi, Alberto Oldani, Marta Bonaldi, Carolina Rubicondo, Alessandro Delcarro, Yong Ha Lee, Stefano Olmi","doi":"10.1177/10926429261449962","DOIUrl":"10.1177/10926429261449962","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a leading global health challenge associated with increased morbidity and mortality from cardiovascular disease, type 2 diabetes, hypertension (HTN), and other metabolic comorbidities. Bariatric surgery is currently the most effective long-term treatment for severe obesity. However, 20-30% of patients may experience weight regain or unsatisfactory metabolic outcomes after primary surgery, requiring revisional (redo) procedures. The Single Anastomosis Sleeve Ileal Bypass (SASI) is an innovative bariatric technique, recently proposed as a redo option due to its favorable balance of restrictive and malabsorptive mechanisms and technical simplicity. SASI is still considered \"experimental\" in major international guidelines, and data on its efficacy as revisional surgery are limited.</p><p><strong>Methods: </strong>This retrospective study included 30 patients (mean age 50.8 ± 10.75 years) undergoing SASI after failed primary bariatric procedures (sleeve gastrectomy, gastric plication, Bariclip) between 2023 and 2024. Parameters analyzed included weight, body mass index (BMI), percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL), remission of type 2 diabetes (T2DM), HTN, obstructive sleep apnea (OSA), gastroesophageal reflux disease (GERD), surgical complications, nutritional status. Follow-up was conducted at 1, 6, and 12 months postoperatively.</p><p><strong>Results: </strong>Preoperatively, mean weight was 124 ± 29.1 kg and BMI 45.05 ± 5.4 kg/m². At 1, 6, and 12 months after SASI, mean BMI was 42.85 ± 7.69, 37.6 ± 6.3, and 32.7 ± 3.83 kg/m², respectively; mean weight was 113 ± 21.6, 99.25 ± 31.3, and 89.1 ± 18 kg. At 12 months, mean %EWL was 57.6 ± 19 and %TWL was 29.58 ± 8.16, exceeding standard benchmarks for bariatric success. Remission rates of T2DM, HTN, OSA and GERD all improved markedly, with nearly complete resolution of comorbidities at 12 months. No peri- or postoperative complications were observed. Considering the nutritional status at 12 months follow-up, no significant alterations were detected. In particular, we chose to analyze laboratory parameters such as serum albumin (3,7 ± 3), vitamin B12 (490 ± 250 pg/mL), folate (9 ± 6 ng/mL), iron (110 ± 32 ug/mL), ferritin (100 ± 35 ng/mL), and hemoglobin (12 ± 1,5).</p><p><strong>Conclusion: </strong>The SASI procedure demonstrated significant efficacy and safety as a revisional bariatric surgery, producing substantial weight loss, favorable metabolic improvement, and no surgical complications in this single-center cohort. These findings support the use of SASI as a valid option for redo bariatric procedures. Further prospective studies with larger cohorts and longer follow-up are needed to assess long-term results and nutritional outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"707-713"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935071","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":"Robotic Versus Laparoscopic Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: A Systematic Review and Comparative Meta-Analysis.","authors":"Thaís Henriques Abud, Maria Eduarda Caetano Batista de Paiva, Mateus Lima Ulisses Trindade, Camila Sigaud Frizzo, Lucas Monteiro Delgado, Claudia Theis, Sergio Mazzola Poli de Figueiredo, Fernanda Bellotti Formiga, Bernardo Fontel Pompeu","doi":"10.1177/10926429261485235","DOIUrl":"https://doi.org/10.1177/10926429261485235","url":null,"abstract":"<p><strong>Background: </strong>Ileal pouch-anal anastomosis (IPAA) is the standard restorative procedure for patients with ulcerative colitis requiring colectomy. Although robotic-assisted surgery has gained increasing acceptance in colorectal surgery, its role in IPAA remains uncertain.</p><p><strong>Methods: </strong>A systematic search was conducted across PubMed, Scopus, and the Cochrane Central Register of Controlled Trials up to May 2026. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the <i>I</i>² statistic. Sensitivity analyses were conducted to analyze outcomes with moderate or substantial heterogeneity.</p><p><strong>Results: </strong>Six comparative observational studies involving 946 patients were included; 460 underwent robotic-assisted IPAA, and 486 underwent laparoscopic IPAA. No significant differences were observed between approaches regarding anastomotic leak (OR: 0.69; 95% CI: 0.37 to 1.28; <i>P</i> = .234), bleeding (OR: 0.59; 95% CI: 0.21 to 1.64; <i>P</i> = .309), Clavien-Dindo grade III or higher complications (OR: 1.17; 95% CI: 0.57 to 2.41; <i>P</i> = .670), conversion to open surgery (OR: 0.46; 95% CI: 0.16 to 1.34; <i>P</i> = .156), postoperative ileus (OR: 1.11; 95% CI: 0.65 to 1.91; <i>P</i> = .705), overall morbidity (OR: 1.17; 95% CI: 0.84 to 1.63; <i>P</i> = .361), reoperation (OR: 1.06; 95% CI: 0.27 to 4.19; <i>P</i> = .933), or 30-day readmission (OR: 0.83; 95% CI: 0.59 to 1.17; <i>P</i> = .278). Likewise, no significant differences were identified in operative time (MD 26.3 minutes; 95% CI: -1.9 to 54.4; <i>P</i> = .07) or hospital stay (MD -0.5 days; 95% CI: -1.5 to 0.5; <i>P</i> = .34). Sensitivity analyses did not materially alter the direction or statistical significance of the pooled estimates despite moderate to high heterogeneity in selected outcomes.</p><p><strong>Conclusion: </strong>Available observational evidence suggests that robotic-assisted IPAA yields short-term outcomes comparable to those of laparoscopic IPAA; however, the certainty of evidence is very low, and definitive conclusions are constrained by the observational nature of the available data.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261485235"},"PeriodicalIF":1.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892803","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":"A Task-Specific Performance Rating Scale for Laparoscopic Intracorporeal Suturing and Knot Tying: Development and Initial Evaluation.","authors":"Xiang Xia, Zihan Zhou, Yihong Lu, Zhengqian Bian, Qiushi Tang, Zizhen Zhang","doi":"10.1177/10926429261486295","DOIUrl":"https://doi.org/10.1177/10926429261486295","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic intracorporeal suturing and knot tying is a core minimally invasive surgical skill, but generic global rating instruments may not identify the task-specific technical errors needed for targeted feedback. We developed an 8-item performance rating scale for a standardized simulator task and evaluated its measurement properties.</p><p><strong>Methods: </strong>In a cross-sectional cohort, 82 participants across 5 training levels completed 1 interrupted laparoscopic suture consisting of 1 needle pass, 3 intracorporeal knots, and final cutting. Deidentified videos were independently scored by 3 raters. Interrater reliability was estimated using 2-way random effects, absolute-agreement intraclass correlation coefficients (ICCs). Between-level performance was assessed using Kruskal-Wallis tests, Holm-adjusted pairwise comparisons, and Spearman correlation. Twelve learners completed the task before and after standardized training.</p><p><strong>Results: </strong>Quality scores differed across training levels (<i>P</i> < .001) and correlated strongly with level (Spearman rho = 0.872, <i>P</i> < .001). Completion time decreased with level (rho = -0.897, <i>P</i> < .001). Total-score reliability was excellent (ICC[2,1] = 0.960; ICC[2,3] = 0.986). After training, mean quality score increased by 5.83 points, and completion time decreased by 29.17 seconds (both <i>P</i> < .001).</p><p><strong>Conclusions: </strong>The scale provides a reliable, reproducible method for video-based assessment of laparoscopic intracorporeal suturing and knot-tying performance. Its principal current use is to differentiate novice and early-stage operators and to track progress during simulator-based practice. More demanding tasks and multicenter evaluation are needed before use for advanced proficiency decisions.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261486295"},"PeriodicalIF":1.1,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889085","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":"Beyond HbA1c: Multivariate Clustering and Propensity-Weighted Analysis Identify High-Risk Patients with Diabetes Undergoing Bariatric Surgery.","authors":"Fathima Ruba Shamnad, Juan S Barajas-Gamboa, Alfredo D Guerron, Javed Raza, Juan Pablo Pantoja, Juan Cruz Lopez Meyer, Safa Botros Hegazin, Cynthia Salloum, Carlos Abril, John Rodriguez","doi":"10.1177/10926429261486261","DOIUrl":"https://doi.org/10.1177/10926429261486261","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative glycemic control is a key concern in bariatric surgery. However, the extent to which suboptimal HbA1c levels impact short-term postoperative morbidity remains uncertain. This study evaluated the association between preoperative HbA1c categories and 30-day postoperative morbidity in a large Middle Eastern bariatric surgery cohort, using propensity score weighting and unsupervised clustering to refine risk stratification.</p><p><strong>Methods: </strong>This retrospective cohort analysis included 1778 bariatric surgery patients operated between 2019 and 2024 at a tertiary referral center in the United Arab Emirates. Patients were stratified into two groups: controlled HbA1c (≤6.5%, <i>n</i> = 1557) and elevated HbA1c (>6.5%, <i>n</i> = 221). Baseline demographics, perioperative parameters, and 30-day outcomes were extracted from a prospectively maintained registry. Statistical analysis included inverse probability weighting using propensity scores to adjust for age, BMI, and sex. Principal component analysis (PCA) followed by K-means clustering was performed on age and HbA1c to identify multivariate patient subgroups. Both unweighted and weighted analyses were performed.</p><p><strong>Results: </strong>Elevated HbA1c patients were older than those with controlled HbA1c (43.2 ± 12.1 versus 34.6 ± 10.8 years, <i>P</i> < .001 unweighted; 43.2 ± 12.1 versus 42.1 ± 12.0 years, <i>P</i> = .364 weighted). BMI was modestly higher in the elevated group but not significant after weighting. Thirty-day complication rates were low across all groups. The highest risk was observed in patients >60 years with diabetes (8.1%), while patients ≤20 years had negligible complications. In adults 21-60 years, complication rates increased modestly with HbA1c (normal 3.9%-5.3%, prediabetes 3.9%-6.3%, diabetes 6.5%-8.6%). No deaths occurred. Other complications, including deep/organ-space SSI, pneumonia, pulmonary embolism, renal failure, myocardial infarction, transfusion, gastrointestinal bleeding, readmission, and reoperation, were rare and showed no significant differences across HbA1c strata (all <i>P</i> > .05).</p><p><strong>Conclusion: </strong>Elevated HbA1c was not an independent predictor of short-term morbidity after bariatric surgery. PCA-cluster analysis identified a distinct high-risk subgroup: older diabetic patients, who demonstrated the greatest vulnerability to short-term complications. These findings suggest that perioperative risk assessment should move beyond HbA1c cutoffs alone and incorporate multivariate patient profiling to guide individualized care.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261486261"},"PeriodicalIF":1.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882144","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":"Clinical Outcomes of Magnesium-Based Balloon-Expandable Biodegradable Stenting for Benign Biliary Strictures: A Single-Center Retrospective Cohort Study.","authors":"Mariano Eduardo Giménez, Chiara Innocenzi, Ignacio Corteggiano, Juliana Maria Racedo, Lucas Fehlauer, Samantha Robert, Pablo Acquafresca, Eduardo Houghton, Mariano Palermo","doi":"10.1177/10926429261486279","DOIUrl":"https://doi.org/10.1177/10926429261486279","url":null,"abstract":"<p><strong>Background: </strong>Benign biliary strictures, most commonly anastomotic after hepaticojejunostomy or related to bile duct injury, are conventionally managed with balloon dilation, multiple plastic stents, or covered metal stents, all of which typically require repeated procedures. Magnesium-based balloon-expandable biodegradable stents (UNITY-B) have been proposed as a single-step alternative, but dedicated cohort data are limited.</p><p><strong>Methods: </strong>We retrospectively reviewed 22 consecutive UNITY-B stent-placement procedures performed in 21 patients with benign biliary strictures at a single center (April 2024-February 2026). The primary endpoint, clinical success (freedom from stricture recurrence during follow-up), was estimated using the Kaplan-Meier method at the patient level (<i>n</i> = 21), with a procedure-level sensitivity analysis (<i>n</i> = 22) and a competing-risks sensitivity analysis (Aalen-Johansen estimator) accounting for two unrelated deaths. Technical success and stent-related complications, assessed within 30 days after stent placement, were evaluated at the procedure level.</p><p><strong>Results: </strong>Median age was 58.0 years (interquartile range 51.0-70.0); 76.2% of strictures were anastomotic at a hepaticojejunostomy. Technical success was achieved in 22/22 procedures (100%), with no stent-related complications within 30 days. Stricture recurrence occurred in 6/21 patients (28.6%) at a median of 7.0 months; all underwent reintervention. Kaplan-Meier freedom from recurrence was 90.5% (95% CI 67.0-97.5%) at 6 months and 66.0% (95% CI 38.7-83.3%) at 12 months. Two deaths, unrelated to the procedure, occurred during follow-up.</p><p><strong>Conclusions: </strong>In this small, retrospective, single-arm cohort, magnesium-based balloon-expandable biodegradable biliary stenting was technically feasible, with no stent-related complications observed within 30 days after stent placement, and freedom from recurrence in approximately two-thirds of patients at 1 year. These findings are hypothesis-generating; prospective comparative studies with longer follow-up are needed before this approach can be positioned relative to established alternatives.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261486279"},"PeriodicalIF":1.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882262","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":"Surgical Efficacy of Robotic Adrenalectomy: Korean Nationwide Comparative Data Analysis Focusing on Robotic Modality, Surgical Approach, and Tumor Characteristics.","authors":"Jae-Wook Chung, Kisoo Lee, Taek Sang Kim, Dongho Shin, Ho Seok Chung, Tae Gyun Kwon, Young Hwii Ko, Wansuk Kim","doi":"10.1177/10926429251411372","DOIUrl":"10.1177/10926429251411372","url":null,"abstract":"<p><strong>Purpose: </strong>Despite insufficient evidence of safety, single-port robotic surgery is becoming increasingly popular. This retrospective study compared the surgical efficacy of single-port robotic adrenalectomy (RA) and conventional multi-port RA.</p><p><strong>Materials and methods: </strong>Data were collected from 303 patients who underwent RA across seven centers from January 2018 to June 2024.</p><p><strong>Results: </strong>The mean age of the patients was 51.6 ± 12.8 years, and 41.3% (125/303) of them were male. Left-sided adrenal tumors were present in 58.1% (176/303) of the patients. Clinical tumor size was 3.5 ± 2.0 cm. Robotic partial adrenalectomy, retroperitoneal, and single-port RAs were performed in 96 (31.7%), 57 (18.8%), and 42 (13.9%) patients, respectively. A Jackson-Pratt drain was not inserted in 69 cases (22.8%), and hospital stay was 4.3 ± 1.7 days. Given the different patient selection criteria for multi-port and single-port RAs, propensity score matching (PSM) was conducted according to the laterality of the procedure, tumor size, and tumor characteristics. After PSM, intraoperative and postoperative (≥30 days) complication rates were not different between the multi-port and single-port RA groups. The incidence of complications was not significantly different between the two groups when the tumor size was stratified as 4 cm (2.0% versus 3.7%). Multivariate logistic regression analysis revealed that the surgical method (multi-port versus single-port) was not associated with perioperative complications. Instead, it depended on whether the tumor was a cortical carcinoma or a pheochromocytoma.</p><p><strong>Conclusion: </strong>Both multi- and single-port RAs are safe. In certain patients, single-port RA can be an alternative surgical option.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"671-676"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718872","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":"The Role of Artificial Intelligence Large Language Models in Literature Search Assistance to Evaluate the Impact of Smoking Inguinal and Ventral Hernia Repairs: A Post-Hoc Analysis.","authors":"Joao Pedro Kasakewitch, Marina Eguchi, Victor Perim, Gabriele Eckerdt Lech, Carlos Balthazar, Raquel Nogueira, Flavio Malcher, Diego L Lima","doi":"10.1177/10926429251393122","DOIUrl":"10.1177/10926429251393122","url":null,"abstract":"<p><strong>Background: </strong>Smoking is associated with higher complication and recurrence rates in ventral and inguinal hernia repairs, but evidence is fragmented. This study evaluated the efficacy of AI-based large language models (LLMs) for identifying literature on the impact of smoking on hernia repairs.</p><p><strong>Methods: </strong>ChatGPT 4.0, ChatGPT 4o, Microsoft Copilot, and Google Gemini were instructed to search PubMed, Embase, and Scopus for retrospective/prospective studies and randomized controlled trials regarding smoking's effects on ventral and inguinal hernia repairs. The models' outputs were cross-checked against previous systematic reviews to assess accuracy.</p><p><strong>Results: </strong>The artificial intelligence (AI) tools generated 24 citations, of which only nine (37.5%) proved valid and relevant. Thirteen (54.2%) were fabricated references, and two (8.3%) cited studies that did not match the specified criteria. Additionally, the AIs identified two studies missed by previous systematic reviews but overlooked 35 (79.5%) recognized by those reviews.</p><p><strong>Conclusions: </strong>Although LLMs can quickly compile potentially relevant references, they are prone to fabricating or omitting crucial studies. Human verification remains essential for conducting reliable, comprehensive literature searches in systematic reviews and meta-analyses.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"664-670"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490810","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":"Safety and Outcomes of Surgical Resection in Primary Tracheal Tumors: A Single-Center Experience.","authors":"Mustafa Vedat Doğru, Umut Kilimci, Gizem Özçıbık Işık, Oğuzhan Bayraktar, Efsun Gonca Uğur Chousein, Mehmet Akif Özgül, Merih Dilan Albayrak, Mehmet Ali Bedirhan, Celal Buğra Sezen, Özkan Saydam","doi":"10.1177/10926429261449960","DOIUrl":"10.1177/10926429261449960","url":null,"abstract":"<p><strong>Introduction: </strong>Primary tracheal tumors are rare pathologies that pose significant diagnostic and therapeutic challenges due to their low incidence, nonspecific symptoms, and technical complexity of surgical management. This study aimed to evaluate the clinical characteristics, surgical outcomes, and oncological results of patients treated for primary tracheal tumors at a single experienced center.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of patients who underwent surgical treatment for primary tracheal tumors between October 2010 and October 2025. Patients treated for tracheal stenosis or managed with nonsurgical modalities alone were excluded. Demographic data, tumor characteristics, surgical approaches, perioperative outcomes, pathological findings, adjuvant treatments, and survival data were analyzed.</p><p><strong>Results: </strong>Nineteen patients (63.2% female, 36.8% male) with a mean age of 58.4 years were included. Surgical approach was individualized according to tumor localization and consisted of collar incision, collar incision combined with partial sternotomy, thoracotomy, or video-assisted thoracoscopic surgery. No difference was seen in the means of complication, survival, operation time, or length of hospital stay between continuous or interrupted sutures with PDS or polypropylene materials. Postoperative complications occurred in three patients (15.8%), including wound infection in two patients and anastomotic dehiscence complicated by pneumonia in one patient, which resulted in postoperative mortality. Malignant pathology was identified in 84.2% of patients, and selected cases with tumor-positive surgical margins received adjuvant radiotherapy. No tumor recurrence was observed, and 89.5% of patients were alive at the end of follow-up. Mean overall survival was 157.7 months.</p><p><strong>Conclusions: </strong>In the management of primary tracheal tumors, early diagnosis, appropriate patient selection, surgical treatment performed in experienced centers, and the use of a multimodal treatment approach when indicated constitute the key determinants of successful oncological and functional outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"677-681"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857485","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":"Surgical Management of Pediatric Superior Mesenteric Artery Syndrome: A Single Institution Continued Experience.","authors":"Seth A Saylors, Shawn D St Peter","doi":"10.1177/10926429261450553","DOIUrl":"10.1177/10926429261450553","url":null,"abstract":"<p><strong>Introduction: </strong>Superior mesenteric artery syndrome (SMAS) is an uncommon cause of abdominal pain, emesis, and weight loss in children. While there are many surgical options, we previously reported a small series of laparoscopic duodenal lowering (DL), which became our standard first approach. Here, we report our expanded experience on the surgical management of patients with SMAS.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of patients who underwent surgical management of SMAS between January 2008 and December 2023 at our institution.</p><p><strong>Results: </strong>22 patients underwent surgical management for SMAS during this study period. The majority of patients were female (<i>n</i> = 19, 86%), and median age at time of surgery was 17 years (interquartile ranges: 16.0, 18.4). The median measured aorto-SMA angle was 16° (12, 20), with 3 patients having an aorto-SMA angle as narrow as 10°. Twenty patients underwent laparoscopic DL, and 2 patients underwent laparoscopic duodenojejunostomy, as they had previously undergone surgical procedures for SMAS at another institution (open duodenal de-rotation, open DL, and median arcuate ligament release). Of the 20 patients who underwent DL, 12 patients (60%) had resolution of their symptoms. Two of these patients had recurrence of symptoms within 6 months and underwent subsequent LDJ. Of the 8 patients without improvement after DL, 2 underwent subsequent LDJ with improvement of symptoms. The median follow-up for all patients was 51 days (33, 321). In both univariate and multivariate statistical analyses, having a diagnosis of Ehlers-Danlos syndrome was predictive of failure to achieve symptom resolution after DL (<i>P</i> = .004). No other clinical or demographic characteristics were found to be predictive of successful resolution of symptoms from surgery.</p><p><strong>Conclusions: </strong>Patients with SMAS are a complex population. The more conservative DL can be an efficacious first step when approaching surgical management of SMAS. Future investigation is warranted to characterize which patients are more likely to fail operative intervention or require repeat operations.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"691-695"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943728","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":"Construction of an Intelligent Decision-Making Model for Laparoscopic Common Bile Duct Repair.","authors":"Xuhao Wang, Yuesheng Sun, Xiaomin Xu, Min Li, Lidan Gao, Yiren Hu, Wenhuan Wang","doi":"10.1177/10926429261427263","DOIUrl":"10.1177/10926429261427263","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to develop a machine learning-based decision-support model to assist surgeons in intraoperatively selecting the optimal repair strategy (primary duct closure [PDC] versus T-tube drainage [TTD]) following laparoscopic common bile duct exploration (LCBDE).</p><p><strong>Methods: </strong>Clinical data from 117 patients with common bile duct stones (CBDS) who underwent LCBDE were retrospectively analyzed. Patients were categorized into PDC (<i>n</i> = 66) and TTD (<i>n</i> = 51) groups. After baseline comparison using SPSS, the dataset was standardized and split. Feature selection was performed using SelectKBest, Recursive Feature Elimination (RFE), and RFE with Cross-Validation (RFECV). Several machine learning classifiers were trained and evaluated based on accuracy, F1 score, precision, recall, and the area under the ROC curve (AUC).</p><p><strong>Results: </strong>Baseline characteristics were similar between groups, except for higher total protein and more frequent purulent bile in the TTD group. RFE identified five optimal predictive features: age, white blood cells, C-reactive protein, total protein, and albumin. The Random Forest classifier, combined with RFE feature selection, demonstrated the best predictive performance, achieving an AUC of 0.83, an accuracy of 0.72, a precision of 0.87, and a recall of 0.62.</p><p><strong>Conclusion: </strong>We successfully constructed an intelligent decision-making model for laparoscopic bile duct repair. Utilizing RFE and Random Forest, the model identifies key clinical features to provide personalized surgical recommendations, which may enhance precision treatment for patients with CBDS.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"682-690"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576120","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}