Pub Date : 2026-02-01Epub Date: 2025-12-24DOI: 10.1016/j.gassur.2025.102306
Jeremias Elias Moreira , Ivana Ivanoff , Marco Santillán Pazmiño , Pedro Martín , Verónica Milesi , Pablo Stringa , Anastasios D. Giannou , Lucrecia Cúneo , Fernando Ogresta , Araceli Castro , Augusto Pellegrino Damelio , Martín Eleta , María Virginia Gentilini , Martín Rumbo , Gabriel Eduardo Gondolesi
Background
Primary abdominal wall closure after intestinal and multivisceral transplants remains a challenge. Avascular transplant of the abdominal rectus fascia (TxARF) has emerged as an alternative to reduce postoperative morbidity and mortality. This study aimed to evaluate tissue and immunological responses to TxARF in a rat model without immunosuppression.
Methods
A total of 34 TxARFs were performed in rats (17 isogenic [ISO] and 17 allogeneic [ALLO]), with recipients sacrificed at 30 and 120 days after surgery. Serum and graft samples were analyzed for donor-specific antibodies (DSAs), elasticity, cellular analysis by flow cytometry, histopathology, and immunohistochemistry for CD3+ cells.
Results
Muscle fiber loss was observed at 30 days, with collagen content significantly higher in ALLO (55.97 ± 3.68) and ISO (33.13 ± 3.85) groups than controls (3.78 ± 0.47) (P <.0001). The lateral portions of the grafts showed more large blood vessels, whereas the medial areas had small vessels. The ALLO group exhibited increased resistance to stretching and elasticity loss. Despite the lack of immunosuppression, CD3+ levels in all groups were similar to controls, with only 1 animal showing a positive DSA response.
Conclusion
Long-term changes include muscle fiber replacement with fibrosis and loss of elasticity, especially in the alloreactive group. No significant immune response occurred, confirming the fascia’s low immunogenicity.
{"title":"Biological, mechanical, and immune changes in an abdominal rectus fascia transplant model in rats","authors":"Jeremias Elias Moreira , Ivana Ivanoff , Marco Santillán Pazmiño , Pedro Martín , Verónica Milesi , Pablo Stringa , Anastasios D. Giannou , Lucrecia Cúneo , Fernando Ogresta , Araceli Castro , Augusto Pellegrino Damelio , Martín Eleta , María Virginia Gentilini , Martín Rumbo , Gabriel Eduardo Gondolesi","doi":"10.1016/j.gassur.2025.102306","DOIUrl":"10.1016/j.gassur.2025.102306","url":null,"abstract":"<div><h3>Background</h3><div>Primary abdominal wall closure after intestinal and multivisceral transplants remains a challenge. Avascular transplant of the abdominal rectus fascia (TxARF) has emerged as an alternative to reduce postoperative morbidity and mortality. This study aimed to evaluate tissue and immunological responses to TxARF in a rat model without immunosuppression.</div></div><div><h3>Methods</h3><div>A total of 34 TxARFs were performed in rats (17 isogenic [ISO] and 17 allogeneic [ALLO]), with recipients sacrificed at 30 and 120 days after surgery. Serum and graft samples were analyzed for donor-specific antibodies (DSAs), elasticity, cellular analysis by flow cytometry, histopathology, and immunohistochemistry for CD3+ cells.</div></div><div><h3>Results</h3><div>Muscle fiber loss was observed at 30 days, with collagen content significantly higher in ALLO (55.97 ± 3.68) and ISO (33.13 ± 3.85) groups than controls (3.78 ± 0.47) (<em>P</em> <.0001). The lateral portions of the grafts showed more large blood vessels, whereas the medial areas had small vessels. The ALLO group exhibited increased resistance to stretching and elasticity loss. Despite the lack of immunosuppression, CD3+ levels in all groups were similar to controls, with only 1 animal showing a positive DSA response.</div></div><div><h3>Conclusion</h3><div>Long-term changes include muscle fiber replacement with fibrosis and loss of elasticity, especially in the alloreactive group. No significant immune response occurred, confirming the fascia’s low immunogenicity.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102306"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145843759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-15DOI: 10.1016/j.gassur.2025.102303
Sergio Carandina , Salvatore Avallone , Viola Zulian , Francesco Angrisani , Luigi Angrisani , Antonio Iannelli
Background
Preoperative esophagogastroduodenoscopy (EGD) is a key component of revisional bariatric surgery workup. However, the completeness and surgical relevance of reports may vary depending on whether the examination is performed by a gastroenterologist or a bariatric surgeon. This study aimed to compare the diagnostic completeness and surgical relevance of preoperative EGD reports performed by gastroenterologists with that performed by bariatric surgeons in candidates for revisional bariatric surgery.
Methods
This was a retrospective study that reviewed 88 patients who underwent revisional bariatric surgery after sleeve gastrectomy (SG) or gastric bypass (GB) between January 2024 and April 2025 in 2 bariatric centers in France. Patients were divided into 2 groups: group G (endoscopy by gastroenterologists [n = 44]) and group S (endoscopy by bariatric surgeons [n = 44]). Each report was evaluated using a standardized checklist of surgery-relevant items. The primary endpoint was the Completeness Index (CoI; percentage of mandatory items documented). The secondary endpoints included use of objective measurements, classification of sleeve dilation, documentation of bile reflux, and structured reporting.
Results
In the SG subgroup (n = 48), reports by surgeons achieved higher CI scores than those of gastroenterologists (93.5% ± 10.3% vs 69.6% ± 10.6%, respectively; P <.0001). Sleeve dilation classification and bile reflux were consistently documented by surgeons but rarely by gastroenterologists. In the GB subgroup (n = 40), surgeon-performed reports also showed greater completeness than gastroenterologist-performed reports (88.7% ± 11.4% vs 41.2% ± 9.1%, respectively; P <.0001), with more frequent documentation of pouch size, anastomosis diameter, and configuration. Both groups described anatomical landmarks, such as the esophagogastric junction, comparably.
Conclusion
Surgeon-performed EGD provides more complete, surgery-oriented information than gastroenterologist-performed examinations, particularly regarding sleeve morphology, pouch size, and anastomotic configuration. Structured reporting and collaboration are essential for optimizing preoperative evaluation in revisional bariatric surgery.
背景:术前食管胃十二指肠镜检查(EGD)是矫正减肥手术检查的关键组成部分。然而,报告的完整性和外科相关性可能会因检查是由胃肠病学家还是减肥外科医生进行而有所不同。目的:比较胃肠病学家和减肥外科医生对改进性减肥手术患者术前EGD报告的诊断完整性和手术相关性。背景:法国的两个减肥中心。方法:我们回顾性分析了2024年1月至2025年4月期间88例在套管胃切除术(SG)或胃旁路手术(GB)后接受矫正性减肥手术的患者。患者分为两组:G组(胃肠内科医生内镜检查,n=44)和S组(减肥外科医生内镜检查,n=44)。每个报告都用标准化的手术相关项目清单进行评估。主要终点是完整性指数(记录的强制性项目的百分比)。次要终点包括使用客观测量、套筒扩张分类、胆汁反流记录和结构化报告。结果:在SG亚组(n=48)中,外科医生报告的完整性指数得分高于胃肠病学医生(93.5±10.3% vs 69.6±10.6%)。结论:外科医生进行的EGD比胃肠病学医生进行的检查提供了更完整的、以手术为导向的信息,特别是在套状形态、袋大小和吻合口结构方面。结构化的报告和协作对于优化改良减肥手术的术前评估至关重要。
{"title":"Preoperative endoscopy in revisional bariatric surgery: who should hold the scope?","authors":"Sergio Carandina , Salvatore Avallone , Viola Zulian , Francesco Angrisani , Luigi Angrisani , Antonio Iannelli","doi":"10.1016/j.gassur.2025.102303","DOIUrl":"10.1016/j.gassur.2025.102303","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative esophagogastroduodenoscopy (EGD) is a key component of revisional bariatric surgery workup. However, the completeness and surgical relevance of reports may vary depending on whether the examination is performed by a gastroenterologist or a bariatric surgeon. This study aimed to compare the diagnostic completeness and surgical relevance of preoperative EGD reports performed by gastroenterologists with that performed by bariatric surgeons in candidates for revisional bariatric surgery.</div></div><div><h3>Methods</h3><div>This was a retrospective study that reviewed 88 patients who underwent revisional bariatric surgery after sleeve gastrectomy (SG) or gastric bypass (GB) between January 2024 and April 2025 in 2 bariatric centers in France. Patients were divided into 2 groups: group G (endoscopy by gastroenterologists [n = 44]) and group S (endoscopy by bariatric surgeons [n = 44]). Each report was evaluated using a standardized checklist of surgery-relevant items. The primary endpoint was the Completeness Index (CoI; percentage of mandatory items documented). The secondary endpoints included use of objective measurements, classification of sleeve dilation, documentation of bile reflux, and structured reporting.</div></div><div><h3>Results</h3><div>In the SG subgroup (n = 48), reports by surgeons achieved higher CI scores than those of gastroenterologists (93.5% ± 10.3% vs 69.6% ± 10.6%, respectively; <em>P</em> <.0001). Sleeve dilation classification and bile reflux were consistently documented by surgeons but rarely by gastroenterologists. In the GB subgroup (n = 40), surgeon-performed reports also showed greater completeness than gastroenterologist-performed reports (88.7% ± 11.4% vs 41.2% ± 9.1%, respectively; <em>P</em> <.0001), with more frequent documentation of pouch size, anastomosis diameter, and configuration. Both groups described anatomical landmarks, such as the esophagogastric junction, comparably.</div></div><div><h3>Conclusion</h3><div>Surgeon-performed EGD provides more complete, surgery-oriented information than gastroenterologist-performed examinations, particularly regarding sleeve morphology, pouch size, and anastomotic configuration. Structured reporting and collaboration are essential for optimizing preoperative evaluation in revisional bariatric surgery.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102303"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-16DOI: 10.1016/j.gassur.2025.102305
Enrique Biel , Juan Sánchez-Parrilla , Manuel Pera
{"title":"Dysphagia megalatriensis as differential diagnosis of recurrence in a long-term survivor of gastric cancer: an uncommon cause of dysphagia beyond the alimentary tract","authors":"Enrique Biel , Juan Sánchez-Parrilla , Manuel Pera","doi":"10.1016/j.gassur.2025.102305","DOIUrl":"10.1016/j.gassur.2025.102305","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102305"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-20DOI: 10.1016/j.gassur.2025.102287
Nicholas Galouzis, Evelyn V. Alexander, Maria Fotinos, Lusine Mesropyan, Carrie Luu, Mohammad R. Khreiss, Taylor S. Riall
Background
Optimal treatment of locoregional pancreatic cancer includes chemotherapy and surgical resection. Chemotherapy can be difficult to tolerate, requiring dose reductions or missed cycles. This study aimed to evaluate the rates of dose reduction and outcomes based on the relative dose intensity (RDI) of chemotherapy received.
Methods
This was a single-institution retrospective study (2020–2024) of patients who underwent curative-intent treatment of pancreatic malignancy with modified fluorouracil, leucovorin, irinotecan, and oxaliplatin (mFOLFIRINOX) or gemcitabine/nab-paclitaxel (Gem-Nab) and surgical resection. The total chemotherapy dose administered was recorded, and the outcomes were compared between patients who received <70% RDI and those who received ≥70% RDI of the standard dosing regimens.
Results
A total of 46 patients had complete dosing information (33 in the mFOLFIRINOX group and 13 in the Gem-Nab group). In addition, 56.5% of patients met the 70% threshold (60.6% in the mFOLFIRINOX group and 46.2% in the Gem-Nab group). Compared with patients who received ≥70% RDI, those who received <70% RDI were significantly older (65.7 ± 11.4 vs 73.0 ± 7.1, respectively; P =.01) and had a higher Charlson Comorbidity Index (4.5 ± 2.1 vs 5.9 ± 1.4, respectively; P =.02). Dose reduction was required in 59.0% of patients during treatment. Of note, 20% of patients who completed >5 months of treatment still received <70% RDI and had significantly worse survival (15.5 months in patients who received <70% RDI vs 40.5 months in patients who received ≥70% RDI; P =.05).
Conclusion
Dose reduction is common when treating resectable pancreatic cancer with mFOLFIRINOX or Gem-Nab. Just over half the cohort achieved the ≥70% RDI threshold. Time in months or cycles may not adequately define chemotherapy completion, as one-fifth of patients completed treatment by duration but failed to achieve the ≥70% RDI threshold, which affected survival.
{"title":"Chemotherapy dose intensity and outcomes in resected pancreatic cancer","authors":"Nicholas Galouzis, Evelyn V. Alexander, Maria Fotinos, Lusine Mesropyan, Carrie Luu, Mohammad R. Khreiss, Taylor S. Riall","doi":"10.1016/j.gassur.2025.102287","DOIUrl":"10.1016/j.gassur.2025.102287","url":null,"abstract":"<div><h3>Background</h3><div>Optimal treatment of locoregional pancreatic cancer includes chemotherapy and surgical resection. Chemotherapy can be difficult to tolerate, requiring dose reductions or missed cycles. This study aimed to evaluate the rates of dose reduction and outcomes based on the relative dose intensity (RDI) of chemotherapy received.</div></div><div><h3>Methods</h3><div>This was a single-institution retrospective study (2020–2024) of patients who underwent curative-intent treatment of pancreatic malignancy with modified fluorouracil, leucovorin, irinotecan, and oxaliplatin (mFOLFIRINOX) or gemcitabine/nab-paclitaxel (Gem-Nab) and surgical resection. The total chemotherapy dose administered was recorded, and the outcomes were compared between patients who received <70% RDI and those who received ≥70% RDI of the standard dosing regimens.</div></div><div><h3>Results</h3><div>A total of 46 patients had complete dosing information (33 in the mFOLFIRINOX group and 13 in the Gem-Nab group). In addition, 56.5% of patients met the 70% threshold (60.6% in the mFOLFIRINOX group and 46.2% in the Gem-Nab group). Compared with patients who received ≥70% RDI, those who received <70% RDI were significantly older (65.7 ± 11.4 vs 73.0 ± 7.1, respectively; <em>P</em> =.01) and had a higher Charlson Comorbidity Index (4.5 ± 2.1 vs 5.9 ± 1.4, respectively; <em>P</em> =.02). Dose reduction was required in 59.0% of patients during treatment. Of note, 20% of patients who completed >5 months of treatment still received <70% RDI and had significantly worse survival (15.5 months in patients who received <70% RDI vs 40.5 months in patients who received ≥70% RDI; <em>P</em> =.05).</div></div><div><h3>Conclusion</h3><div>Dose reduction is common when treating resectable pancreatic cancer with mFOLFIRINOX or Gem-Nab. Just over half the cohort achieved the ≥70% RDI threshold. Time in months or cycles may not adequately define chemotherapy completion, as one-fifth of patients completed treatment by duration but failed to achieve the ≥70% RDI threshold, which affected survival.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102287"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stage IV gastric cancer remains challenging to treat despite recent advances in systemic therapy. Among patients with favorable responses to chemotherapy, conversion surgery aiming for R0 resection has shown promise in improving survival. Immune checkpoint inhibitors (ICIs) have become a key component of systemic treatment, but their prognostic impact in the setting of conversion surgery remains unclear.
Methods
This retrospective single-center study included 98 patients with gastric cancer who received platinum-based doublet chemotherapy followed by minimally invasive surgery. Patients were stratified into ICI (n = 41) and non-ICI groups (n = 57). Perioperative outcomes, progression-free survival (PFS), and overall survival (OS) were evaluated using Kaplan–Meier analysis and Cox regression models.
Results
The median operative time was 345 min, and the median blood loss was 5 mL. R0 resection was achieved in 79.6% of cases, and the median hospital stay was 7 days. Clavien–Dindo grade ≥ II complications occurred in 12.2% of patients. ICI-treated patients had significantly longer PFS (hazard ratio [HR], 0.418; P =.0008) and OS (HR, 0.437; P =.024). R0 resection was independently associated with improved PFS (HR, 0.179; P <.0001) and OS (HR, 0.231; P <.0001). Multivariate analysis identified pathological N status, R0 resection, and ICI use as independent predictors of PFS.
Conclusion
Among patients who underwent conversion surgery in this real-world cohort, those treated with ICI-based chemotherapy demonstrated more favorable long-term outcomes than those treated with chemotherapy alone. Although our findings do not demonstrate a causal relationship of ICI therapy on resectability, they suggest that ICI-based chemotherapy may be associated with improved survival in appropriately selected patients with human epidermal growth factor receptor 2–negative stage IV gastric cancer. Prospective studies are warranted to clarify optimal indications and perioperative strategies for integrating ICI-based regimens into conversion treatment.
{"title":"A single-center retrospective study of conversion surgery in stage IV gastric cancer: association with immune checkpoint inhibitor-based chemotherapy","authors":"Yuki Ushimaru, Takeshi Omori, Kazuyoshi Yamamoto, Kei Yamamoto, Yasunori Masuike, Yoshitomo Yanagimoto, Norihiro Matsuura, Takahito Sugase, Takashi Kanemura, Ryota Mori, Masatoshi Kitakaze, Masahiko Kubo, Yasunari Fukuda, Hisateru Komatsu, Masaaki Miyo, Toshinori Sueda, Yoshinori Kagawa, Kunihito Gotoh, Shogo Kobayashi, Hiroshi Miyata","doi":"10.1016/j.gassur.2025.102301","DOIUrl":"10.1016/j.gassur.2025.102301","url":null,"abstract":"<div><h3>Background</h3><div>Stage IV gastric cancer remains challenging to treat despite recent advances in systemic therapy. Among patients with favorable responses to chemotherapy, conversion surgery aiming for R0 resection has shown promise in improving survival. Immune checkpoint inhibitors (ICIs) have become a key component of systemic treatment, but their prognostic impact in the setting of conversion surgery remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included 98 patients with gastric cancer who received platinum-based doublet chemotherapy followed by minimally invasive surgery. Patients were stratified into ICI (n = 41) and non-ICI groups (n = 57). Perioperative outcomes, progression-free survival (PFS), and overall survival (OS) were evaluated using Kaplan–Meier analysis and Cox regression models.</div></div><div><h3>Results</h3><div>The median operative time was 345 min, and the median blood loss was 5 mL. R0 resection was achieved in 79.6% of cases, and the median hospital stay was 7 days. Clavien–Dindo grade ≥ II complications occurred in 12.2% of patients. ICI-treated patients had significantly longer PFS (hazard ratio [HR], 0.418; <em>P</em> =.0008) and OS (HR, 0.437; <em>P</em> =.024). R0 resection was independently associated with improved PFS (HR, 0.179; <em>P</em> <.0001) and OS (HR, 0.231; <em>P</em> <.0001). Multivariate analysis identified pathological N status, R0 resection, and ICI use as independent predictors of PFS.</div></div><div><h3>Conclusion</h3><div>Among patients who underwent conversion surgery in this real-world cohort, those treated with ICI-based chemotherapy demonstrated more favorable long-term outcomes than those treated with chemotherapy alone. Although our findings do not demonstrate a causal relationship of ICI therapy on resectability, they suggest that ICI-based chemotherapy may be associated with improved survival in appropriately selected patients with human epidermal growth factor receptor 2–negative stage IV gastric cancer. Prospective studies are warranted to clarify optimal indications and perioperative strategies for integrating ICI-based regimens into conversion treatment.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102301"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-10DOI: 10.1016/j.gassur.2025.102300
Mayin Lin , John C. Hsieh , Miya C. Yoshida , Julie S. Hong , Christopher M. Foglia , Steven Y. Chao
{"title":"Impact of Medicaid expansion on treatment and outcomes in patients undergoing surgery for common colorectal conditions","authors":"Mayin Lin , John C. Hsieh , Miya C. Yoshida , Julie S. Hong , Christopher M. Foglia , Steven Y. Chao","doi":"10.1016/j.gassur.2025.102300","DOIUrl":"10.1016/j.gassur.2025.102300","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102300"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-10DOI: 10.1016/j.gassur.2025.102297
Shea Gallagher , Cameron Ghafil , Li Ding , Yu-Tung Wu , Edward Compton , Shivani Sundaram , Philip Paulson , Morgan Schellenberg , James Buxbaum , Matthew Martin , Kenji Inaba , Kazuhide Matsushima
Background
The management of foreign body ingestion (FBI) in the adult population varies widely given the lack of evidence-based guidelines. This study aimed to identify risk factors associated with the need for operative intervention in these cases.
Methods
This was a retrospective cohort study between July 2015 and January 2021. All adult patients (age ≥18 years) presenting after FBI were included. We collected and analyzed demographics and clinical outcomes data. Multivariable regression was used to identify foreign body (FB) characteristics associated with operative interventions.
Results
A total of 303 patient encounters were included. Ingested FBs were classified as sharp/pointed (64.7%), blunt (40.6%), magnetic (8.3%), or corrosive/battery (5.0%). Notably, 40% underwent endoscopic interventions, including esophagogastroduodenoscopy (35.3%) and colonoscopy (4.6%). Twelve patients (4.0%) underwent an operative intervention secondary to perforation or failure to progress. Patients with perforation or failure to progress had longer median FB lengths than patients without these complications (11.5 vs 3.0 cm; P <.001). On multivariate regression analysis, FB length was significantly associated with the need for operative intervention (odds ratio [OR], 1.67 for each centimeter increment; P <.001). The ingestion of sharp/pointed objects was associated with a lower risk of operative intervention (OR, 0.20; P =.04).
Conclusion
Adult patients who present after FBI can often be managed conservatively. The length of ingested objects seems to be more associated with the need for operative intervention rather than the shape. Early endoscopic removal of high-risk FBs should be considered when feasible.
背景:由于缺乏循证指南,成年人摄入异物的管理存在很大差异。本研究的目的是确定与这些病例需要手术干预相关的危险因素。方法:这是一项2015年7月至2021年1月的回顾性队列研究。所有摄入异物后出现的成年患者(年龄≥18岁)均纳入研究。我们收集并分析了人口统计学和临床结果数据。使用多变量回归来识别与手术干预相关的异物特征。结果:共纳入303例患者。误食异物分为尖锐类(64.7%)、钝性类(40.6%)、磁性类(8.3%)、腐蚀性类(5.0%)。40%的患者接受了内镜干预,包括食管胃十二指肠镜检查(35.3%)和结肠镜检查(4.6%)。12例(4.0%)患者因穿孔或进展失败而接受手术干预。与没有这些并发症的患者相比,穿孔或进展失败的患者的中位异物长度更长(11.5cm vs. 3.0cm)。结论:摄入异物后出现的成年患者通常可以保守治疗。摄入物体的长度似乎与手术干预的需要有关,而不是形状。在可行的情况下,应考虑早期内镜下切除高危异物。
{"title":"Predictors for operative intervention in adult patients with foreign body ingestion","authors":"Shea Gallagher , Cameron Ghafil , Li Ding , Yu-Tung Wu , Edward Compton , Shivani Sundaram , Philip Paulson , Morgan Schellenberg , James Buxbaum , Matthew Martin , Kenji Inaba , Kazuhide Matsushima","doi":"10.1016/j.gassur.2025.102297","DOIUrl":"10.1016/j.gassur.2025.102297","url":null,"abstract":"<div><h3>Background</h3><div>The management of foreign body ingestion (FBI) in the adult population varies widely given the lack of evidence-based guidelines. This study aimed to identify risk factors associated with the need for operative intervention in these cases.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study between July 2015 and January 2021. All adult patients (age ≥18 years) presenting after FBI were included. We collected and analyzed demographics and clinical outcomes data. Multivariable regression was used to identify foreign body (FB) characteristics associated with operative interventions.</div></div><div><h3>Results</h3><div>A total of 303 patient encounters were included. Ingested FBs were classified as sharp/pointed (64.7%), blunt (40.6%), magnetic (8.3%), or corrosive/battery (5.0%). Notably, 40% underwent endoscopic interventions, including esophagogastroduodenoscopy (35.3%) and colonoscopy (4.6%). Twelve patients (4.0%) underwent an operative intervention secondary to perforation or failure to progress. Patients with perforation or failure to progress had longer median FB lengths than patients without these complications (11.5 vs 3.0 cm; <em>P</em> <.001). On multivariate regression analysis, FB length was significantly associated with the need for operative intervention (odds ratio [OR], 1.67 for each centimeter increment; <em>P</em> <.001). The ingestion of sharp/pointed objects was associated with a lower risk of operative intervention (OR, 0.20; <em>P</em> =.04).</div></div><div><h3>Conclusion</h3><div>Adult patients who present after FBI can often be managed conservatively. The length of ingested objects seems to be more associated with the need for operative intervention rather than the shape. Early endoscopic removal of high-risk FBs should be considered when feasible.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102297"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Single-port mediastinoscopic radical esophagectomy represents the least invasive form of esophagectomy that avoids thoracotomy or thoracoscopy. However, conventional double-instrument approaches are constrained by a narrow operative field, often leading to limited mediastinal lymph node dissection and a risk of recurrent laryngeal nerve (RLN) injury. Although the introduction of continuous intraoperative nerve integrity monitoring (NIM) has markedly reduced the incidence of RLN palsy, the adequacy of lymphadenectomy remains a major concern. To address this limitation, we introduced a triple-instrument cervical approach to enhance operative visibility and precision.
Methods
Between May 2020 and April 2025, 48 consecutive patients with thoracic esophageal cancer underwent single-port mediastinoscopic radical esophagectomy with continuous NIM at our institution. Among these patient, 26 underwent a triple-instrument cervical approach, whereas 22 underwent a conventional double-instrument approach. Clinicopathological characteristics and perioperative outcomes were compared between the 2 groups.
Results
Triple-instrument access significantly increased the number of mediastinal lymph nodes retrieved (median: 22 [IQR, 7–46] vs 16 [IQR, 2–42]; P =.048), without significant differences in blood loss (median: 123 vs 63 mL; P =.266), RLN palsy (7.7% vs 4.5%; P =.881), or hospital stay (median: 14 days in both groups; P =.883). Multivariate analysis identified the triple-instrument technique as an independent predictor of high lymph node yield (odds ratio, 5.55 [95% CI, 1.19–25.8]; P =.029).
Conclusion
The triple-instrument cervical approach represents a technically feasible and oncologically sound refinement of single-port mediastinoscopic esophagectomy. By combining continuous NIM and improved ergonomics, this technique enhances mediastinal lymphadenectomy without increasing morbidity.
背景:单孔纵隔镜根治性食管切除术是一种微创的食管切除术,避免了开胸或胸腔镜手术。然而,传统的双器械入路受到狭窄手术野的限制,常常导致纵隔淋巴结清扫受限,并有喉返神经(RLN)损伤的风险。尽管术中持续神经完整性监测(NIM)的引入显著降低了RLN麻痹的发生率,但淋巴结切除术的充分性仍然是一个主要问题。为了解决这一局限性,我们引入了三器械颈椎入路来提高手术的可视性和精确性。方法:2020年5月至2025年4月,在我院连续48例胸段食管癌患者行单孔纵隔镜根治性食管切除术并持续NIM。其中26例采用三器械入路,22例采用常规双器械入路。比较两组患者的临床病理特征及围手术期结果。结果:三器械入路显著增加了纵隔淋巴结清扫数(中位数为22 [IQR 7-46] vs 16 [IQR 2-42], P = 0.048),出血量(中位数为123 vs 63mL, P = 0.266)、RLN麻痹(中位数为7.7% vs 4.5%, P = 0.881)和住院时间(两组中位数为14天,P = 0.883)无显著差异。多因素分析表明,三仪器技术是高淋巴结率的独立预测因子(优势比= 5.55,95% CI 1.19-25.8, P = 0.029)。结论:三器械宫颈入路是单孔纵隔镜食管切除术技术上可行、肿瘤上合理的改进方法。通过结合连续NIM和改进的人体工程学,该技术在不增加发病率的情况下加强了纵隔淋巴结切除术。
{"title":"Lymphadenectomy through a triple-instrument cervical approach: a technical advance in single-port mediastinoscopic radical esophagectomy for esophageal cancer","authors":"Shuhei Komatsu , Tomoki Konishi , Soichiro Ogawa , Yoshihisa Matsumoto , Yuji Fujita , Hisataka Matsuo , Yoshiaki Kuriu , Hisashi Ikoma , Kazuma Okamoto , Hirotaka Konishi , Hitoshi Fujiwara , Eigo Otsuji , Atsushi Shiozaki","doi":"10.1016/j.gassur.2025.102296","DOIUrl":"10.1016/j.gassur.2025.102296","url":null,"abstract":"<div><h3>Background</h3><div>Single-port mediastinoscopic radical esophagectomy represents the least invasive form of esophagectomy that avoids thoracotomy or thoracoscopy. However, conventional double-instrument approaches are constrained by a narrow operative field, often leading to limited mediastinal lymph node dissection and a risk of recurrent laryngeal nerve (RLN) injury. Although the introduction of continuous intraoperative nerve integrity monitoring (NIM) has markedly reduced the incidence of RLN palsy, the adequacy of lymphadenectomy remains a major concern. To address this limitation, we introduced a triple-instrument cervical approach to enhance operative visibility and precision.</div></div><div><h3>Methods</h3><div>Between May 2020 and April 2025, 48 consecutive patients with thoracic esophageal cancer underwent single-port mediastinoscopic radical esophagectomy with continuous NIM at our institution. Among these patient, 26 underwent a triple-instrument cervical approach, whereas 22 underwent a conventional double-instrument approach. Clinicopathological characteristics and perioperative outcomes were compared between the 2 groups.</div></div><div><h3>Results</h3><div>Triple-instrument access significantly increased the number of mediastinal lymph nodes retrieved (median: 22 [IQR, 7–46] vs 16 [IQR, 2–42]; <em>P</em> =.048), without significant differences in blood loss (median: 123 vs 63 mL; <em>P</em> =.266), RLN palsy (7.7% vs 4.5%; <em>P</em> =.881), or hospital stay (median: 14 days in both groups; <em>P</em> =.883). Multivariate analysis identified the triple-instrument technique as an independent predictor of high lymph node yield (odds ratio, 5.55 [95% CI, 1.19–25.8]; <em>P</em> =.029).</div></div><div><h3>Conclusion</h3><div>The triple-instrument cervical approach represents a technically feasible and oncologically sound refinement of single-port mediastinoscopic esophagectomy. By combining continuous NIM and improved ergonomics, this technique enhances mediastinal lymphadenectomy without increasing morbidity.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102296"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145708386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The RefluxStop procedure, shown to effectively eliminate gastroesophageal reflux disease (GERD) symptoms in clinical trial, has been offered at our clinic since 2020. Promising short-term outcomes in the initial cohorts have been published. The outcomes for 100 patients with a follow-up of at least 1 year have been presented.
Methods
A retrospective cohort study was conducted with the first 100 patients to reach the 12-month postoperative follow-up. The primary endpoint was symptom resolution, which was quantified using the GERD Health-Related Quality of Life (GERD-HRQL) score. The secondary effectiveness endpoints included patient satisfaction and proton pump inhibitor (PPI) use. Safety data were reported as surgical complications up to 90 days and device- or surgery-related complications during the 12-month follow-up.
Results
At baseline, 53% of the patients had a hiatal hernia of ≥4 cm, 66% of the patients had ineffective esophageal motility, and 46% of the patients reported preoperative dysphagia. The median GERD-HRQL score (0–75 points) decreased by 97.6% from 42.5 (IQR, 29.0–50.0) preoperatively to 1.0 (IQR, 0.0–5.0) at 12 months (P <.001). PPI use decreased from 94.8% at baseline to 5.2% at 12 months. Two cases of early device penetration to the stomach occurred, attributable to surgical technique with unduly tight pouch closure; no intervention was required. In addition, two patients (2%) required revision surgery for hiatal repair, with both having a hernia of >7 cm at baseline.
Conclusion
In this cohort of 100 patients with severe symptoms, the RefluxStop procedure resulted in excellent 12-month outcomes, with a median of 97.6% improvement in the total GERD-HRQL score, resolving GERD symptoms to a high level of satisfaction, even in patients with clinically complex conditions.
{"title":"Laparoscopic antireflux surgery with the RefluxStop implant for severe sufferers with complex disease: a retrospective study of the first 100 patients with 12-month follow-up at an early adopter institution","authors":"Joerg Zehetner , Norbert Niebuhr , Ioannis Linas , Ulf Kessler , Yannick Fringeli","doi":"10.1016/j.gassur.2025.102293","DOIUrl":"10.1016/j.gassur.2025.102293","url":null,"abstract":"<div><h3>Background</h3><div>The RefluxStop procedure, shown to effectively eliminate gastroesophageal reflux disease (GERD) symptoms in clinical trial, has been offered at our clinic since 2020. Promising short-term outcomes in the initial cohorts have been published. The outcomes for 100 patients with a follow-up of at least 1 year have been presented.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted with the first 100 patients to reach the 12-month postoperative follow-up. The primary endpoint was symptom resolution, which was quantified using the GERD Health-Related Quality of Life (GERD-HRQL) score. The secondary effectiveness endpoints included patient satisfaction and proton pump inhibitor (PPI) use. Safety data were reported as surgical complications up to 90 days and device- or surgery-related complications during the 12-month follow-up.</div></div><div><h3>Results</h3><div>At baseline, 53% of the patients had a hiatal hernia of ≥4 cm, 66% of the patients had ineffective esophageal motility, and 46% of the patients reported preoperative dysphagia. The median GERD-HRQL score (0–75 points) decreased by 97.6% from 42.5 (IQR, 29.0–50.0) preoperatively to 1.0 (IQR, 0.0–5.0) at 12 months (<em>P</em> <.001). PPI use decreased from 94.8% at baseline to 5.2% at 12 months. Two cases of early device penetration to the stomach occurred, attributable to surgical technique with unduly tight pouch closure; no intervention was required. In addition, two patients (2%) required revision surgery for hiatal repair, with both having a hernia of >7 cm at baseline.</div></div><div><h3>Conclusion</h3><div>In this cohort of 100 patients with severe symptoms, the RefluxStop procedure resulted in excellent 12-month outcomes, with a median of 97.6% improvement in the total GERD-HRQL score, resolving GERD symptoms to a high level of satisfaction, even in patients with clinically complex conditions.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102293"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-10DOI: 10.1016/j.gassur.2025.102299
Abu Bakar Hafeez Bhatti
{"title":"Invited commentary on “Minimally invasive surgery in hepatocellular carcinoma: evolving trade-offs of patient selection and recurrence risk”","authors":"Abu Bakar Hafeez Bhatti","doi":"10.1016/j.gassur.2025.102299","DOIUrl":"10.1016/j.gassur.2025.102299","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102299"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145743049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}