Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Association Between Postoperative Stent Dwell Time and Stone-Free Status Following Pediatric Retrograde Intrarenal Surgery: A Retrospective Cohort Study.","authors":"Ismail Ulus, Yusuf Sahin, Ibrahim Hacibey, Ahmet Yaser Muslumanoglu","doi":"10.1177/10926429261479448","DOIUrl":"10.1177/10926429261479448","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the association between postoperative stent dwell time and stone-free status following retrograde intrarenal surgery (RIRS) in pediatric patients.</p><p><strong>Methods: </strong>This retrospective study included pediatric patients who underwent RIRS for renal stones ≤20 mm. Residual stone fragments were assessed by low-dose computed tomography at 3 months postoperatively and defined as either a single fragment >2 mm or the presence of multiple residual fragments regardless of size. Logistic regression analyses were performed to identify factors associated with stone-free status, including postoperative stent dwell time.</p><p><strong>Results: </strong>A total of 108 pediatric patients were included, with a mean age of 9.8 ± 4.5 years, and 74 patients (68.5%) were male. Residual fragments were observed in 40 patients (37.0%). In univariable logistic regression analysis, stone burden (<i>P</i> < .001), fragmentation time (<i>P</i> < .001), and the presence of multiple stones (<i>P</i> = .022) were associated with residual fragments. In multivariable analysis, stone burden (<i>P</i> = .007) and fragmentation time (<i>P</i> = .003) remained independent predictors of residual fragments, whereas postoperative stent dwell time was not independently associated with stone-free status (<i>P</i> = .381).</p><p><strong>Conclusion: </strong>No evidence was found to support an association between postoperative stent dwell time and stone-free status following pediatric RIRS. Earlier stent removal may therefore be feasible in uncomplicated pediatric patients without compromising stone-free outcomes. Further large-scale prospective studies are needed to establish clinical recommendations regarding stent duration.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261479448"},"PeriodicalIF":1.1,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722746","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":"Virtual-Reality Laparoscopic Simulation in Togo and Financial Barriers to Scale-Up.","authors":"Efoé-Ga Yawod Olivier Amouzou, Ananivi Sogan, Fousseni Alassani, Komi Sikpa, René Ayaovi Gayito Adagba, Kwasivi Fiadjoe, Marius Nedelcu, Komlan Adabra, Boyodi Tchangai, Anamaria Nedelcu, Ekoué Dosseh","doi":"10.1177/10926429261478776","DOIUrl":"10.1177/10926429261478776","url":null,"abstract":"<p><strong>Background: </strong>Virtual reality (VR) is a key tool of modern surgical education, yet minimally invasive surgery training remains scarce in sub-Saharan Africa. We describe the first experience of VR laparoscopic simulation in a developing sub-Saharan country and assess the feasibility of such training in Togo and the financial barriers to its dissemination.</p><p><strong>Methods: </strong>This was a cross-sectional, questionnaire-based survey of surgeons and trainees enrolled in two VR laparoscopic simulation workshops held in March and September 2022 at the skills-transfer centre of the Biasa Clinic in Lomé, using the Virtamed LaparoS anatomical-model simulator. Seven standardized tasks were used, and participants rated each task and the course design on Likert scales. The primary endpoint was feasibility, defined as successful completion of two workshops with locally trained faculty by the end of 2022. Data were analyzed with Epi Info 7.2.</p><p><strong>Results: </strong>A total of 15 of 18 enrolled practitioners responded (participation rate 83.3%). The mean age was 34.2 ± 5.2 years, with a male-to-female ratio of 2:1; one-third were foreign nationals and two-thirds were gynecologists. Residents and surgeons in training accounted for 53.3% of participants, and 53.3% had never performed laparoscopic surgery. The overall impression was good for 73.3%. Circular cutting was the most difficult task. All participants considered that simulation could improve their practice, and 93.3% endorsed mandatory integration in residency curricula. Four participants (26.7%) considered the course expensive, and the main reported limitations were lack of funding, scarcity of laparoscopic towers, and absence of locally engineered solutions.</p><p><strong>Conclusion: </strong>VR laparoscopic simulation is feasible, well accepted, and locally sustainable in Togo and is seen by trainees as an essential component of surgical education. Its scale-up is chiefly constrained by the high cost of equipment and training, which calls for public investment, partnerships, and the development of affordable, locally adapted simulation tools.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261478776"},"PeriodicalIF":1.1,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723974","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":"Comment on: Avoiding the Umbilical Incision in Obese Patients Undergoing Laparoscopic Cholecystectomy: A Retrospective Cohort Study of Wound-Related Outcomes.","authors":"Nadia Naeem, Christopher R Smith","doi":"10.1177/10926429261478778","DOIUrl":"https://doi.org/10.1177/10926429261478778","url":null,"abstract":"","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261478778"},"PeriodicalIF":1.1,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714284","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":"Age-Stratified Outcomes of Off-Clamp Robot-Assisted Partial Nephrectomy: A Comparison of Patients Younger Than 65 Years and Those Aged 65 Years or Older.","authors":"Oh Jun Yun, Jun-Koo Kang, Sang Hyub Lee, Yun-Sok Ha, Seock Hwan Choi, Bum Soo Kim, Hyun Tae Kim, Tae-Hwan Kim, Eun Sang Yoo, Tae Gyun Kwon, Jae-Wook Chung","doi":"10.1177/10926429261479471","DOIUrl":"https://doi.org/10.1177/10926429261479471","url":null,"abstract":"<p><strong>Background: </strong>Evidence for completely off-clamp robot-assisted partial nephrectomy (RAPN) in older patients is limited. We compared age-stratified short-term outcomes.</p><p><strong>Methods: </strong>We reviewed 146 consecutive patients who underwent off-clamp RAPN between June 2022 and March 2026: 99 were aged <65 years and 47 were aged ≥65 years. Outcomes included perioperative measures, 90-day major complications, postoperative day 1 (POD1) hemoglobin (Hb) decline, estimated glomerular filtration rate (eGFR) change, and surgical margin status. Parsimonious linear models adjusted for age group, baseline Hb or eGFR, tumor size, and RENAL score; expanded models were sensitivity analyses.</p><p><strong>Results: </strong>Older patients had more hypertension, diabetes mellitus, and cardiovascular disease and lower baseline Hb and eGFR (all <i>P</i> < .05). Console time, estimated blood loss, and length of stay did not differ significantly, and no major complication occurred. Positive margins occurred in 5/85 younger and 1/44 older patients with evaluable data (<i>P</i> = .663); margin status was unassigned in 17 nonmalignant cases. The median POD1 Hb decline was 1.0 versus 1.2 g/dL (<i>P</i> = .779), and the median 1-month eGFR change was 1.0 mL/min/1.73 m² in both groups (<i>P</i> = .746). In parsimonious models, neither age-group coefficient reached statistical significance: Hb decline, β = -0.01 (95% confidence interval [CI], -0.30 to 0.28; <i>P</i> = .937); 1-month eGFR change, β = -3.21 (95% CI, -6.80 to 0.38; <i>P</i> = .080).</p><p><strong>Conclusions: </strong>No statistically significant age-group differences were detected in the evaluated short-term perioperative and functional outcomes. However, the confidence intervals, particularly for 1-month eGFR, did not exclude clinically relevant disadvantage in older patients and do not establish equivalence.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261479471"},"PeriodicalIF":1.1,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714311","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":"Impact of Surgical Timing on Outcomes of Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis: A Multicenter Real-World Analysis.","authors":"Carlo Bergamini, Andrea Balla, Giulia Montori, Salvador Morales Conde, Ferdinando Agresta, Alessio Giordano","doi":"10.1177/10926429261478769","DOIUrl":"https://doi.org/10.1177/10926429261478769","url":null,"abstract":"<p><strong>Background: </strong>Early laparoscopic cholecystectomy is recommended for acute calculous cholecystitis (ACC), although the optimal timing within the recommended early treatment window remains uncertain. This study evaluated whether different time intervals from symptom onset to surgery influence operative difficulty and perioperative outcomes in routine emergency surgical practice.</p><p><strong>Methods: </strong>A retrospective multicenter study was conducted including consecutive patients who underwent LC for Tokyo Grade I or II ACC between January 2021 and December 2025. Patients were stratified according to Tokyo severity grade and further categorized into five predefined intervals according to time from symptom onset to surgery (≤6 hours, 6 to 12 hours, 12 to 24 hours, 24 to 72 hours, and > 72 hours). Demographic characteristics, comorbidities, operative findings, postoperative outcomes, and length of hospital stay were analyzed. Multivariable regression models were used to evaluate the independent association between surgical timing and perioperative outcomes after adjustment for relevant clinical confounders.</p><p><strong>Results: </strong>A total of 306 patients were included, including 235 (76.8%) with Tokyo Grade I and 71 (23.2%) with Tokyo Grade II ACC. Delayed surgery was independently associated with greater intraoperative blood loss (adjusted mean ratio 1.29, 95% CI: 1.19 to 1.40; <i>P</i> < .001). In contrast, no independent association was observed between surgical timing and conversion to open surgery, overall postoperative complications, major complications (Clavien-Dindo grade ≥III), operative time, or length of hospital stay after multivariable adjustment. Although severe postoperative events were numerically more frequent in delayed subgroups, these differences were not statistically significant.</p><p><strong>Conclusions: </strong>Within a real-world emergency surgery setting, surgical timing appears to influence technical complexity more than postoperative morbidity. Delayed intervention was associated with increased intraoperative blood loss but not with worse adjusted postoperative outcomes. These findings support an individualized, patient-tailored approach to early laparoscopic cholecystectomy rather than strict adherence to fixed temporal thresholds.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261478769"},"PeriodicalIF":1.1,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708309","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 Surgery for Crohn's Disease: A Systematic Review and Meta-Analysis with Trial Sequential Analysis.","authors":"Bernardo Fontel Pompeu, Bianca Vaz Micherino, Julia Hoici Brunini, Gabriel Leal Barone, Lucas Monteiro Delgado, Lorrany Ramos Aguiar, Giuliana Daneluci Melillo, Philipe Franco do Amaral Tafner, Claudia Theis, Leonardo de Melo Del Grande, Sergio Mazzola Poli de Figueiredo, Fernanda Bellotti Formiga","doi":"10.1177/10926429261445559","DOIUrl":"10.1177/10926429261445559","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic surgery (Lap) is widely recognized as the standard minimally invasive method for colorectal surgeries. Although robotic surgery (Rob) has seen increased adoption, its application in inflammatory bowel disease 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 February 2026. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed via the inconsistency (<i>I</i>²) statistic. Trial sequential analysis (TSA) was applied to assess the robustness of the cumulative evidence.</p><p><strong>Results: </strong>Four observational studies, including 3776 patients, were analyzed; 246 underwent Rob and 3530 underwent Lap. Compared with Lap, Rob was associated with a significantly lower rate of overall postoperative complications (OR: 0.56; 95% CI: 0.31 to 0.99; <i>P</i> = .047). No significant differences were observed between approaches in postoperative ileus (OR: 1.16; 95% CI: 0.67 to 2.01; <i>P</i> = .595), anastomotic leak (OR: 0.92; 95% CI: 0.38 to 2.22; <i>P</i> = .852), surgical site infection (OR: 0.70; 95% CI: 0.36 to 1.36; <i>P</i> = .297), reoperation (OR: 1.00; 95% CI: 0.42 to 2.35; <i>P</i> = .997), or stoma formation (OR: 0.47; 95% CI: 0.18 to 1.25; <i>P</i> = .130). The length of hospital stay was similar between groups (MD: <i>= -0.20</i> days; 95% CI: = -0.80 to 0.31; <i>P</i> = .37). Operative time was significantly longer in Rob (MD: + 51.8 minutes; 95% CI: 32.0 to 71.6; <i>P</i> < .001). TSA indicated that most outcomes remained underpowered, suggesting a persistent risk of random error.</p><p><strong>Conclusion: </strong>Rob for Crohn's disease is a safe and feasible minimally invasive approach, with lower overall postoperative complications than Lap. However, Rob was associated with longer operative times, while most perioperative outcomes remain comparable. Further well-designed prospective studies are required to confirm these findings.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"568-577"},"PeriodicalIF":1.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718857","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":"Effects of Daikenchuto (TJ-100) After Gastrointestinal Oncological Surgery: An Updated Meta-Analysis of Randomized Controlled Trials.","authors":"Gabriele Eckerdt Lech, Luiza Bertolli Lucchese Moraes, Carolina Moronte Sturmer, Sophia Zigouras, Abier Abdelnaby, Satoru Morita, Kohei Shigeta, Diego L Lima","doi":"10.1177/10926429261438352","DOIUrl":"10.1177/10926429261438352","url":null,"abstract":"<p><strong>Introduction: </strong>Daikenchuto is an herbal medicine that has been shown to improve gastrointestinal motility. Therefore, we aimed to perform a meta-analysis to evaluate the use of daikenchuto in patients undergoing gastrointestinal oncological surgery.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing daikenchuto with control (placebo or no medicine) in patients undergoing gastrointestinal oncological surgery. Statistical analysis was performed using R statistical software 4.2.1. Heterogeneity was assessed with <i>I</i>².</p><p><strong>Results: </strong>We included 1,158 patients from 9 RCTs. Daikenchuto significantly reduced the time to first bowel movement (TFBM) (mean difference [MD] -11.15 hours; 95% CI: -16.96--5.34; <i>P</i> < .001), and the length of hospital stay (MD -0.5 days; 95% CI: -0.92--0.07; <i>P</i> = .022). The time to initial flatus (TIF) (MD -8.82; 95% CI: -18.34 to 0.69; <i>P</i> = .069) and the postoperative ileus incidence (OR: 0.98; 95% CI: 0.58 to 1.64; <i>P</i> = .934) presented no differences between groups. Subgroup analyses yielded no differences between open and laparoscopic approaches in TFBM (<i>P</i> = .91). In TIF, the results presented differences between groups (<i>P</i> < .01) and a significant reduction for the laparoscopic approach (MD -14.54 hours; 95% CI: -22.04--7.05; <i>P</i> < .01). When considering the type of cancer (foregut vs colorectal), we found no differences between groups in TFBM (<i>P</i> = .57), despite a reduction in colorectal surgery alone (MD -12.64 hours; 95% CI: -20.22--5.06; <i>P</i> = .001). For TIF, colorectal surgery was also associated with a reduction (MD -14.54 hours; 95% CI: -22.04--7.05; <i>P</i> < .01). Trial sequential analysis supported a beneficial effect for daikenchuto in the TFBM outcome.</p><p><strong>Conclusion: </strong>Our findings demonstrated a decrease in intestinal motility time and length of hospital stay with the use of daikenchuto, providing valuable evidence for the clinical context, particularly in consideration of laparoscopic and colorectal surgeries.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"606-615"},"PeriodicalIF":1.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700563","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":"Objective Assessment of Laparoscopist Performance and Its Relationship with Intraoperative Technical Errors in Pediatric Laparoscopic Inguinal Hernia Repair: A Retrospective Observational Study.","authors":"Yohei Sanmoto, Masanaga Matsumoto, Akio Kawami, Kouji Masumoto","doi":"10.1177/10926429261444641","DOIUrl":"10.1177/10926429261444641","url":null,"abstract":"<p><strong>Background: </strong>Although camera navigation is integral to pediatric endoscopic surgery, no validated framework exists for assessing laparoscopist performance. This study evaluated the validity of a modified Objective Structured Assessment of Camera Navigation Skills (OSA-CNS) and investigated how laparoscopist performance influenced procedural safety.</p><p><strong>Methods: </strong>This retrospective study evaluated unilateral single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) procedures performed in males at our institution between January and December 2022. Laparoscopist performance was assessed using a modified OSA-CNS. Two blinded raters independently scored surgical videos to evaluate inter-rater reliability and internal consistency. Technical errors and events were obtained from previous studies using the Generic Error Rating Tool. Modified OSA-CNS scores were compared using the Kruskal-Wallis test. The associations of laparoscopist performance with errors, events, and procedure time were analyzed using surgeon-clustered linear regression.</p><p><strong>Results: </strong>Briefly, 25 unilateral procedures with 185 errors and 40 events were included. The median procedure time was 23.3 (20.3-29.4) min. The modified OSA-CNS demonstrated excellent inter-rater reliability (intraclass correlation coefficient = 0.96) and internal consistency (Cronbach's α = 0.88-0.91). It distinguished performance across laparoscopists with differing experiences (<i>P</i> = .0020). Higher laparoscopist scores were associated with fewer errors (β = -0.19, 95% CI: -0.34 to -0.04; <i>P</i> = .025) but not with event counts or procedure time.</p><p><strong>Conclusions: </strong>The modified OSA-CNS is reliable and valid for evaluating laparoscopist performance in pediatric SILPEC. Its ability to reflect skill differences and its association with error frequency underscore its value in surgical education and intraoperative safety improvement.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"620-626"},"PeriodicalIF":1.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693383","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 Sphincter Augmentation for Gastroesophageal Reflux Disease: Experience from a Single Center in the Middle East.","authors":"Ashraf Maghrabi, Moaz Abulfaraj, Murad Aljiffry, Wisam Jamal, Emad Aljahdli, Alaa Habeebullah, Suha Kaaki, Aroub Kaaki","doi":"10.1177/10926429261445262","DOIUrl":"10.1177/10926429261445262","url":null,"abstract":"<p><strong>Background: </strong>Magnetic sphincter augmentation (MSA) using the LINX device is a minimally invasive treatment for gastroesophageal reflux disease (GERD). With increasing rates of sleeve gastrectomy and associated postoperative GERD, evaluating MSA outcomes in both post-bariatric and <i>de novo</i> patients is clinically relevant. Data from the Middle East remain limited.</p><p><strong>Methods: </strong>This retrospective cohort study included 30 consecutive patients who underwent LINX placement for GERD at King Abdulaziz University Hospital between 2018 and 2024. Briefly, 20 patients (66.7%) had prior sleeve gastrectomy, while 10 patients (33.3%) were <i>de novo</i> cases. Primary outcomes were improvement in GERD-Health-Related Quality of Life (GERD-HRQL) scores and proton pump inhibitor (PPI) discontinuation. Secondary outcomes included perioperative complications and comparison between patient groups.</p><p><strong>Results: </strong>The mean age was 42.8 years, and the mean body mass index was 26.9 kg/m². Hiatal hernia was present in 76.7% of patients (23/30). The mean operative time was 65 minutes, with a median LINX size of 15 beads. Early postoperative dysphagia occurred in 23.3% (7/30), with 10% (3/30) requiring endoscopic dilation (two postsleeve and one <i>de novo</i>). One postsleeve patient (3.3%) required laparoscopic device removal for migration after failed dilation; removal was technically challenging but uncomplicated, with sustained GERD improvement, likely related to hiatal scarring. Mean GERD-HRQL scores improved from 27.2 to 7.1 (<i>P</i> < .001), with 76.7% achieving a ≥50% reduction. Complete PPI cessation occurred in 66.7% (20/30), and 86.7% (26/30) achieved at least a 50% dose reduction. Outcomes were comparable between postsleeve and <i>de novo</i> patients.</p><p><strong>Conclusions: </strong>MSA appears safe and effective for GERD management in this Middle Eastern cohort, with outcomes comparable to international reports. Similar results in postsleeve gastrectomy and <i>de novo</i> patients support broader applicability. This series provides valuable regional outcome data.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"585-591"},"PeriodicalIF":1.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730041","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":"Linear-Stapled Gastrojejunal Anastomosis Linked to Higher Marginal Ulcer Rates After Roux-en-Y Gastric Bypass: A Cohort of 1875 Patients.","authors":"Yeisson Rivero-Moreno, Arturo Estrada, Valentina Viscarret, Adnan Khoja, Grishma Patel, Yashraj Srivastava, Victoria Dai, Shannon Keisling, Jenny Choi, Erin Moran-Atkin, Diego Camacho","doi":"10.1177/10926429261443430","DOIUrl":"10.1177/10926429261443430","url":null,"abstract":"<p><strong>Background: </strong>The three most commonly used surgical techniques for creating the gastrojejunal anastomosis (GJA) during Roux-en-Y gastric bypass (RYGB) are circular-stapled (CS), linear-stapled (LS), and hand-sewn (HS). There is currently no definitive conclusion regarding which one produces the best surgical outcomes. This study aimed to compare the postoperative complications at the GJA based on the surgical technique used.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on patients who underwent RYGB between 2018 and 2023, comparing the surgical technique used for the GJA. The primary outcome of the study was postoperative complications at the GJA: Marginal ulcers (MU), perforation, and stenosis.</p><p><strong>Results: </strong>A total of 1875 patients were included. The 63.4% (<i>n</i> = 1189) underwent primary RYGB, and 36.6% (<i>n</i> = 686) underwent sleeve conversion to RYGB. Females were 86.9% (<i>n</i> = 1629), with a mean age of 44.4 ± 11.12 years. Patients who underwent LS had a higher frequency of MU (CS = 8.96%, LS = 12.32%, and HS = 6.12%, <i>P</i> < .001) and overall GJA complications (CS = 6.37%, LS = 7.82%, and HS = 3.95%, <i>P</i> < .01). The frequency of GJA perforations and stenosis was also higher in patients with LS, although no statistically significant difference. In multivariable analysis, LS anastomosis (OR = 1.74, <i>P</i> = .042), age of >65 years old (OR = 3.8, <i>P</i> = .004), and albumin of < 3.5 mg/dL (OR = 4.5, <i>P</i> = .021) were significant independent predictors of MU at the GJA after RYGB.</p><p><strong>Conclusions: </strong>In patients undergoing RYGB, whether as a conversion or primary procedure, the overall complication rates for GJA and MUs were higher in those who underwent LS compared with those who received CS or HS anastomosis.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"599-605"},"PeriodicalIF":1.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787774","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}