Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"SADI-S Versus Distal OATB (SASI): Does the Duodenal Pathway Matter in Ileal-Level Single-Anastomosis Surgery?","authors":"Patrick Noel, Carlos Augusto Scussel Madalosso, Paulo Reis Rizzo Esselin de Melo, Sergio Santoro, Moises Jacobs, Nilton T Kawahara, Victor Ramos Mussa Dib","doi":"10.1177/10926429261449961","DOIUrl":"https://doi.org/10.1177/10926429261449961","url":null,"abstract":"<p><strong>Background: </strong>Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SG) (SADI-S) and distal one anastomosis transit bipartition (dOATB) represent two distal single-anastomosis metabolic procedures sharing similar anatomical configurations but differing fundamentally in their approach to duodenal transit. Both combine SG with an omega-loop anastomosis to the distal ileum approximately 250-300 cm from the ileocecal valve. However, SADI-S positions the anastomosis on the duodenal bulb, achieving complete duodenal exclusion, while dOATB performs a prepyloric antral anastomosis, preserving duodenal transit through a bipartition mechanism. This fundamental difference raises a critical question: Does complete duodenal exclusion matter for metabolic outcomes in distal intestinal procedures?</p><p><strong>Methods: </strong>We conducted a narrative review comparing anatomical, physiological, and clinical aspects of SADI-S and dOATB, emphasizing the role of duodenal exclusion in weight loss (WL), metabolic improvements, and nutritional consequences. We examined the hypotheses to provide a theoretical framework for understanding these procedures.</p><p><strong>Results: </strong>Both procedures demonstrate excellent WL, with total WL ranging from 35% to 45% and excess WL exceeding 80% at medium-term follow-up. Type 2 diabetes remission rates are remarkably high in both groups (85%-95%). SADI-S has a more extensive evidence base with longer follow-up and IFSO and ASMBS endorsement. Distal OATB, while demonstrating comparable metabolic efficacy, offers theoretical advantages in nutritional preservation through maintained duodenal transit and facilitated endoscopic access to the biliopancreatic system. The holoileum hypothesis suggests that adequate ileal stimulation through an elongated common channel may be more important than duodenal exclusion <i>per se</i>.</p><p><strong>Conclusions: </strong>Current evidence suggests that excellent metabolic outcomes can be achieved with distal single-anastomosis procedures regardless of duodenal exclusion status. The elongated common channel and ileal stimulation appear to be the critical determinants of metabolic success. Distal OATB may offer advantages in nutritional preservation and endoscopic accessibility while maintaining comparable metabolic efficacy. Prospective randomized trials directly comparing these procedures are warranted.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261449961"},"PeriodicalIF":1.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845449","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":"Initial Clinical Experience and Technical Insights in Single-Port Robotic Gastrectomy: A Consecutive Case Series Report.","authors":"Chang Eon Lim, Jae Hun Chung, Dongwon Lim, Si-Hak Lee, Dae Gon Ryu, Su Jin Kim, Cheol Woong Choi, Sun-Hwi Hwang","doi":"10.1177/10926429261427346","DOIUrl":"10.1177/10926429261427346","url":null,"abstract":"<p><strong>Background: </strong>Single-port (SP) robotic gastrectomy (SPRG) using the da Vinci SP system is an emerging minimally invasive technique, but evidence regarding its safety and feasibility remains limited. This study reports early clinical outcomes and technical insights from a consecutive series of single-port robotic distal gastrectomy (spRDG) for gastric cancer.</p><p><strong>Methods: </strong>Nine patients with resectable gastric cancer underwent spRDG using a subumbilical vertical approach with a single 25-mm SP port and a plus-one assistant port. Lymphadenectomy (LND) (D1 + or D2) followed Korean Gastric Cancer Association (KGCA) guidelines, and intracorporeal Billroth I, Billroth II, or Roux-en-Y reconstruction was performed. A standardized postoperative pathway was used. Perioperative variables, pathology, and textbook outcomes (TO) were assessed.</p><p><strong>Results: </strong>All procedures were completed without conversion. Median operative time was 265 minutes (range, 181-390), console time 220 minutes (166-330), and estimated blood loss 30 mL (20-50). Intracorporeal reconstruction was successful in all patients. Six patients received D1 + dissection, and 3 received D2. R0 resection was obtained in all cases, with a mean of 30.2 retrieved lymph nodes and no metastatic nodes. TO was achieved in 8 patients (88.9%). The single TO failure occurred in a patient with a recent transurethral prostatectomy, who developed persistent hematuria requiring urologic care and prolonged hospitalization.</p><p><strong>Conclusions: </strong>Early experience demonstrates that spRDG is feasible, safe, and oncologically adequate in appropriately selected patients. Successful implementation requires familiarity with platform-specific ergonomics and workflow. Until supported by larger studies, indications should remain focused on distal gastrectomy requiring D1 + LND.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"390-396"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437112","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":"3D Laparoscopic Radical Prostatectomy: The Romolo Hospital Experience.","authors":"Jacopo Lauria, Giulio Zappalà, Flavio Calogero Sidoti, Gianluca Scarpelli, Antonio Greco, Vincenzo Andracchio, Francesco Chiaradia, Alberto Piana, Stefano Alba","doi":"10.1177/10926429261422298","DOIUrl":"10.1177/10926429261422298","url":null,"abstract":"<p><strong>Objective: </strong>To describe a standardized surgical approach for 3D transperitoneal laparoscopic radical prostatectomy (3D T-LRP) performed in a single high-volume surgical center and to assess its impact on early urinary continence, erectile function, oncological outcomes, and overall safety.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 360 patients with clinically localized prostate cancer (cT1-T2, N0, and M0) who underwent 3D T-LRP at Romolo Hospital (Italy) between January 2018 and December 2022. Procedures were performed by two experienced surgical teams with standardized operative protocols. All patients followed a structured pelvic floor rehabilitation protocol initiated immediately after catheter removal. Perioperative variables, functional outcomes (continence and erectile function), oncological parameters, and complications were prospectively recorde.d in an institutional database and retrospectively analyzed.</p><p><strong>Results: </strong>The median operative time was 180 minutes (interquartile range [IQR]: 150-210), with pelvic lymph node dissection performed in 44.2% of cases. Positive surgical margins were observed in 15% of patients. Continence (defined as 0-1 pad/day) was achieved in 75.8% at 1 week, 83.4% at 3 months, and 92.5% at 6-12 months post-catheter removal. The median pad weight decreased from 350 g at T0 to 50 g at T1. In the nerve-sparing subgroup, the median IIEF-5 score at 6-12 months was 18 (IQR: 16-20), with 83% achieving a score ≥16. The postoperative complication rate was 10.3%, with no Clavien-Dindo grade ≥IIIb events.</p><p><strong>Conclusion: </strong>3D T-LRP performed with a standardized technique by experienced teams and followed by immediate pelvic floor rehabilitation yielded encouraging results in terms of early continence, erectile function, oncological safety, and low morbidity. These outcomes support 3D-LRP as a technically effective and economically sustainable minimally invasive alternative to robotic surgery.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"341-349"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327945","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 Use of Sugammadex for Neuromuscular Blockade Reversal after Inguinal Hernia Repair: A Systematic Review and Meta-Analysis.","authors":"Ana Caroline D Rasador, Júlia Burmann, Camila Barros, Júlia Kasmirski, Natália P Pascotini, Diego L Lima, Maggie E Bosley, Vahagn Nikolian","doi":"10.1177/10926429261421065","DOIUrl":"10.1177/10926429261421065","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative urinary retention (POUR) is a common complication following inguinal hernia repair (IHR), and it can be influenced by the type of neuromuscular blockade reversal medication used, especially acetylcholinesterase inhibitors. Among the available options for neuromuscular blockade reversal, Sugammadex has gained significant popularity due to its effectiveness, speed, and safety profile. Additionally, some studies suggest that it prevents POUR compared to acetylcholinesterase inhibitors. We aimed to perform a systematic review and meta-analysis to assess the POUR rates with the use of Sugammadex after IHR.</p><p><strong>Methods: </strong>PubMed, EMBASE, Cochrane, LILACS, and Web of Science databases were systematically searched without date or language restrictions from inception to October 2024. The databases were searched for studies comparing Sugammadex with other medications for neuromuscular blockade reversal after IHR. The primary outcome was POUR.</p><p><strong>Results: </strong>From 212 records, 3 retrospective cohort studies and 1 clinical trial were included in our pooled analysis, totaling 1390 patients. 573 (41.2%) patients were in the Sugammadex group, compared to 817 (58.8%) patients in the non-Sugammadex group. 135 (9.7%) patients underwent open IHR, compared to 468 (33.6%) patients who underwent minimally invasive repairs. Our meta-analysis revealed that the use of Sugammadex was associated with a significantly lower risk of POUR compared to other medications (RR 0.11; 95% CI 0.05, 0.28; <i>P</i> < .001), with a relative risk reduction of 89%.</p><p><strong>Conclusion: </strong>Sugammadex is associated with a significantly lower risk of POUR following IHR when compared to other medications for neuromuscular blockade reversal following IHR. Despite its higher cost and decreased availability in some centers, the use of Sugammadex should be strongly considered as the preferred option to prevent POUR and minimize the need for hospital readmissions.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"360-366"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327948","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 Impact of Operative Timing on Postoperative Complications in Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis: A Retrospective Cohort Study.","authors":"Hilmi Bozkurt, Melih Taşkın, Cumhur Özcan, Tahsin Çolak","doi":"10.1177/10926429261428956","DOIUrl":"10.1177/10926429261428956","url":null,"abstract":"<p><strong>Background: </strong>Acute appendicitis (AA) is one of the most common surgical conditions presenting as acute abdomen. Delaying appendectomy can increase the risk of perforation. However, patients admitted or treated at night have been found to have higher complication rates compared to those treated during the daytime. This study aims to investigate whether the time of day of laparoscopic appendectomy for AA has a significant effect on morbidity and mortality rates.</p><p><strong>Materials and methods: </strong>Patients over 18 years of age who underwent laparoscopic appendectomy for uncomplicated AA at the General Surgery Clinic of Mersin University Hospital between 01.01.2020 and 31.12.2024 were retrospectively reviewed. Patients were analyzed according to age, gender, comorbidities, medication use, operative time, duration of pain, need for postoperative intensive care, preoperative laboratory values, time of diagnosis, postoperative complications, and time of surgery, categorized as daytime (08:00-17:00) and nighttime (17:00-08:00). Postoperative complications were compared between patients operated on during daytime and nighttime.</p><p><strong>Results: </strong>The study was completed with a total of 172 patients. The mean age was 32 (range 18-86). Of the patients, 100 (58.1%) were male. The time of diagnosis was during the day for 78 (45.3%) patients. Based on the time of surgery, 103 (59.9%) were performed during the daytime and 69 (40.1%) at nighttime. Univariate analyses found no statistically significant relationship between postoperative complications and the time of operation.</p><p><strong>Conclusion: </strong>Our study showed that in patients undergoing laparoscopic appendectomy for uncomplicated appendicitis, surgery performed during daytime or nighttime hours yielded similar results in terms of complications.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"372-375"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437067","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":"Critical View of Safety in Laparoscopic Cholecystectomy: Prospective Evaluation Using Doublet Photography.","authors":"Probal Neogi, Suyash Sharma, Krishna Singh, Vishal Kewlani, Pankaj Kumar","doi":"10.1177/10926429261430299","DOIUrl":"10.1177/10926429261430299","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to see the percentage of achievability of Critical View of Safety (CVS), using a doublet photograph technique in a tertiary care center, and identify factors beyond the surgeon in terms of the gender, age, socioeconomic status, and pathology of the disease.</p><p><strong>Methods: </strong>This prospective observational study analyzed 356 laparoscopic cholecystectomy cases performed by 2 experienced surgeons (>500 cases). A validated scoring system assessed three CVS criteria: identification of two structures connected to the gallbladder, the cystic plate, and hepatocytic triangle clearance. CVS was deemed satisfactory with a mean score ≥5.0, evaluated intraoperatively by the surgeon and independently scored by another. Patients' socioeconomic status was measured by the modified Kuppuswamy scale, and intraoperative findings were correlated with CVS attainment.</p><p><strong>Results: </strong>The CVS was attained in 56.64% of cases. Socioeconomic status showed a weak association with CVS achievement (Cramér's V = 0.155, <i>P</i> = .073), with lower-class patients disproportionately represented in the \"No CVS\" group (residual = 1.73). Intraoperative factors significantly impacted CVS attainment, with short cystic ducts, large stones at the neck, and severe adhesions reducing success rates. Acute cholecystitis (β = -1.40, <i>P</i> < .001) and empyema (β = -1.66, <i>P</i> < .001) negatively impacted CVS, while blue/dull gallbladder (β = + 1.10) improved it.</p><p><strong>Conclusion: </strong>The attainability of the CVS using the doublet photograph technique is low, with satisfactory CVS achieved in only slightly more than half of cases. Despite experienced surgeons, patient-related factors and intraoperative difficulties-particularly acute cholecystitis, empyema, and severe adhesions-significantly limited CVS attainment. These findings indicate that the doublet photograph technique alone is insufficient to reliably ensure CVS, emphasizing the need for early intervention and adjunctive safety strategies during difficult cholecystectomies.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"384-389"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391158","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":"Gastrojejunostomy Tube Placement in Pediatric Patients: A Comparison of Staged Versus Primary Techniques and Associated Outcomes.","authors":"Sage A Vincent, Emily C Meneses, Alexandra Barone-Camp, Shannon N Acker, Jose Diaz-Miron","doi":"10.1177/10926429261427701","DOIUrl":"10.1177/10926429261427701","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric gastrojejunostomy tube (GJT) placement can be done staged (sGJT), with gastrostomy tube (GT) placement and later exchange for GJT, or in a single procedural setting, referred to as primary GJT (pGJT). Here, we compare procedural metrics and outcomes for sGJT versus pGJT placement.</p><p><strong>Methods: </strong>A retrospective cohort study of pediatric patients undergoing GJT placement between 2014 and 2024 categorized patients as pGJT, planned sGJT (GT with documented plan for GJT conversion) or delayed GJT (GT with gastric feed trials and later conversion to GJT within 12 months). Generalized linear regressions assessed associations between GJT placement modality and outcomes of interest.</p><p><strong>Results: </strong>There were 90 patients who underwent GJT placement (30 pGJT, 29 planned sGJT, 31 delayed sGJT). pGJT had 76% longer procedure time than delayed sGJT (<i>P</i> < .001). Delayed sGJT had 6.8 and 8.0 times greater radiation exposure than planned sGJT and pGJT, respectively (<i>P</i> = .009). Intraoperative visceral perforation occurred in 3 out of 90 patients (pGJT <i>n</i> = 2, planned sGJT <i>n</i> = 1, <i>P</i> = .422). Hospital length of stay (LOS) was at least 1.5 times greater in patients undergoing sGJT placement (incidence rate ratio = 1.54 for delayed and 2.28 for planned, both <i>P</i> < .001). Rate of jejunal limb retrograde migration was higher in patients undergoing pGJT. Overall, 77.8% of patients undergoing GJT experienced any complication within 1 year, but only 1.1% of patients experienced a major complication requiring reoperation.</p><p><strong>Conclusions: </strong>Pediatric pGJT is associated with longer procedure time, but shorter hospital LOS and reduced radiation exposure when compared with patients undergoing planned or delayed sGJT placement. Complication rates after GJT are high regardless of placement modality.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"397-405"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391161","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":"Avoiding the Umbilical Incision in Obese Patients Undergoing Laparoscopic Cholecystectomy: A Retrospective Cohort Study of Wound-Related Outcomes.","authors":"Yasunori Uesato, Susumu Inamine","doi":"10.1177/10926429261445558","DOIUrl":"https://doi.org/10.1177/10926429261445558","url":null,"abstract":"<p><strong>Background: </strong>The umbilical port is routinely used for camera insertion and specimen retrieval in laparoscopic cholecystectomy (LC). However, the umbilicus is anatomically vulnerable and may be associated with an increased risk of surgical site infection (SSI) and port-site hernia (PSH), particularly in obese patients. We evaluated the clinical impact of avoiding an umbilical incision in obese patients undergoing LC.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 75 patients with a body mass index (BMI) ≥ 32 who underwent LC between April 2019 and November 2025. Patients were divided into an umbilical incision group (<i>n</i> = 46) and a nonumbilical incision group (<i>n</i> = 29). The primary endpoint was overall postoperative complications (Clavien-Dindo grade ≥ II) within 6 months. Absolute risk differences and corrected odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.</p><p><strong>Results: </strong>Postoperative complications occurred in six patients (12.8%) in the umbilical incision group and in none (0%) in the nonumbilical incision group (<i>P</i> = .076). Although the difference did not reach statistical significance, all observed complications occurred in the umbilical incision group. The absolute risk difference was 13.0% (95% CI 3.3%-22.8%). After Haldane-Anscombe correction, the estimated OR for complications associated with the umbilical incision approach was 9.47 (95% CI 0.51-174.76). All complications were wound-related (four SSIs and two PSHs). Operative time, blood loss, and postoperative hospital stay were significantly lower in the nonumbilical incision group. All outcome measures consistently favored the nonumbilical approach.</p><p><strong>Conclusions: </strong>Although statistical significance was not reached, all wound-related complications occurred exclusively in the umbilical incision group. Avoiding an umbilical incision in obese patients undergoing LC may represent a clinically reasonable strategy associated with a potential reduction in wound-related morbidity. Larger prospective studies are warranted.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261445558"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822401","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":"Conversion Rate in Laparoscopic Cholecystectomy as a Critical Benchmark.","authors":"Jens Schwarz, Charlotte Reithmann, Martin Rothe, Hans-Dieter Allescher, Holger Vogelsang","doi":"10.1177/10926429261421340","DOIUrl":"10.1177/10926429261421340","url":null,"abstract":"<p><strong>Background: </strong>Conversion from laparoscopic to open cholecystectomy is associated with increased morbidity. A low conversion rate, together with a low complication rate, may serve as a surrogate marker of surgical quality. This study aimed to analyze the conversion rate at a secondary referral center in relation to bile duct injuries and to identify risk factors associated with conversion.</p><p><strong>Methods: </strong>We performed a retrospective analysis of all laparoscopically initiated cholecystectomies between January 2013 and December 2022. Demographic and clinical data, surgical indication, timing, difficulty level (Nassar and Randhawa scores), conversion rates, and bile duct injuries (Neuhaus system) were evaluated.</p><p><strong>Results: </strong>A total of 1534 laparoscopic cholecystectomies were performed. The overall conversion rate was 2.0% (<i>n</i> = 31), with 84% of conversions occurring in emergency cases. Converted patients showed a high prevalence of known risk factors. Most converted cholecystectomies (80.6%) were performed during daytime hours; only 6.5% of conversions occurred after midnight. The incidence of bile duct injuries was 0.26%, well below the average reported in the literature.</p><p><strong>Conclusion: </strong>A low conversion rate combined with a low rate of bile duct injuries can serve as a surgical quality indicator. Risk stratification using established scoring systems, laparoscopic skills such as intraoperative cholangiography, appropriate timing of surgery, and team composition may contribute to achieving a low conversion rate.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"356-359"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285672","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":"Sleeve Gastrectomy to Roux-en-Y Gastric Bypass Conversion Versus Primary Roux-en-Y Gastric Bypass: Impact of Robotic Platform on Propensity-Matched Outcomes.","authors":"Tamar Tsenteradze, Agustina A Pontecorvo, Enrique F Elli","doi":"10.1177/10926429261427258","DOIUrl":"10.1177/10926429261427258","url":null,"abstract":"<p><strong>Purpose: </strong>With the increasing prevalence of sleeve gastrectomy, complications and insufficient weight loss have become more common, making conversion to Roux-en-Y gastric bypass (RYGB) a frequent revisional approach. Given the higher risk of revisional surgery, we aimed to compare primary versus conversion RYGB surgery and assess whether robotic assistance impacts outcomes.</p><p><strong>Method: </strong>This retrospective study included 378 patients after 2:1 propensity score matching based on demographic and clinical characteristics, comparing primary Roux-en-Y gastric bypass (P-RYGB) with sleeve gastrectomy-to-Roux-en-Y gastric bypass (SG-RYGB). The matched cohort included both robotic and laparoscopic cases performed at a single tertiary center between 2012 and 2024. A secondary 2:1 matched sub-analysis of robotic cases (<i>n</i> = 297) evaluated whether robotic assistance reduced differences between primary and revisional surgery. Weight-loss outcomes were assessed at 6 and 12 months in the full cohort, with an additional sub-analysis limited to SG-RYGB performed for weight-loss indications.</p><p><strong>Results: </strong>In the full cohort (<i>n</i> = 378), SG-RYGB was associated with longer operative time, greater blood loss (<i>P</i> < .001), longer hospital stay (<i>P</i> = .04), and higher late complication rates (<i>P</i> = .04). In the robotic-only matched analysis (<i>n</i> = 297), differences in operative time and blood loss were no longer significant, and early and late outcomes were comparable, although length of stay still remained longer for SG-RYGB (<i>P</i> = .05). Among patients undergoing SG-RYGB for weight loss purposes only, total body weight loss percentage reached 16.5% ± 6.6% at 6 months and 20.4% ± 7.1% at 12 months but remained lower than that observed in the P-RYGB group (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>SG-RYGB conversion demonstrated favorable outcomes and meaningful weight loss. Robotic assistance was associated with improved operative time, reduced blood loss, and fewer late complications in the SG-RYGB group, further narrowing differences with P-RYGB, supporting its role in complex revisional bariatric surgery at high-volume centers.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"376-383"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437076","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}