Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery最新文献

{"title":"Postoperative hospitalization time in laparoscopic and laparotomic Roux-En-Y gastric bypass: a retrospective observational cohort study.","authors":"Tomer Lederman Bookobza, Gabriel Scaramuzzi Seferian, Giovanna Pedrazzoli Rodrigues, Wilson Rodrigues Freitas Junior, Osvaldo Antônio Castro Prado, Luiz Vicente Berti, Elias Jirjoss Ilias, Patrícia Colombo Souza, Paulo Kassab","doi":"10.1590/0102-672020260000043e1972","DOIUrl":"10.1590/0102-672020260000043e1972","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a growing problem both in Brazil and worldwide, and bariatric surgery is a well-established method for reducing weight and, consequently, reducing the risk of death attributed to cardiovascular and metabolic problems. Roux-en-Y gastric bypass is currently the most popular surgical technique in Brazil, performed via either laparotomy or laparoscopy.</p><p><strong>Aims: </strong>To compare the length of hospital stay after Roux-en-Y gastric bypass performed via laparoscopic and laparotomic approaches.</p><p><strong>Methods: </strong>An observational study using retrospective data from medical records, comparing patients who underwent Roux-en-Y gastric bypass by laparoscopy and patients operated on by laparotomy, with similar comorbidities.</p><p><strong>Results: </strong>The sample consisted of 64 patients who underwent surgery: 31 via laparoscopy and 33 via laparotomy, of whom 84.4% were female, with a mean age of 44.1 (SD=10.1). 15.6% were male, with a mean age of 40.2 (SD=13.3). Among the four variables evaluated (sex, age, length of hospital stay, and type of surgery), the only statistically significant difference found was in the length of hospital stay according to each type of surgery, with patients undergoing Roux-en-Y gastroplasty via laparoscopic approach remaining hospitalized for a mean of 2.45 days (SD=1.12), while those undergoing the same surgery via laparotomic approach remained hospitalized for a mean of 3.42 days (SD=1.17).</p><p><strong>Conclusions: </strong>The findings of this study indicate a numerically and statistically significant difference in length of hospital stay between both surgical access routes for bariatric surgery, with a shorter stay observed in the laparoscopic approach. This information is relevant, as it has financial impact by reducing bed occupancy time and the costs arising from hospitalization.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1972"},"PeriodicalIF":1.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Waiting time for bariatric and metabolic surgery in the Brazilian public health system and comorbidities: what is the impact?","authors":"Fernando de Barros, Leonardo Halamy Pereira, Ana Beatriz Fonseca, Breno Gonçalves da Silva, Daniel Alejandro Encalada, Thais Leiros Kleinsorgen Motta, Eduardo Pinho Braga","doi":"10.1590/0102-672020260000025e1954","DOIUrl":"10.1590/0102-672020260000025e1954","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a multifactorial disease with a high prevalence that leads to several comorbidities, posing significant challenges for healthcare systems. Bariatric and metabolic surgery (BMS) has been established as the most effective treatment for patients with obesity; however, in Brazil, limited access remains a critical barrier.</p><p><strong>Aims: </strong>This study aimed to evaluate the clinical, demographic, and metabolic characteristics of patients with obesity undergoing BMS in the Brazilian Unified Health System and to analyze the relationship between waiting time and comorbidities.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted involving 1,000 patients with obesity who underwent treatment between July 2022 and June 2024. Clinical, anthropometric, and laboratory variables were analyzed using regression analysis and statistical tests to assess the association between waiting time and comorbidities.</p><p><strong>Results: </strong>A significant correlation was found between prolonged waiting time and an increased number of comorbidities (R²=0.686; p<0.001). Furthermore, the number of comorbidities explained 60% of the variability in waiting time (R²=0.600; p<0.001), with a mean increase of 1.92 years for each additional comorbidity (95%CI 1.82-2.02). Patients on the waiting list for more than 10 years had higher rates of hypertension, type 2 diabetes, and dyslipidemia. Waiting time also had an impact on some metabolic syndrome parameters, including glycated hemoglobin (Hb1Ac) (r=+680, p=0.031), low-density lipoprotein (LDL) (r=+640, p=0.044), and total cholesterol (r=+830, p=0.008).</p><p><strong>Conclusions: </strong>Prolonged waiting time for bariatric and metabolic surgery is associated with an increased burden of metabolic comorbidities and their consequences.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1954"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological features, morbidity and survival in gastric adenocarcinoma, with a focus on stage III: a retrospective institutional cohort analysis.","authors":"Mariana Freire Pinto, Paulo Kassab, Osvaldo Antonio Prado Castro, Anna Clara Hebling Mitidieri","doi":"10.1590/0102-672020260000037e1966","DOIUrl":"10.1590/0102-672020260000037e1966","url":null,"abstract":"<p><strong>Background: </strong>Gastric adenocarcinoma remains one of the leading causes of cancer mortality worldwide, according to the International Agency for Research on Cancer. Stage III, as defined by the 8th edition of the American Joint Committee on Cancer Tumor, Node, and Metastasis (TNM) system, comprises a biologically heterogeneous group, resulting in clinicopathological variations that directly impact prognosis and therapeutic decisions.</p><p><strong>Aims: </strong>To evaluate the clinicopathological features, surgical morbidity and mortality, and overall survival of patients with gastric adenocarcinoma treated at a tertiary center, and to analyze prognostic differences among stage III subgroups.</p><p><strong>Methods: </strong>This retrospective cohort study included patients treated between 2008 and 2018. Demographic variables, tumor characteristics, TNM staging (8th edition), type of surgical procedure, complications according to the Clavien-Dindo classification, and 30-day mortality were analyzed. Overall survival was estimated using the Kaplan-Meier method and compared with the log-rank test, with a significance level of 5%.</p><p><strong>Results: </strong>This retrospective cohort study included patients treated between 2008 and 2018. We analyzed demographic variables, tumor characteristics, TNM staging (8th edition), type of surgical procedure, complications according to the Clavien-Dindo classification, and 30-day mortality. Overall survival was estimated using the Kaplan-Meier method and compared with the log-rank test, with a significance level of 5%.</p><p><strong>Conclusions: </strong>Stage III gastric adenocarcinoma demonstrates marked clinicopathological heterogeneity, which directly impacts morbidity, mortality, and survival. Lymph node involvement is a relevant prognostic determinant.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1966"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-stage outpatient laparoendoscopic treatment of cholecystocholedocholithiasis.","authors":"Gabriel Garcia Schmitt, Alberto Facury Gaspar, Jorge Resende Lopes Júnior, Víctor Antônio Peres Alves Ferreira Avezum, Leonardo Santos Lima, Rafael Kemp, Ajith Kumar Sankarankutty, José Sebastião Dos Santos","doi":"10.1590/0102-672020260000029e1958","DOIUrl":"10.1590/0102-672020260000029e1958","url":null,"abstract":"<p><strong>Background: </strong>Single-stage outpatient treatment of cholecystocholedocholithiasis is feasible, highlighting the importance of appropriate patient selection, professional training, and healthcare service organization to support this approach.</p><p><strong>Aim: </strong>To identify clinical and procedural factors associated with outpatient management and hospital stay following single-stage laparoendoscopic treatment of cholecystocholedocholithiasis.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at hospitals affiliated with the Ribeirão Preto School of Medicine, Universidade de São Paulo (FMRP-USP), between 2019 and 2024. Patients were stratified into three groups according to care setting: outpatient (G1); outpatient with overnight stay (G2); and inpatient (G3). Clinical, surgical, and outcome data were analyzed using logistic regression models, χ2 tests, and Fisher's exact tests (p=0.05).</p><p><strong>Results: </strong>Among 177 patients included, 41 were allocated to G1, 80 to G2, and 56 to G3. Compared with G2, G1 patients had shorter operative time (124.2 vs. 143.8 min; p=0.038), more frequent use of the Rendez-Vous technique (p=0.044), and less frequent use of papillary dilation (p=0.041). Patients in G3 had a higher prevalence of ASA III physical status (p=0.045), higher rates of postoperative complications (p=0.025) and biliary stent use (p=0.001), and lower bile duct clearance rates (p=0.004).</p><p><strong>Conclusions: </strong>Single-stage outpatient laparoendoscopic treatment of cholecystocholedocholithiasis is safe and effective. Clinical severity, treatment complexity, and failure of bile duct clearance were more strongly associated with inpatient hospitalization, whereas overnight stay among outpatients was not associated with improved postoperative outcomes. The implementation of enhanced recovery protocols and telemedicine-based postoperative assessment strategies may further reduce hospital stay.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1958"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Videolaparoscopic pancreatojejunostomy using a hybrid technique in chronic pancreatitis without significant ductal dilatation.","authors":"Ian Torres de Lima, Luiz Henrique Costa, Thiago Nogueira Costa, Estela Regina Ramos Figueira, André Luis Montagnini, Paulo Herman, José Jukemura","doi":"10.1590/0102-672020260000034e1963","DOIUrl":"10.1590/0102-672020260000034e1963","url":null,"abstract":"<p><strong>Background: </strong>Chronic pancreatitis without significant main duct dilation is difficult to treat, as classic drainage procedures are less effective. Endoscopic therapy is often limited by complex anatomy, multiple strictures, stones, and the need for repeated procedures, frequently providing incomplete pain relief. Surgery offers better long-term pain control, but small-duct disease requires alternative strategies.</p><p><strong>Aims: </strong>To record the case of a 52-year-old man with alcoholic chronic pancreatitis who had progressive abdominal pain requiring opioids. Imaging showed a mildly dilated (6 mm), tortuous pancreatic duct with segmental strictures and a peripancreatic cystic lesion.</p><p><strong>Methods: </strong>Endoscopic treatment was considered suboptimal, and surgery was indicated. A hybrid laparoscopic pancreaticojejunostomy was performed, combining Izbicki's V-shaped parenchymal excision with a longitudinal Partington-Rochelle anastomosis. The goal was to achieve effective decompression despite the small duct diameter, while preserving a minimally invasive approach.</p><p><strong>Results: </strong>Recovery was uneventful. Oral intake was resumed on the third postoperative day, and discharge occurred on the fifth. At six months, the patient had complete pain relief, a 20% reduction in insulin requirement, and improved control of exocrine insufficiency.</p><p><strong>Conclusions: </strong>This hybrid laparoscopic technique is feasible and may be an effective alternative for patients with chronic pancreatitis and small-duct disease when standard procedures are unsuitable.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1963"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Size alone is not enough: Ki-67 and invasion patterns identify high-risk pancreatic neuroendocrine tumors.","authors":"Dante Altenfelder Silva Mesquita Cortelli, Silvio Melo Torres, Igor Correia de Farias, Alessandro Landskron Diniz, Heber Salvador de Castro Ribeiro, André Luis de Godoy, Caroline Almeida Gonçalves, Felipe José Fernández Coimbra","doi":"10.1590/0102-672020260000027e1956","DOIUrl":"10.1590/0102-672020260000027e1956","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic neuroendocrine tumors (pNETS) constitute a heterogeneous and rare disease worldwide. Diagnosis rates have been increasing, and the evaluation of prognostic factors has become even more important in the treatment decision-making process.</p><p><strong>Aims: </strong>To present results and prognostic factors in patients undergoing surgical treatment for pNETS at a single Brazilian center.</p><p><strong>Results: </strong>The most frequently performed surgical procedure was PCC+S 60.0%. The median hospital stay was 8 (5-13) days, and postoperative mortality occurred in 1.7%. Overall survival in 3 and 5 years was 93.8 and 92.1%, respectively. Disease-free survival at 3 and 5 years was 87.1 and 71.8%, respectively. Patients with tumors smaller than 2.0 cm did not present with lymph node disease or recurrence, and patients with tumors measuring 2.1-2.5cm had lymph node disease in 11.1% and recurrence in 11.1%. In univariate and multivariate analysis, the presence of lymphatic and perineural invasion and Ki67 (3-20) were strongly correlated with positive lymph node disease and recurrence, respectively.</p><p><strong>Conclusions: </strong>The presence of lymphatic and perineural invasion, Ki67 (3 to 20), and tumors larger than 2.5 cm correlated with positive lymph node disease and recurrence.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1956"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is necrotizing enterocolitis associated with the 896A/G polymorphism in the toll-like receptor 4 (TLR4) gene?","authors":"Danielle Lopes Teixeira Ferdinando, Alexandre Alberto Barros Duarte, Vânia Belintani Piatto, Heloisa Cristina Caldas","doi":"10.1590/0102-672020260000030e1959","DOIUrl":"10.1590/0102-672020260000030e1959","url":null,"abstract":"<p><strong>Background: </strong>The pathophysiology of necrotizing enterocolitis (NEC) involves changes in intestinal development that hinder its functionality, leading to both metabolic and gene and phenotypic changes. Among the genetic factors the 896A/G polymorphism in the Toll-Like Receptor 4 (TLR4) gene can trigger is an inappropriate and persistent inflammatory response, leading to the progression of lesions and necrosis of the intestinal mucosa, and reduced perfusion of the microvasculature, increasing susceptibility to the disease.</p><p><strong>Aims: </strong>To determine the prevalence of the 896A/G polymorphism in the TLR4 gene in neonates with and without NEC.</p><p><strong>Methods: </strong>Case-control study, in which 100 neonates were evaluated, 50 diagnosed with NEC (Case Group) and 50 without the disease (Control Group), of both sexes. DNA was extracted from peripheral blood leukocytes, and the region encompassing the polymorphism was amplified by polymerase chain reaction/restriction fragment length polymorphism.</p><p><strong>Results: </strong>Males were predominant in both groups: Cases (54%) and Controls (56%) (p=1.0000). Moderately and extremely preterm infants were the most frequent in the Case (90%) and Controls (96%) (p=0.6132) groups. Very low birth weight and extremely low birth weight neonates were predominant in the Case Group (60%) and in the Control Group (72%) (p=0.0995). Of the 50 neonates with NEC, 66% responded positively to clinical treatment, and 86% were discharged from hospital. The 896A/G polymorphism in the TLR4 gene was not identified in the 200 alleles analyzed (100%).</p><p><strong>Conclusions: </strong>The absence of the 896A/G polymorphism in the TLR4 gene in NBs with and without NEC does not exclude the possibility of alterations in this and/or other genes, highlighting the importance of additional studies to elucidate this relationship.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1959"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local excision for anal squamous cell carcinoma: challenges in patient selection and diagnosis.","authors":"Lucas Faraco Sobrado, Giulia Carli Mendes, Caio Sergio Rizkallah Nahas, Guilherme Cutait de Castro Cotti, Antônio Rocco Imperiale, Diego Fernandes Maia Soares, Carlos Frederico Sparapan Marques, Ulysses Ribeiro Junior","doi":"10.1590/0102-672020260000040e1969","DOIUrl":"10.1590/0102-672020260000040e1969","url":null,"abstract":"<p><strong>Background: </strong>Local excision (LE) has a limited role in the management of anal squamous cell carcinoma (SCC), typically restricted to carefully selected early-stage tumors. However, in clinical practice, LE is often performed in broader contexts, particularly in patients with large perianal lesions without prior confirmation of invasive carcinoma, in whom diagnostic uncertainty may influence treatment decisions.</p><p><strong>Aims: </strong>To evaluate oncologic outcomes after LE for anal SCC, with particular emphasis on the role of lesion characteristics, diagnostic uncertainty, and treatment patterns in real-world practice.</p><p><strong>Methods: </strong>This was a retrospective study of patients with anal SCC who underwent LE as primary treatment and were followed at a tertiary cancer center between 2010 and 2024. Clinical, pathological, and treatment data were collected, including tumor characteristics, margin status, use of adjuvant therapy, and oncologic outcomes.</p><p><strong>Results: </strong>A total of 20 patients with invasive anal SCC were included. The mean tumor size was 3.24 cm (standard deviation ±1.75 cm), with lesions up to 6.9 cm. No patients received chemoradiotherapy before LE. Only two patients met conventional criteria for LE (<2 cm, well or moderately differentiated tumors). Overall, 14 patients (70%) required additional treatment following LE, including chemoradiotherapy or abdominoperineal resection. Among patients initially managed with surveillance, 44% developed local recurrence, even in cases with negative margins.</p><p><strong>Conclusions: </strong>Outcomes following LE for anal SCC are strongly influenced by patient selection and clinical context. In this real-world cohort, most patients outside established criteria required additional treatment, underscoring the limitations of LE in large perianal lesions. These findings highlight the importance of careful preoperative evaluation and maintaining a high index of suspicion for invasive carcinoma to guide appropriate initial management.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1969"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiological response of lower esophageal sphincter pressure to abdominal pressure in obese individuals: a retrospective cross-sectional study.","authors":"Yolanda Oliveira Pinto, Fernando Augusto Mardiros Herbella, Diego Adão, Leonardo de Mello Del Grande","doi":"10.1590/0102-672020260000044e1973","DOIUrl":"10.1590/0102-672020260000044e1973","url":null,"abstract":"<p><strong>Background: </strong>The physiological response of the lower esophageal sphincter (LES) to abdominal pressure (AP) plays a key role in the esophagogastric junction (EGJ) integrity. However, in obesity, this interplay remains unclear, particularly in the presence of anatomical alterations.</p><p><strong>Aims: </strong>This study aims to evaluate the correlation between abdominal pressure and LES basal pressure in obese patients, and to analyze the influence of EGJ morphology on this interaction.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included 47 obese patients (BMI>35 kg/m2) who underwent high-resolution esophageal manometry. Patients were divided into two groups based on EGJ morphology: normal (Type I) and abnormal (Types II/III, hiatal hernia) and were compared based on clinical and manometric variables. Correlation analyses between AP and LES pressure were performed for the entire sample and stratified by EGJ morphology.</p><p><strong>Results: </strong>No statistically significant correlation was found between AP and LES pressure in the overall sample (rho=0.05; p=0.737). In the subgroup analysis, there was a non-significant trend toward increased LES pressure in patients with normal EGJ morphology (r=0.26; p=0.150) and decreased LES pressure in those with hiatal hernia (r=-0.39; p=0.131). No significant differences in BMI, abdominal circumference, AP, or LES pressure were observed between groups.</p><p><strong>Conclusions: </strong>In obese individuals, abdominal pressure does not show correlation with LES pressure. However, EGJ morphology may influence sphincteric behavior, with a trend toward LES pressure increase in normal EGJ and reduction in altered morphologies. These findings highlight the multifactorial nature of esophagogastric dysfunction.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1973"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic ureteral injury in colorectal surgery: a retrospective cohort analysis of risk factors and preventive strategies.","authors":"Giovanna Savoy Pazin, Helena da Cunha Lopes de Lima, Marcelo Lopes de Lima, Wagner Eduardo Matheus, Claudio Saddy Rodrigues Coy, Raquel Franco Leal, Maria de Lourdes Setsuko Ayrizono","doi":"10.1590/0102-672020260000028e1957","DOIUrl":"10.1590/0102-672020260000028e1957","url":null,"abstract":"<p><strong>Background: </strong>Iatrogenic ureteral injuries (IUI) are rare surgical complications in abdominopelvic surgeries, with an incidence varying between 0.15 and 1.0%.</p><p><strong>Aims: </strong>To evaluate the incidence of IUI in elective colorectal surgeries performed in a tertiary university hospital.</p><p><strong>Methods: </strong>This is a retrospective analysis of patients operated from 2004 to 2022, who presented IUI. Demographic data, underlying disease, predisposing factors, surgery access, location of the lesions and their characteristics, diagnosis time, treatment carried out, and follow-up were analyzed.</p><p><strong>Results: </strong>In the period, 2,312 abdominopelvic surgeries were performed, of which 1,998 were open and 314 were laparoscopic, with 19 IUI (0.82%). The mean age was 55.6 years, 57.9% were male, and 89.5% were white. The majority of patients were overweight (52.6%), and 73.7% had a history of abdominal surgery. Primary rectal adenocarcinoma was the most common disease (47.4%), followed by tumor recurrences (21.0%). IUI occurred in 1.91% of laparoscopic surgeries and 0.65% of open surgeries (p=0.053); patients with tumor recurrence presented more IUI than those with primary tumors or benign diseases (p=0.006). They were commonly observed in the left ureter (52.6%) and in the distal portion (89.5%), the main mechanism being the section (57.9%). Intraoperative diagnosis occurred in 12 patients (63.2%). IUI correction was predominant in ureteral reimplantation and end-to-end ureteral anastomosis. Postoperative complications were common (47.4%), and one patient died from causes unrelated to surgery.</p><p><strong>Conclusions: </strong>IUI presented low incidence in colorectal elective surgeries and were more frequent in surgeries for tumor recurrences, in the left ureter and the distal third. Early diagnosis with repair of the injury provided better results.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1957"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}