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Antral Preservation in Sleeve Gastrectomy: A Game Changer for Gut Health

The debate on the optimal distance between the starting point of gastric transection and the pylorus in laparoscopic sleeve gastrectomy (LSG) remains unresolved. Some opt for a shorter distance to maximize weight loss, while others prefer a longer distance, believing it offers protection against post-surgery issues like vomiting and gastroesophageal reflux disease (GERD). This meta-analysis compared the outcomes of 6-cm and 2-cm distances from the pylorus, favoring the former due to its potential to reduce postoperative vomiting, GERD, and leaks.

Review by Diab AF, Kim A (…) DuCoin CG et 4 al. in Obes Surg

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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TOETVA: Aesthetic Thyroid Surgery Learning Curve and Castle Tumor Case

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers a cosmetic edge over traditional thyroid surgery. Researchers assessed TOETVA’s learning curve and its effectiveness in treating carcinoma showing thymus-like differentiation (CASTLE) tumors. The study found longer operation times in TOETVA, but it excelled in skin numbness and cosmetic outcomes. The learning curve analysis revealed that a surgeon becomes proficient in TOETVA after about 50 cases. Also, diagnosing CASTLE tumors is tricky, requiring specific markers. TOETVA is a viable option with safety and aesthetic advantages.

Journal Article by Jin X, Huang Z, Guo P and Yuan R in Langenbecks Arch Surg

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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Predicting Postoperative Pneumonia in Esophageal Cancer Patients

Sarcopenia, a condition involving muscle loss, is common in esophageal cancer patients. This study delved into how sarcopenia, particularly during neoadjuvant chemotherapy (NAC), affects postoperative complications, especially postoperative pneumonia (PP). By analyzing 113 patients, they found that the criteria of the modified European Working Group on Sarcopenia in Older People (EWGSOP) before NAC had high sensitivity (100%) and reasonable specificity (75.8%) in predicting PP. Low body mass index and %vc before NAC were significantly linked to sarcopenia by the modified EWGSOP criteria. Ultimately, pre-NAC sarcopenia was a crucial predictor of postoperative pneumonia, suggesting the need for targeted interventions to prevent PP in these patients.

Journal Article by Nishi S, Miki Y (…) Maeda K et 8 al. in Dig Surg

© 2023 S. Karger AG, Basel.

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Optimal Inferior Mesenteric Artery Ligation in Colorectal Cancer Surgery

In colorectal cancer surgery, the debate about whether to perform high or low ligation of the inferior mesenteric artery (IMA) continues. This study compared the outcomes of both approaches and examined the extent of lymph node dissection of the IMA. The results, after matching patient groups, showed that high ligation was associated with better recurrence-free survival. However, it’s crucial to ensure thorough lymph node dissection even with high ligation. Positive IMA lymph nodes were linked to advanced cancer stages, and the location of IMA lymph node recurrences differed between the two ligation groups.

Journal Article by Nakamura Y, Yamaura T (…) Kuroda N et 6 al. in Dig Surg

© 2023 S. Karger AG, Basel.

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ERCP Vital in Managing Post-COVID-19 Cholangiopathy with Dismal Prognosis

Endoscopic findings reveal that post-COVID-19 cholangiopathy resembles secondary sclerosing cholangitis, affecting critically ill patients. It emerges early during intensive care, causing significant and often irreversible damage to bile ducts. Typical cholangiographic features include a centripetal pattern of bile duct destruction, “vanishing bile ducts,” and intraductal biliary casts. This condition is associated with peribiliary liver abscesses. The prognosis is grim, with a 1-year liver transplant-free survival rate of 44%. Endoscopic procedures, especially ERCP with cast removal, are invaluable for diagnosis, prognosis, and treatment.

Journal Article by Silke L, Donata G (…) Christian J et 11 al. in Am J Gastroenterol

Copyright © 2023 by The American College of Gastroenterology.

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Pretreatment Pan-Immune-Inflammation Value Predicts Neoadjuvant Immunochemotherapy Outcomes for Esophageal Cancer

Researchers assessed the Pan-Immune-Inflammation Value (PIV) as an indicator of neoadjuvant immunochemotherapy (NICT) response in esophageal squamous cell carcinoma. Among 218 patients, PIV was linked to achieving a pathological complete response. High PIV predicted poorer 3-year overall survival and disease-free survival compared to low PIV. PIV independently forecasted outcomes. A novel risk stratification model improved prognosis accuracy. This suggests that pretreatment PIV is a sensitive predictor for NICT effectiveness in esophageal cancer. Further prospective studies are needed to confirm these prognostic results.

Journal Article by Feng J, Wang L (…) Cheng X et 2 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Gender Bias in Colorectal Surgery Fellowship Recommendation Letters

An analysis of recommendation letters for colorectal surgery fellowship candidates revealed gender-based differences. Women applicants received longer short answer responses, while men applicants had lengthier letters. Furthermore, the study uncovered that men were often described with more technical skill-related terms, while women’s letters contained emotional and cognitive language. Recognizing these discrepancies is crucial for addressing gender bias in the surgical field and ensuring a more equitable application process for aspiring surgeons.

Journal Article by Oslock WM, Lansing SS (…) Husain S et 4 al. in Am J Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Understanding the Impact of Second Victim Syndrome (SVS) on Surgeons: A Scoping Review

A Scoping Review unpacked the underexplored realm of Second Victim Syndrome (SVS) in surgeons. SVS, affecting 50% of healthcare providers, often leads to enduring emotional turmoil, impacting personal lives and professional practices. The review emphasized that surgeons, due to their high-stress profession, also grapple with SVS. The study examined SVS’s prevalence, its psychological, physical, and professional consequences, and factors influencing surgeons’ responses. It underscores the need to enhance support systems for surgeons facing SVS and to tackle this issue head-on, considering its profound impact.

Journal Article by Chong RIH, Yaow CYL (…) Tan HK et 4 al. in Am J Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Active Learning Enhances Automated Recognition of Surgical Features in Esophageal Surgery

This study delves into “surgomics,” a method that customizes surgical outcome predictions using machine learning and real-time surgical data. The challenge? Gathering high-quality annotations from experts. To address this, the researchers investigated active learning (AL) to make annotation more efficient. They chose ten video-based features linked to intraoperative bleeding complications during robot-assisted esophagectomies. AL significantly improved the recognition of surgical instruments compared to traditional equidistant sampling. This work showcased the potential of AL to streamline the annotation process without compromising machine learning performance in recognizing crucial surgical features.

Journal Article by Brandenburg JM, Jenke AC (…) Wagner M et 22 al. in Surg Endosc

© 2023. The Author(s).

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Preoperative Weight Loss Program in Hepatocellular Carcinoma Patients with High BMI

Researchers investigated the impact of a weight-loss program (WLP) on patients with a high body mass index (BMI) before undergoing liver resection for hepatocellular carcinoma (HCC). In a study of 19 patients with a BMI of 25.0 or higher, WLP successfully led to weight loss without affecting short- or long-term surgical outcomes. The program improved liver function and immune-nutrition status while preserving skeletal muscle mass, offering a promising strategy for optimizing HCC patient health before surgery.

Journal Article by Saito Y, Morine Y (…) Shimada M et 8 al. in World J Surg

© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.

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