Metabolic and bariatric surgery remains one of the most effective interventions in the management of obesity and its associated medical conditions. The field has continuously grown to now encompass newer procedures that include one-anastomosis gastric bypass, single anastomosis duodeno-ileal bypass with sleeve gastrectomy, sleeve gastrectomy with transit bipartition, and single anastomosis sleeve ileal bypass. These procedures were developed with an aim to tackle current weight loss challenges and safety concerns that tend to present with the more common procedures. Taken together, they have been shown to induce excess weight loss ranging from 64% to 93% over 5 to 10 years, contribute to near-complete resolution of obesity-associated medical conditions, and simultaneously achieve lower rates of complications. However, as most of the current literature reports short-term outcomes, this review aims to identify and discuss their long-term efficacy and safety profiles, emphasizing the need for standardized guidelines that would encourage wider adoption and optimize patient outcomes.
Aim: Robotic-assisted surgery has been successfully introduced in hiatal hernia repair; however, clear advantages over laparoscopy remain limited, with small series and contradictory results. This study aims to evaluate the outcomes of robotic hiatal hernia repair in non-selected patients.
Methods: All patients presenting with symptomatic hiatal hernia were included. The DaVinci® robotic platform was used, and a strict standardized operative technique was performed. Preoperative and postoperative data were prospectively collected and retrospectively analyzed.
Results: A total of 103 consecutive, unselected patients underwent surgery. Median total operating time was 72 min [range 46-168 min]. The 30-day complication rate was 12% (12/103). After a median follow-up of 29 months [range 1-64 months], the late complication rate was 5% and the recurrence rate was 5%.
Conclusion: Robotic surgery is a valuable option for hiatal hernia repair, especially in difficult cases or emergency operations. Whether this translates to better long-term outcomes needs to be further investigated in series with longer follow-up.
The endoluminal functional lumen imaging probe (EndoFLIP) has emerged as a transformative tool in the operative and perioperative management of foregut disorders, including achalasia, gastroesophageal reflux disease (GERD), and esophagogastric junction outflow obstruction. Unlike traditional modalities such as high-resolution manometry and barium swallow studies, EndoFLIP provides real-time, intraoperative assessment of distensibility, compliance, and luminal geometry at the esophagogastric junction. As such, EndoFLIP may augment surgical precision in procedures such as Heller myotomy, fundoplication, and peroral endoscopic myotomy (POEM) by enabling physiologic calibration rather than reliance on static anatomical correction. We further discuss its evolving role in risk stratification, postoperative surveillance, and personalized foregut surgical planning. As the field moves toward functional and minimally invasive solutions, EndoFLIP may offer a data-driven framework to optimize patient outcomes through physiology-informed decision-making in real time.
Aim: Combined ablation and resection (CARe) is a recognized approach for managing multiple colorectal liver metastases (CRLM). Perioperative and long-term results of laparoscopic versus open CARe were evaluated in this study.
Methods: This retrospective multicenter cohort study included CRLM patients who underwent CARe at three hospitals between January 2018 and December 2023. Laparoscopic and open approaches were compared for perioperative and oncological results, with propensity score matching (PSM) applied to reduce baseline imbalance-related bias.
Results: Of the 107 CARe procedures, 65 (60.7%) were performed laparoscopically and 42 (39.3%) via open approach. After PSM, patients who underwent laparoscopic CARe had significantly lower intraoperative blood loss (55 vs. 100 mL, P = 0.028) and shorter postoperative hospital stays (6 vs. 8 days, P = 0.005) compared to those who underwent open surgery. However, the complication rates were comparable (P = 0.415). No differences in median recurrence-free survival (14.9 vs. 13.5 months, P = 0.781) or overall survival (70.9 vs. 48.7 months, P = 0.183) were observed. Notably, laparoscopic CARe group had a higher repeat resection rate following intrahepatic recurrence (52.94% vs. 20.00%, P = 0.036).
Conclusion: Laparoscopic CARe is a safe and effective approach for multiple CRLM, offering reduced perioperative morbidity and enhanced feasibility of repeat hepatic resection compared with the open approach.