Scientific Programme

Oncologic right hemicolectomy (rHC) remains the only curative treatment for right-sided colon cancer. Despite its increasing complexity, this procedure is not centralized in many countries, underscoring the need for rigorous assessment and continuous improvement in surgical quality.

Benchmarking is a validated quality improvement tool. By defining best achievable outcomes as reference (i.e. benchmarks), it enables centers to evaluate their performance and identify weaknesses or areas for improvement.

This analysis aimed to establish benchmarks for outcome parameters in minimal-invasive rHC.

We analyzed data from consecutive patients with adenocarcinoma of the colon who underwent minimal-invasive rHC between July 2017 and June 2022 at 19 expert centers across five continents. Ideal cases were defined as elective surgeries for cT1-T3 tumors without distant metastases, major comorbidities, or significant prior abdominal surgeries. Benchmarks were derived for 19 clinically relevant surgical outcomes, including perioperative and oncological parameters, procedure-specific complications, overall morbidity, and mortality. Benchmarks were set at the 75^th percentile for negative outcomes and the 25^th percentile for positive outcomes across all centers’ medians.

Among 3154 patients, 686 (22%) qualified as ideal. The proportion of ideal cases varied widely across centers (range: 2 – 51%) (Figure 1). Key benchmarks at 3 months were overall morbidity ≤38%, major (Clavien-Dindo ≥3a) complications ≤8%, and 0% mortality.  Procedure-specific benchmarks were anastomotic leak ≤3%, and deep surgical site infections ≤6%. Finally, oncologic benchmarks included R0 resection rates 100% and ≥12 lymph nodes harvested ≥96.9% (Table 1). Ideal compared to non-ideal patients and centers performing ≥500 cases compared to <500 cases annually demonstrated superior outcomes.

This study demonstrates that, despite its complexity, minimally invasive rHC can be performed with low morbidity and high oncological accuracy. The established benchmarks provide a reference for centers striving to achieve excellence in this procedure.

Anastomotic insufficiency remains a devastating complication in colorectal surgery.

This study sought to develop a statistical model to predict the occurence of anastomotic insufficiency and support preoperative planning, helping to mitigate risks.

Data from the international prospective TaTME registry were analyzed. Random Forest and logistic regression models were developed to estimate the probability of anastomotic insufficiency, taking into account demographics and clinical variables.

A total of 2,262 patients from the registry were analysed and split in a training and test datased. Significant predictors identified by the models included BMI, age, tumor height, and hospital. The Random Forest model emphasized weight as a significant variable, while the logistic regression model highlighted gender as an important predictor. In both models, tumor height and hospital were independent predictors of anastomotic insufficiency. Logistic regression emerged as the superior model, exhibiting a higher predictive accuracy of 65% when compared to Random Forest.

This study successfully identified several critical preoperative risk factors for anastomotic insufficiency in colorectal surgery, including BMI, age, tumor height, and hospital-specific variability. The logistic regression model demonstrated better predictive power, making it a valuable tool for assisting surgeons in preoperative risk assessment.

Early-onset colorectal cancer (EOCC), defined as colorectal cancer (CRC) ≤ 50 years, has seen an alarming rising incidence in Western countries.

This study aims to analyze clinical, socio-economic, and oncological treatment differences between EOCC patients and those with later-onset colorectal cancer (LOCC).

This multicenter observational cohort study included CRC patients treated from 01/01/2023 to 30/06/2024 across 11 centers in Northwestern Switzerland. Data was collected through questionnaires and patient charts

We included 764 patients, thereof 58.9% male. Mean age was 42.1 for EOCC (n=80) and 70.8 years for LOCC (n=684). EOCC were more frequently non-Swiss (67.5% vs. 32.2%, p<0.001), reported greater financial hardship (p<0.001), had higher glucose consumption (>5 units/week) (48.8% vs. 35.2%, p=0.02), and more often had second-degree relatives with CRC (p=0.05). Childhood radiation exposure was higher in LOCC versus EOCC (94.6% vs. 88.8%, p=0.05). Most common EOCC symptoms were abdominal pain (54.6%) and rectal bleeding (50.6%) versus rectal bleeding (35.4%) and changes in bowel habits (25.3%) in LOCC. EOCC experienced longer time to diagnosis (7.2 vs. 4.2 months, p=0.03). At the 75th percentile, EOCC reached a higher UICC stage (IIIC) compared to LOCC (IIIA). Adjuvant therapy was more common in EOCC with colon cancer (52.4% vs. 35.2%, p=0.04) and rectal cancer (58.3% vs. 33.3%, p=0.02) than in LOCC. Defunctioning ostomies were more frequent in EOCC than LOCC colon cancer patients (13.2% vs. 3.2%, p=0.01), with no difference in rectal cancer patients (p>0.99). Overall, EOCC had shorter hospital stays (8.66 vs. 11.43 days, p=0.05), while ICU stays, retrieved lymph nodes, and operation time were comparable.

EOCC patients experienced diagnostic delays, more advanced disease at presentation, and notable socioeconomic and lifestyle disparities. These findings highlight the need for risk-adjusted screening programs and personalized diagnostic strategies to enable earlier detection and improved outcomes for individuals under 50.

Although multidisciplinary tumor boards (MDT) represent the gold standard for decision-making in cancer treatment, they require significant resources and may be susceptible to human bias. Artificial intelligence (AI), particularly large language models such as ChatGPT, has the potential to enhance or optimize the decision-making processes. The present study examines the potential for integrating AI into clinical practice by comparing MDT decisions with those generated by ChatGPT. 

The aim of this study is to evaluate the concordance between the therapeutic recommendations proposed by a MDT and those generated by a large language model (ChatGPT) for colorectal cancer. 

A retrospective, monocentric comparative study was conducted involving consecutive patients with newly diagnosed colorectal cancer discussed at our MDT. The pre-therapeutic and post-therapeutic MDT recommendations were compared with those of ChatGPT-4 in respect of concordance.  

In the pre-therapeutic discussions, complete concordance was observed in 72.5% cases, with partial concordance in 10.2% and discordance in 17.3%. For post-therapeutic discussions, the concordance increased to 82.8%. 11.8% of decisions displayed partial concordance, and 5.4% demonstrated discordance. It is noteworthy that discordance was more frequent in patients > 77 years and with ASA ≥ III. 

There is a substantial concordance between the recommendations generated by ChatGPT and those provided by traditional MDT, indicating the potential utility of AI in supporting clinical decision-making for colorectal cancer management. 

Multimodal treatment of rectal cancer involves a combination of radiotherapy (RT), chemotherapy, and surgery. There has beena an increasing interest in organ preservation strategies. Response strongly correlates with RT dose, but dose escalation with external beam remains limited. Papillon is an endocavitary Radiotherapy device,which delivers low energy X-rays, allowing for safe dose escalation and better complete response rate directly at the tumour location.

This study reports on the use of Papillon in a swiss cohort

Retrospective study on a prospective database of all patient treated between January 2015 and end of 2024.

Inclusion criteria: small tumors (< than 3 cm), for larger tumors after a standard CRT and a median interval of 3 weeks

Application of the boost according to the OPERA trial protocol

Assessment at 6 weeks after the end of the Papillon , at 3 months and every 3-month interval for the first 2 years and every 6 months thereafter.

Kaplan Meier for local relapse and TME-free survival. Local relapse was defined as any visible tumor on rectoscopy and or MRI and confirmed by histology after achieving complete response. TME-free survival was defined as the organ preservation at 12 month

Between January 2015 and end 2024, 24 rectal cancer patients were treated with the addition of a boost delivered by Papillon to standard RT, with or without chemotherapy, in an upfront organ preservation strategy. After a median follow-up (FU) of   43 months, the organ preservation rate was 96% (23/24), and the local relapse rate was 8% (2/24). None of our patients developed grade 3 or more toxicities.

Our results demonstrate that the addition of Papillon contact RT provides a high rate of local remission with sustained long-term organ preservation, offering a promising alternative to traditional surgical approaches in patients with rectal cancer

The number of patients diagnosed with colorectal cancer under the age of 50 is increasing. The aetiology of early-onset CRC remains incompletely elucidated, with uncertainty surrounding potential contributory factors such as the prevalence of genetic alterations.

The objective of this study was to compare the prevalence of genetic alterations that are associated with CRC in early-onset colorectal cancer (EOCC) with late-onset colorectal cancer (LOCC).

The molecular profiles of patients diagnosed with locally advanced or metastatatic CRC between 2015 and 2023 in two large pathology departments were analyzed using targeted next-generation sequencing.

A total of 769 patients were included in this retrospective study (70 patients in the EOCC group and 699 in the LOCC group). The male:female ratio of patients was 59.7:40.3, with 27.4% (n=144) of patients diagnosed with UICC Stage III and 51.33% (n=270) with Stage IV disease. In the EOCC group, 67.7% (n=46) of patients had a KRAS mutation compared to 68.1% (n=469) in the LOCC group (p=1.0). The percentage of patients with a BRAF mutation in the EOCC group was 84.1% (n=58) compared to 86.5% (n=602) in the LOCC group (p=0.58). NRAS mutations were detected in 97.1% (n=66) of EOCC patients and 96.7% (n=666) of LOCC patients (p=1.0). TP53 mutations were found in 53.1% (n=26) of EOCC patients and 55.5% (n=257) of LOCC patients (p=0.76), while SMAD4 mutations were found in 6.12% (n=3) of EOCC patients and 10.6% (n=49) of LOCC patients (p=0.46). There was no difference in the presence of microsatellite instability between the two groups.

No significant differences were observed for the commonly known mutations in this medium-sized cohort of advanced CRC. Future molecular studies of EOCC might rather focus on epigenetic factors than particular mutational patterns.

Lymph node metastases (LNM) have an important prognostic value in colorectal cancer (CRC) and staging intends to determine adjuvant treatment. Lymph node ratio, defined as the proportion of positive lymph nodes compared to the total amount of resected lymph nodes, seems to have an important prognostic impact while taking the quality of lymphadenectomy and number of resected lymph nodes into account compared to the conventional N-stage. Previous studies could demonstrate better prognostic predication of LNR compared to conventional N-stage.

We aimed to evaluate the prognostic impact of LNR on the outcome of patients with CRC.

This is a unicentre retrospective cohort study. We included all patients undergoing surgical resection for colorectal cancer between 2014 and 2022 in a specialised centre in Switzerland. We used predefined LNRs from previous publications in CRC. Survival rates according to N-stage and LNRs were analysed using uni- and multivariate Cox regression.

493 patients were included. The median number of resected lymph nodes was 28. 5-year overall survival (OS) was 94% in N0-stage (n=301/493). Patients with LNMs (n=192/493) had decreasing 5-year overall survival (72% with pN1 and 52% in pN2). LNR showed decreasing 5-year OS with increasing LNR (50% in LNR2, 36% in LNR3 and 30% in LNR4, p < 0.001). Additionally, disease free survival (DFS) showed the same dynamic with 50% 5-year DFS in LNR2-3 and 33% in LNR 4 (p = 0.002). While most of the N1-stage patients showed LNR1, 4/122 (3%) had LNR2-3 and therefore a poorer prognosis.

The predefined LNRs should be standardly used for risk stratification in CRC as they add to the prognostic value of the conventional N-stage. LNR allows to predict 5 year OS and DFS more precisely than conventional N-stage.

Colorectal cancer (CRC) affects 4.5% of the general population, with 15% involving the right colon. Surgery, when feasible, varies from conventional right colectomy to Complete Mesocolic Excision (CME). Although better oncological outcomes were reported in the literature after CME, there is an acknowledged higher risk of operative vascular lesions. Various approaches have been proposed to facilitate CME, such as the “open book” model and 3D modelling of the mesenteric vessels, however CME remains technically challenging.

Our study aims to analyze whether preoperative CT imaging with vascular mapping (PVM) of the superior mesenteric vessels could offer guidance on the vascular anatomy during CME.

This prospective, monocentric study aims to include 30 patients undergoing CME for right CRC. Preoperatively, a biphasic CT scan with 3-D vascular reconstruction of the superior mesenteric vessels is performed. Vascular distances are calculated based on CT, then compared to intraoperative documentation of the mesenteric vessels (Figure 1). Primary outcomes are the surgeons’ evaluation of the benefit of vascular mapping and the statistical correlation of the vascular distances between CT guidance and operative finding.

To this day, 22 patients have been included. Surgeons found the preoperative vascular mapping very useful (3.58/5 on a Likert scale). Mean operation time was 263 minutes, with a mean of 36 lymph nodes harvested and no vascular lesions. Postoperative ileus occurred in 27% (6/22), Clavien-Dindo complications III-V in 13,6% (3/22) with one anastomotic leak (4,5%) and one death after discharge at home of unknown cause. Statistical analysis of the vascular distances will be performed upon completion of the study.

Our preliminary data suggest that PVM may be a valuable tool for reducing the risks associated with CME and aiding vascular ligation in this complex surgical technique. Further studies are required to asses PVM utility in CME and confirm these outcomes.

Modern surgical guidance in oncologic colerectal resections can be enhanced by visualizing lymphatic flow during surgery, informing the extent of lymphadenectomy and the precise extent of digestive resection. Indeed, lymphadenectomy is mandatory in a curative procedure.

The objective of the present work is to review the practice and impact of indocyanine green fluorescence imaging for real-time identification of lymphatic flow and especially sentinel nodes in patients undergoing elective surgery for colorectal cancer.

A systematic review was conducted to identify relevant studies on sentinel node mapping using indocyanine green (ICG) in colorectal cancer surgery. A comprehensive search was performed in electronic databases including PubMed, Embase, and Cochrane Library from inception to December 2024. The search strategy incorporated relevant keywords and MeSH terms, combining variations of "colorectal neoplasms," "sentinel lymph node," "indocyanine green," and related terms. The search was limited to articles published in English language.

A total of 337 relevant studies were identified and screened. Among them, 45 studies were considered for eligibility, and 12 were ultimately included in the systematic review. ICG-FI has not yet demonstrated superiority over the standard blue dye technique. Moreover, a notable heterogeneity existed among the reported studies concerning ICG dosage, injection methods, and the definition of positive LN status, making direct comparisons challenging.

 Despite the potential demonstrated in other oncological resections, ICG-FI requires further investigation and standardization, both in protocols and indications to fully harness its capabilities for SLN detection in CRC. This is particularly important for the reliable detection of metastatic lymphnodes. Larger patient populations should be considered in future research to comprehensively assess the efficacy of ICG-FI. This systematic review serves as a valuable resource for researchers and clinicians interested in utilizing ICG-FI for SLN detection in colorectal cancer, yet it also highlights the need for further standardization in this area of study.

It remains uncertain whether robotic inguinal hernia repair offers advantages over conventional minimally invasive techniques.

To evaluate postoperative pain following robotic transabdominal preperitoneal repair (rTAPP) compared to conventional totally extraperitoneal repair (TEP).

Prospective, blinded, 2-group, randomized single-center trial conducted at a tertiary healthcare institution in Switzerland including 182 patients with uni- or bilateral inguinal hernias. Patients were 1:1 randomized to undergo rTAPP or TEP with postoperative pain on a numeric rating scale (NRS 0 - 10) while coughing 24 hours postoperative as the primary outcome. Secondary endpoints included the assessment of multiple pain and quality of life questionnaires, intra- and postoperative complications, procedure time and the surgeon’s workload, measured using the NASA task-load-index.

91 patients (94.4% male, mean age 55.1 +/- 14.5 years, mean BMI 24.6 +/- 2.9 kg/m2, 21.1% bilateral hernias; p = n/s) were randomized to undergo rTAPP and 91 patients (93.4% male, mean age 56.8 +/- 15.2 years, mean BMI 24.8 +/- 3 kg/m2, 22% bilateral hernias) to TEP respectively. Postoperative pain 24 hours after surgery while coughing was 4.52 +/- 2.6 after rTAPP and 4.73 +/- 2.55 after TEP (p = 0.56). 30-days postoperative comprehensive complication index was 1.37 in rTAPP and 1.63 in TEP (p = 0.99). Procedure time for unilateral repair was 79 +/- 15.2 minutes in rTAPP and 64 +/- 15.2 minutes in TEP (p < 0.001). Overall surgeon’s workload was lower in rTAPP compared to TEP (Pillai's Trace = 0.45, F(6, 174) = 12.34, p < .001)

rTAPP and TEP result in comparable postoperative pain, length of stay and complication rates. Surgeons' workload was lower in rTAPP at the cost of a longer operative time. Recurrence rates and cost analysis will be reported 1 year after.

Although biosynthetic mesh is being increasingly used to treat ventral incisional hernias (vIH), there is a paucity of data derived from non-industry-sponsored studies.

Aim of the present study was to compare i) postoperative Surgical Site Occurrences (SSO) and ii) viH recurrence in patients operated with non-absorbable synthetic versus slowly absorbable biosynthetic mesh.

Adult patients who had vIH repair surgery in our tertiary referral hospital between 01.01.2017 and 31.12.2023 were retrospectively assessed. Demographics and surgical outcomes were compared between patients with synthetic (S) versus biosynthetic (BS) vIH mesh repair. SSO were defined as surgical site seroma, infection or hematoma. Standard univariable and multivariable logistic analysis were performed, with significance threshold at p<0.05.

Overall, 95 patients were included in the present study (57.9% males, mean age 63±14years); 56 (58.9%) patients were in the S and n=39 (41.1%) in the BS group. No differences in baseline characteristics or comorbidities were observed. SSO were documented in 48.2% S versus 43.6% BS patients (p=0.657), but seroma rates were increased in S patients (25% versus 5.1% BS, p=0.011). Mesh type was not associated with SSO in multivariable analysis (aOR 0.67, 95%CI 0.23-1.94). Overall 90-day morbidity was comparable, although BS patients had higher readmission rates (17.9% vs 3.6% S, p=0.019). vIH recurrence was observed in 5.4% S vs 7.7% BS patients (p=0.687), with similar mean recurrence intervals (456d S versus 625d BS, p=0.100).

In the present study, vIH repair with a slowly absorbable biosynthetic mesh was associated with similar overall SSO and hernia recurrence rates as a non-absorbable synthetic mesh.

Patients who undergo open abdominal aortic aneurysm (AAA) repair via a midline laparotomy face a 3-fold increased risk of developing an incisional hernia (IH) postoperatively. Recent guidelines in vascular surgery strongly recommend prophylactic mesh reinforcement (PMR) during abdominal wall closure for AAA to reduce the incidence of incisional hernias (IH).

This study aims to evaluate the effectiveness of retromuscular PMR in reducing the incidence of IH after AAA repair, as well as to assess secondary postoperative complications.

This retrospective study includes patients who underwent elective AAA repair with PMR in our institution between 2019 and 2024. Patients' demographics, operative details and postoperative complications were collected from patient’s records. Follow-up consisted in clinical examinations at least one year post-surgery, abdominal ultrasounds (Figure 1, 2 and 3) and EQ-5D-5L questionnaires. The primary outcome was the incidence of IH, secondary outcomes included the incidence of fascial dehiscence, seromas and surgical site infections. Descriptive statistics were used to evaluate both the primary and secondary endpoints.

Twenty-one patients were included. The median follow-up period was 32 months. The overall incidence of IH was 19% (4 cases): three hernias occurred in patients who had been re-operated with incision and closure of the mesh; the fourth was identified through ultrasound examination without any clinical correlation. Re-laparotomy seemed to be a relevant risk factor for hernia development, but the sample size and study configuration limited our ability to confirm a significant association. None of patients developed fascial dehiscence, seromas or surgical site infections (Table 1 and 2). Quality of life was reported to be largely preserved, with most experiencing little to no functional impairment and an average general health score of 80%.

This study provides clinical evidence supporting the application of recent guidelines in vascular surgery regarding the use of retromuscular PMR.

Registration number: Observational study NCT06762561 (https://www.clinicaltrials.gov)

The Lumbar Hernia is a rare entity, there are about 300 cases described in the literature.

It seems to be a once in a lifetime opportunity for a surgeon to treat a lumbar hernia.

The defect lays in the lumbar muscles below the 12th rib and above the iliac crest

There are two types described, the superior lumbar hernia (Grynfeltt-Lesshafthernia) which is more common and the inferior lumbar hernia (Petit hernia)

A 71 year old lady presented with a pain and swelling in the right lumbal aerea for several months. 

The MRI which was ordered by her family doctor showed the clear immage of a superior lumbar hernia.

We indicated an endocopic reapair for this hernia, which can be done laparoscopically (intraperitoneal IPOM or extreperitoneal TAPP, TEP) or retroperitoneally TEP repair (rTEP).

We chose the rTEP, which is very well described in the articel by B.Li et al. "Retroperitoneal totally endoscopic prosthetic repair of a primary lumbar hernia" from 2020.

(Videopresentation)

No postoperative complications occurred. 

Various surgical repair strategies have been recorded for the treatment of the umbar hernia, but there seems to be no currently unified standard.

In our patient RTEP could be performed safe and effective. A simple non coated polypropylene mesh can be used.

Outpatient hernia surgery is increasingly practiced, in a global effort to optimize patient comfort and outcomes, as well as healthcare costs. Standardized patient selection criteria and postoperative pathway are key to limit the risk of unplanned hospital admissions after surgery.

The aim of the current study was to assess the outcomes of our institutional standardized outpatient hernia surgery program and identify factors potentially contributing to outpatient management failure (OMF).

All adult patients undergoing outpatient hernia repair in our tertiary referral center between 06.2013, and 12.2019 were retrospectively assessed. Primary endpoint was the rate of OMF, defined as unplanned hospital admissions and/or consultations for poor pain management. Demographic and surgical characteristics were compared to identify factors associated with OMF. The χ² test or Fisher’s exact test were used for categorical and Student’s t-test for continuous variables, with a significance threshold sat p < 0.05.

Overall, 405 patients were included in the present study. Mean age was 50 years (SD 15), and 85% (n=345) were male. Outpatient management failure (OMF) was observed in 3% (n=12) of all patients. Among demographic parameters, only ASA class was significantly higher in OMF patients (ASA 2-3 in 75% OMF versus 40% non-OMF patients, p=0.039). Bilateral inguinal hernia repair was performed in 41.7%OMS versus 10.4% non-OMF patients, p=0.009), whereas mean operative duration was longer in OMF patients (43.1 min versus 65.8min, p=0.019). Postoperative complications were observed in 5.7% in the whole cohort (50% in OMF versus 4.3% non-OMF patients, p<0.001). Persistent postoperative pain was also more frequent in OMF patients, in 1 week (p=0.033), 1 month (p=0.003) and 3 months (0=0.009) after surgery.

The implementation of a standardized pathway has achieved favorable outcomes in outpatient hernia surgery, with a low overall OMF rate of 3%. Patient- and procedure- related characteristics need careful assessment to optimize patient selection.

The use of robotic surgery for combined abdominal wall hernias, including multiquadrant hernias, is underexplored in the literature. While the prevalence of simultaneous hernias is not well documented, they represent a frequent clinical challenge.

This study aimed to evaluate the feasibility of a robotic approach for treating simultaneous umbilical, incisional, and inguinal hernias.

We retrospectively reviewed a prospectively maintained dataset of abdominal wall hernias to identify patients treated for combined hernias. Patients were divided into two groups based on the robotic docking technique, and the data were analyzed.

From January 2020 to December 2024, 30 patients underwent robotic combined hernia repair. 90% were male, with a mean age of 63.2 (49.8–76.6) years. Single docking was feasible for 30% patients with W1 median hernias with mean diameter of 2.8cm (1.4–4.2) combined with an unilateral inguinal hernia. Double docking was necessary for 70% of patients with wider (W1-3) median hernia defect, mean diameter of 4.0cm (1.2-6.8) or bilateral inguinal hernias. No intraoperative complications were reported. The mean operative time was 148.0 minutes (111.0–185.1) for the single docking and 230.7 minutes (152.1–309.3) for the double docking and the mean hospital stay was 2.1 days (1.5–2.7) for the single docking and 3.4 days (0.5–6.2) for the double docking. The morbidity rate was 11.1% for the single docking and 23.8% for the double docking, only with one reintervention was needed in the double docking. Most of the complications in both groups were surgical site occurrences, managed conservatively. At a mean follow-up of 19.2 months (4.2–34.2), no recurrences were observed.

Robotic multisite hernia repair is a safe and effective minimally invasive option. Single docking offers advantages but is limited to patients with median defects and unilateral inguinal hernias. For median defects combined with bilateral inguinal hernias, double docking is generally required.

Robotic-assisted surgery has been associated with enhanced precision and the potential to reduce postoperative complications in preperitoneal inguinal hernia repair. The novel Swiss robotic platform Dexter, designed as an open and adaptable system, integrates into conventional laparoscopic setups. It was introduced at our high-volume hernia center, where total extraperitoneal hernia repair (TEP) previously served as the standard of care.

This study aims to evaluate the clinical outcomes and feasibility of robotic transabdominal preperitoneal hernia repair (rTAPP) using the Dexter platform during the initial learning curve at a Cantonal Hospital in Switzerland.

From February to December 2024, consecutive patients undergoing Dexter-assisted rTAPP were prospectively enrolled in a database. Postoperative outcomes, including prolonged pain, were assessed during follow-up visits 6–8 weeks after surgery. Importantly, none of the participating surgeons had prior routine experience with robotic surgical platforms before Dexter's implementation.

A total of 66 patients (82% male, median age 61 years, IQR 54–71) underwent rTAPP, with 91% presenting bilateral hernias and 6 cases involving recurrences. The median operative times for bilateral and unilateral hernias were 108 minutes (IQR 93–140) and 90 minutes (IQR 79–109), respectively. Major postoperative complications (Clavien-Dindo grade ≥3) occurred in two patients (3%), both requiring relaparoscopy—one for pain out of proportion on postoperative day 1 and one for foreign body retrieval.

Follow-up data were available for 39 patients (70%). Among these, 83% reported no pain, 14% reported mild pain, and 3% reported moderate pain. There were no hernia recurrences observed during the follow-up period.

Dexter-assisted rTAPP can be safely implemented during the learning curve, demonstrating acceptable safety and feasibility. However, the learning curve is associated with prolonged operative times. Further studies with expanded robotic experience and longer follow-up are required to assess potential benefits, particularly in reducing chronic pain.

Minimally invasive surgery reduces recovery times and complications compared to open procedures. While laparoscopic surgery (LS) is widely used, robotic-assisted techniques (RS) like the DaVinci system are gaining recognition for enhanced precision and potential improvements in patient outcomes.

The aim of this project was to evaluate and compare the differences between RS and conventional LS across various surgical procedures.

Patients undergoing RS for transabdominal preperitoneal hernia repair (TAPP), right hemicolectomy, rectal resection, rectopexy and hiatus hernia repair between January 2019 and December 2022 were included. In addition, patients undergoing LS for the same procedures during this time frame were also included. Patient demographics, operative time, length of hospital stay, complications, costs, and remuneration were analysed retrospectively.

Overall, 88 patients were included. The 46 RS patients were younger than the 42 LS patients (62 vs. 69 years) but both groups had a similar distribution with regards to sex, weight, and Charlson Comorbidity Index.

RS had a significantly longer operative time (162 ± 84 minutes) compared to the LS group (127 ± 67 minutes, p=0.036). However, the RS patients had a shorter length of hospital stay (5.5 ± 4.5 days vs. 8.1 ± 7.1 days, p=0.038). There was no difference regarding complication rates (22% vs 19%, p=0.098).

Costs were not different between RS and LS (24367 vs. 23963 CHF, p=0.916). However, LS had a higher earning-cost balance (RS -2034 vs. LS 6319 CHF, p=0.002).

RS compared to LS is associated with a longer operative time, but a shorter hospital stay and comparable complication rates. Overall, however, LS seems to be more rewarding than RS.

The eTEP-RS technique has become a versatile approach for ventral hernia repair, offering a minimally invasive option while avoiding the risks of intraperitoneal mesh placement. Despite the growing popularity of robotic platforms for this procedure, many Swiss hospitals face limited access to such systems.

This video aims to demonstrate a laparoscopic eTEP-RS repair, emphasizing technical aspects and key anatomical landmarks. The objective is to provide a practical guide for surgeons with limited access to robotic systems who wish to expand their repertoire with a minimally invasive sublay technique.

The video includes high-quality intraoperative footage of a laparoscopic eTEP-RS repair. Step-by-step instructions are provided, focusing on trocar placement, dissection techniques, and achieving optimal visualization of the retromuscular space. The procedure demonstrates the feasibility of using standard laparoscopic instruments to accomplish a tension-free mesh placement.

The video illustrates the key steps of a laparoscopic eTEP-RS technique:

• Effective patient positioning and trocar placement
• Creation of the retromuscular space with visualization of anatomical landmarks
• Mesh placement and fixation
• Tips, tricks and pitfalls

The laparoscopic eTEP-RS technique provides an excellent alternative to open and robotic sublay repairs, enabling the placement of a large mesh in line with current guidelines. This video highlights the feasibility of performing eTEP-RS laparoscopically, making the technique accessible to surgeons in hospitals with limited robotic resources.

Enhanced-view total extraperitoneal plasty (eTEP) is a promising minimally-invasive technique for ventral hernia repair, allowing extensive retromuscular dissection and large mesh placement with low rates of wound complications and fast recovery. The learning curve, however, is flat and technical expertise is crucial for good outcomes.

The aim of this study is to analyze the difficulty and occurence of adverse events of 10 crucial steps in the eTEP procedure for ventral hernia repair. This may provide guidance for a safe introduction of eTEP for surgeons new to this technique.

All patients undergoing eTEP for primary or incisional ventral hernias between October 2023 and December 2024 at three centres were included in this prospective study. 10 crucial surgical steps were defined and each step was rated for its difficulty (0 – 5 points on a numeric rating scale) and analyzed for incidence of adverse events. Surgeon workload was measured using the NASA-Task-Load-Index.

A total of 118 patients underwent eTEP. Suture of the hernia defect was rated the most difficult step (2.49/5), followed by dissection of the hernia defect (2.45/5) and closure of posterior defects (2.19/5).

Common adverse events were pneumoperitoneum during dissection of the hernial sac (50.9%) and minor bleeding during dissection of the retromuscular plane (46.6%). A less common but more severe adverse event was injury to the linea alba in 5 cases during cross-over.

Mean operation time was 97 minutes, median length of stay was 2 days. Operative revisions were necessary in 3.4%. Mean mental and physical workload according to NASA-Task-Load-Index was 44 / 100 and 45 / 100 respectively.

eTEP is a technically challenging procedure with a relatively high surgeon workload, mainly due to suturing and hernia dissection. Detailed knowledge about possible adverse events and their frequency during the procedure is a helpful guide for mastering this technique.

Infrarenal aortic aneurysms with hostile neck anatomies are often treated by fenestrated/branched endovascular aortic repair or by open repair. Both strategies show a higher complication and mortality rate in literature than standard infrarenal endovascular aortic repair (EVAR).

We analyzed the outcome of abdominal aortic aneurysms (AAA) with hostile neck anatomies (HN) treated by EVAR with a conformable stentgraft system (CSS) at our institution.

From April 2019 until December 2024 all patients treated by CSS with HN in AAA were analyzed. We defined HN according to the Delphi Consensus (Marone et al, 2020) and asigned five risk factors (RF): neck length, width, angulation, thrombosis/calcification, conic/barrell shape. Technical success rate, short and long term outcome (30 day mortality, reintervention rate, sac behavior) were analyzed.

100 patients with HN were treated by CSS. Three patients showed a HN with 5 RF, 14 with 4, 20 with 3, 30 with 2, and 33 with one RF, respectively. The technical success rate was 99%. 29 patients showed an endoelak type IA (ELIA) in the angiogram and/or early postoperative CT scan, of these 28 ELIA were resolved after 6 weeks. 30 day mortality was 1%. The median and mean follow-up time was 14 and 20 months. 5 patients had no follow-up CT scan. 4 patients needed a neck related reintervention, two underwent cuff-implantations because of an early (patient with one RF) and a late onset ELIA (4 RF) and two RedoEVAR due to stentgraft migration (4 and 5 RF). In 72% of all patients we achieved sac shrinkage and in 21% sac stabilization.

Infrarenal sealing in HN seems to be a safe option with a good outcome and acceptable reintervention rate. This treatment strategy should be be considered more often and thus, avoiding higher risk surgical procedures.

Endovascular aortic aneurysm repair has become the standard for treating standard abdominal aortic aneurysms (AAA). For complex AAAs, such as juxta-/suprarenal, open surgical repair—entailing suprarenal clamping and, when necessary, reconstruction of the visceral/renal arteries—has historically been considered the gold standard. Nevertheless, newer fenestrated and branched endovascular techniques, provide a valid alternative. Recent ESVS guidelines recommend choosing between open and endovascular repair based on patient fitness, anatomy and preferences.

This study evaluates the results of open surgery for AAA of various complexities, focusing on complications and mortality.

This single-center retrospective study analyzed 185 consecutive patients who underwent open surgery for AAA and aorto-iliac aneurysms between 2017 and 2023. Primary outcomes were 30-days, and overall mortality, while secondary outcomes focused on postoperative complications, especially acute kidney injury (AKI).

Among the 185 patients, 85.95% were male, with a mean age of 70 years. The majority (70.27%) had infrarenal aneurysms, while 27.57% were juxtarenal and 2.16% suprarenal. The mean aneurysm diameter was 59.35 mm, and 73.51% were fusiform. Of the procedures, 83.78% were elective, with 96.22% performed via median laparotomy. Clamping was infrarenal in 67.57%, inter-renal in 12.43%, and suprarenal in 20%, with a mean renal ischemia time of 33.5 minutes. The 30-day mortality was 0.54%, while overall mortality, on a mean follow-up of 38 months, was 8.11%.

Postoperative complications included pulmonary insufficiency (16.22%), minor cardiac events (6.49%), acute limb (2.7%), colitis (2.16%), and spinal cord (1.08%) ischemia. AKI rate was 14.05%. 3.78% persist at 30-days, without long-term dialysis. Late complications included symptomatic incisional hernias (9.73%) and prosthesis infection (1.62%). Peri-operative reintervention rate (aortic and non-aortic related) was 8.11%.

Open surgery remains an effective and viable option for treating AAA, especially in complex cases unsuitable for endovascular repair. Managing cardio-pulmonary and renal function preoperatively is crucial for improving outcomes.

Physician-modified endografts (PMEGs) are increasingly used to treat complex abdominal aortic aneurysms (cAAA), especially when custom-made grafts are unfeasible. Despite their growing use, PMEGs lack standardization and are influenced by practitioner experience and institutional resources.

To evaluate PMEG practices and identify areas for standardization to guide future expert-driven recommendations.

A global cross-sectional survey was conducted using the EDDDIE platform, with 31 questions across six sections covering practitioner demographics, indications, device selection, planning, technical preparation, and free-text comments. Invitations were sent to 4,286 vascular specialists, supplemented by targeted outreach through professional platforms and social media. Responses were collected anonymously and analyzed using descriptive statistics and subgroup analyses.

Of the 1,542 respondendents who accessed the survey link, 227 from 30 countries completed it. Among participants, 40% reported limited PMEG experience, while 25% had performed over 30 procedures. PMEGs were most commonly selected for symptomatic cAAAs, ruptured juxtarenal AAAs, and perforating aortic ulcers (Fig.1). Confidence in addressing challenging anatomies (Fig.2), such as small target vessel diameters or severe stenosis, was significantly higher among practitioners with greater experience. Thoracic grafts were the most frequently used devices (52%), followed by bifurcated abdominal endografts (30%). Approximately 67% of respondents did not use 3D-printed templates, though 22% employed them routinely, often with in-house printing capabilities. Planning preferences for minimal proximal sealing zones varied widely, with 33% opting for at least 20 mm. Amognst technical modifications, preloading vessel fenestrations and using reducing ties showed significant variability based on practitioner experience.

The study underscores the differences in PMEG practices and the need for standardization to enhance patient safety and outcomes. Findings provide a foundation for further efforts to develope practice recommendations based on the areas of strong variability detected.

A staged treatment approach combining open arch repair with Frozen Elephant Trunk (FET) technique, Thoracic Endovascular Aortic Repair (TEVAR), and either Fenestrated or Branched Endovascular Aortic Repair (f/bEVAR) has emerged as a less invasive treatment of thoraco-abdominal aortic aneurysms extent I to III. Nevertheless, this approach imposes significant physiological stress, with the risk of postoperative complications after open repair and rupture in the interval between interventions.

This study analyses the early and late major adverse events (MAEs), including spinal cord ischemia (SCI) and stroke, target vessel instability, reinterventions and mortality rates after this combined treatment.

This is a single-centre retrospective study conducted in a high-volume tertiary aortic centre between January 2017 and December 2024. Patients treated with a combination of FET, TEVAR and f/bEVAR were included. All included patients had at least six months of follow-up. Outcomes were early and late major adverse events (MAEs), including spinal cord ischemia (SCI) and stroke, target vessel instability, reinterventions and mortality rates.

During this period, 500 patients received FET. 100 had afterwards TEVAR for distal FET extension. Twelve patients (seven males) with a mean age of 68.5 ± 6 years received an additional f/bEVAR. Spinal cord ischemia, stroke and 30-day mortality rates were 17% (2/12), 8% (1/12) and 8% (1/12), respectively. Liquor drainage was performed in 17% (2/12) patients. Two patients died during follow-up, one of which was aortic related. Two patients required reintervention during follow-up: one due to type Ib endoleak and another due to bridging stent occlusion of the truncus coeliacus and superior mesenteric arteries.

The staged approach combining FET, TEVAR, and FEVAR or BEVAR provides a feasible and durable solution for complex aortic diseases, with low mortality, acceptable complication rates, and low rate of target vessel instability. Further studies are needed to confirm long-term durability and safety.

Rupture of abdominal aortic aneurysm (AAA) after endovascular aortic repair (EVAR) is rare but represents a critical treatment failure. It poses a significant risk to patient outcome.

The objective of this study was to investigate incidence, causes, treatment options and clinical outcome in patients with ruptured AAA after EVAR (raE) in a single center cohort.

Out of all patients after EVAR between June 2008 and December 2024, we identified those sustaining raE. Data collection included endoleak (EL) type, treatment modality, technical success rate and 30-day mortality.

494 patients after EVAR were included in our surveillance program. Six cases of raE (1.2%) occurred.

The majority of patients underwent regular follow-up imaging after primary EVAR, with the last surveillance on average one year before rupture (range 0.1-3.3 years). The follow-up was uneventful with aneurysm shrinkage in five patients (83%) (mean shrinkage 10mm, range 0-27mm). No graft migration could be discerned.

The mean time interval between initial repair and raE was 3.9 years.

In two patients the cause of raE was an EL type I A, in two an EL type I B and in two an EL type III.

One patient underwent open repair, five were treated endovascularly. Technical success rate was 100%, 30-day mortality 0%.

Follow-up after EVAR is an important pillar of successful endovascular aneurysm treatment. But even with regular monitoring after EVAR and imaging showing sac shrinkage, there is a residual risk of aneurysm rupture, with EL type I and III leading to raE. The patients can be treated mainly endovascularly with a good outcome.

Durability after fenestrated/branched endovascular aneurysm repair B/FEVAR remains a concern, as both techniques have unique challenges due to their complex nature. Late type I or III endoleak (EL) is a rare complication after FEVAR. We describe the use of BEVAR with inner branches after failed FEVAR.

Three male patients (#1 82, #2 80 and #3 68 years old) presented with an expansion of the aortic sac after FEVAR with type Ia, type III and Ib, respectively. One custom-made inner branch (#1) and two (#2 and #3) off-the-shelf E-inside branched grafts (Artivion, NW, Kennesaw, GA 30144, USA) were used. Patient #1 presented with type Ia EL after previous 3x FEVAR due to juxtarenal AAA. Patient #2 had thoracic EVAR and 4- FEVAR for thoracoabdominal aortic aneurysm type III. Patient #3 was treated with a thoracic EVAR and with one fenestration physician-modified FEVAR for truncus coeliacus (TC) due to subacute Stanford B aortic dissection. Three months later patient presented to the emergency department with back pain and aneurysm progression. The TC branch and the bridging stent to TC could not be catheterized due to limited intraortal space, however, perfusion was provided via collaterals. Begraft Plus covered stents (Bentley, Hechinger, Germany) were used as bridging stents for all target vessels. Operating and fluoroscopy times were 325, 291, 322, and, 175, 133, and 127 minutes, respectively.

Patient 1# died six months after the procedure due to non-aortic related causes; patient #2&3 completed one-year and 6-months follow-ups without endoleak or target vessel instability.

Failed fenestrated repair can be successfully treated with custom-made or off-the-shelf branched devices with inner branches. The above-described approach is technically demanding but allows a novel-treating alternative.

Emergent repair of paravisceral aortic aneurysms (pAA) with in situ laser fenestration (ISLF) technique is associated with renovisceral ischemia due to the need to cover the target arteries prior to ISLF creation. We describe two alternative strategies of temporary gutter leak creation to ensure renovisceral perfusion during ISLF repair of symptomatic pAA.

A 79-year-old and an 83-year-old patient, deemed unfit for open repair, presented with a symptomatic pAA. A Cook Zenith Alpha tubular endograft (Cook Medical LLC, Bloomington, IN, USA) was used in both cases. All visceral vessels were pre-stented to serve as a guide marker during ISLF. Prior to the deployment of the endograft, a Cook Flexor 8F sheath (Cook Medical LLC, Bloomington, IN, USA) was placed in the superior mesenteric artery (SMA) (patient #1) (Figure 1), and a 6 x 200 mm angioplasty balloon (Figure 2) was placed between the endograft and the aortic wall (patient #2). Angiograms after visceral coverage confirmed perfusion of the renovisceral arteries through gutter endoleaks. Thereafter, ISLF and bridging stenting for SMA and the renal arteries were performed before the removal of the sheath or PTA balloon to stop the gutter leak. Both patients did not experience any intra- and postoperative complications. No clinical or laboratory signs of renovisceral malperfusion were detected.

The above-described techniques for gutter leak creation during emergent pAA repair with ISLF can potentially reduce reno visceral ischemia and increase the ISLF technique's safety.

The GORE^® EXCLUDER^® Iliac Branch Endoprosthesis (GoIBE) provides endovascular treatment of common iliac artery or aortoiliac aneurysms. It includes an iliac branch component and an internal iliac component (IIC) extending into the internal iliac artery (IIA). The latest instructions for use (IFU) were published in February 2022.

This study evaluates the utility of the current IFU by comparing outcomes between GoIBD implanted within and outside IFU criteria.

A retrospective review of patients undergoing GoIBE surgery between 2015 and 2023 at our institution was conducted, focusing on intraoperative success, postoperative outcomes, and reinterventions. The IFU criteria were analyzed, including femoral/iliac access, presence of aortoiliac or common iliac artery aneurysm, adequate sealing zones of the internal and external iliac artery, proximal landing zone diameter of the common iliac artery and use of an aortoiliac endoprosthesis.

Among 75 patients with 94 GoIBE implanted, 20 met all IFU criteria, while 74 were implanted outside IFU. In total 22 reinterventions were performed. 18 in the outside-IFU group and 4 in the within-IFU group (p=0.685). Postoperative complications were observed in 5 cases, each belonging to the outside-IFU group (p=0.581). Additionally 5 intraoperative complications occurred, all in the outside-IFU group (p=0.581). Two intraoperative IIA occlusions were recorded,  one additional occlusion occurred during follow-up.

There were no significant differences in intraoperative or postoperative complication rates between devices implanted within or outside IFU criteria, suggesting that deviations from the IFU do not inherently compromise procedural outcomes. Follow-up surgery rates were also comparable. Implanting the GoIBE outside IFU appears to be a safe and effective option, allowing for the preservation of the internal iliac artery in most cases.

Roux-en-Y gastric bypass may present long-term complications that require revisional surgery or even reversal to normal anatomy (Figure1). Data on the indications, surgical technique and outcomes of RYGB-reversal remain scarce.

To analyze indications, techniques and surgical outcomes after reversal of Roux-en-Y gastric bypass.

We identified 48 cases of RYGB-reversals with complete 90-day follow-up within a multi-centric international retrospective database of elective secondary bariatric surgery. The operations were performed between 2010–2024 in high volume referral centers in Europe and USA. Data were collected on body weight, associated diseases and on surgical outcomes up to 1-year postoperatively.

Patients were mainly female (81.3%) with a median age of 50 years (IQR 39-56). RYGB-reversal was performed 7 years (median) after primary RYGB in patients with a BMI 23.9 kg/m² (IQR 20-27). Half of the patients underwent at least 1 bariatric revision before the reversal. Main indications for reversal were dumping syndrome (33.3%), excessive weight loss (29.2%), marginal ulcer (14.6%), malabsorption (12.5%) and abdominal pain (10.4%). Rate of conversion to open surgery was 8.3% and the postoperative complications during the first year reached 50%, including 31.3% Clavien-Dindo grade I-II, 16.7% grade III-IV complications and one death. At 1-year, the mean BMI of the cohort increased by 18% to 28.25kg/m²; only 1 patient reached pre-RYGB BMI.

Although RYGB is a theoretically reversible procedure, normal anatomy is re-established only in selected cases which are refractory to medical therapy and often also to revisional bariatric surgery.  RYGB-reversals entail high morbidity, while the       extent of recurrent weight gain at 1-year post-reversal seems to allow patients to remain below the threshold of severe obesity.

Although surgical procedures like Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are highly effective, postoperative outcomes can differ significantly between individuals. These differences are shaped by a range of factors, including preoperative behaviors and psychological traits. Eating disorders (EDs), particularly binge eating, have been linked to less favorable weight loss outcomes following surgery. Certain guidelines even consider severe EDs as contraindications for bariatric surgery.

The aim of this study was to investigate the influence of different EDs on the postoperative outcome of patients undergoing bariatric surgery.

In a retrospective analysis of prospectively collected data, patients who underwent RYGB or SG between January 2010 and December 2018 were examined. Patients were categorized by preoperative eating patterns, including binge eating, snacking, and high consumption of sweets or fatty foods. Demographics, early morbidity, and five-year follow-up data on weight loss, comorbidities, and complications were collected. Outcomes were assessed using the SF-Bari Score, a composite endpoint integrating weight loss, comorbidity improvement, and surgical complications.

Among 1,550 patients, eating patterns varied widely, with most exhibiting multiple EDs. ED patients were younger with higher baseline BMI. Total body weight loss (TBWL%) was initially higher in ED patients but differences diminished over time. SF-Bari Scores were also higher in ED patients at 5 years. RYGB consistently showed lower BMI, higher TBWL%, and higher SF-Bari Scores than SG. RYGB yielded better outcomes for Binge and Sweet ED patients, while significant differences for Nightly ED appeared after 2 years. Female patients achieved greater weight loss and SF-Bari Scores overall.

Pre-operative EDs appear to have minimal or no significant impact on postoperative outcomes after bariatric surgery. These findings suggest the need to reconsider current guidelines, particularly the classification of severe EDs as contraindications for bariatric surgery. 

Sleeve gastrectomy (SG) is one of the most performed bariatric procedures, yet its association with gastroesophageal reflux disease (GERD) remains debated. A substantial proportion of patients develop de novo GERD (DN-GERD) following SG, likely due to anatomical and physiological changes, highlighting the need to identify potential preoperative predictors that could inform risk stratification and guide surgical technique.

This meta-analysis aims to identify preoperative predictors of DN-GERD after SG.

Relevant studies were retrieved from PubMed, Embase, and the Cochrane Library that reported DN-GERD incidence among SG patients without symptomatic preoperative GERD. Only studies that explicitly excluded patients with preoperative GERD and employed a standardized follow-up protocol (using a uniform DN-GERD diagnostic method) were included. A meta-analysis of proportions was performed using a random-effects model with logit transformation to account for heterogeneity.

Out of 2’977 studies, 29 satisfied inclusion (13’351 patients). The overall incidence of DN-GERD was 26.8% (95%CI 20.5%–34.2%) as shown in Figure 1. Further analyses were conducted grouping studies by diagnostic approach: 24 used symptom-based (S) assessment, yielding a 23.2% incidence (95%CI 17.3–30.3%); 11 employed endoscopy (E), reporting 17.9% (95%CI 11.7–26.3%); and 6 utilized 24-hour pH-monitoring (P), with 48% (95%CI 32.6-63.8%). Substantial heterogeneity prompted meta-regression and subgroup analyses. Male sex was linked to higher GERD rates in S group (p=0.0171). In E group, a <4cm dissection from the pylorus showed higher DN-GERD rates (p=0.0008), while no significant difference was observed based on Bougie size (≤36Fr vs. ≥38Fr; p=0.1617) as shown in Figure 2 and 3 respectively.

This meta-analysis underscores the considerable variability in DN-GERD incidence when assessed by symptoms, endoscopy, or pH monitoring. Male sex might predispose to symptomatic GERD. A <4cm dissection might lead to a higher reflux. Additional standardized studies are urgently warranted to further optimize these SG outcomes.

Glucagon-like peptide-1 (GLP-1) receptor agonists have transformed obesity treatment, offering a rapid and safe approach to significant weight loss. However, metabolic and bariatric surgery (MBS) remains an effective option, achieving total weight loss (TWL) of 25%–35% of presurgical body weight. The role of GLP-1 use prior to MBS in patients requiring surgery due to insufficient weight loss or weight regain after GLP-1 treatment remains largely unexplored.

This study aims to assess the potential effects of preoperative GLP-1 receptor agonist treatment on postoperative outcomes following MBS.

This retrospective, single-center study analyzed patients who underwent MBS between January 2022 and December 2023. Postoperative outcomes and 12-month %TWL were compared between patients with prior GLP-1 receptor agonist treatment and those without.

Among the 236 patients included, 70% (n=165) were female. The median age was 39 years (IQR 31–51), and the median BMI was 42 kg/m² (IQR 39–45). The median follow-up duration was 14 months, with 75% of patients having at least 12 months of follow-up. MBS procedures included Sleeve Gastrectomy (n=176, 74%) and Roux-en-Y Gastric Bypass (n=60, 25%). Half of the patients (n=118) received preoperative GLP-1 receptor agonist treatment (liraglutide or semaglutide). 69% (n=82) had treatment failure (>5% %TWL or >10% weight regain). Patient characteristics (except for dyslipidemia), operation time, length of stay, overall and major postoperative morbidity, and readmission rates were similar between the groups. However, %TWL at 12 months was significantly higher in patients without prior GLP-1 receptor agonist treatment (30% vs. 26%, p=0.043) especially when compared to patient with GLP-1 treatment failure (p=0.007).

Preoperative GLP-1 treatment may be associated with lower %TWL after bariatric surgery, potentially due to intrinsic factors or the effects of GLP-1 exposure. Further research is needed to clarify these mechanisms.

Obesity is a chronic disease associated with systemic dysfunction and increased risk of serious health conditions, requiring multifaceted treatment approaches. Although bariatric surgery remains the most effective option, pharmacotherapy—particularly glucagon-like peptide-1 receptor agonists (GLP-1 RAs)—has recently gained recognition as a promising alternative or complement to surgical intervention.

This study compares the outcomes of bariatric surgery in patients treated with and without preoperative GLP-1 receptor agonists, exploring their impact on weight loss, comorbidity resolution, and reasons for transitioning to surgery.

We conducted a retrospective analysis of patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2015-2020, excluding those with revisional surgeries, postoperative GLP-1 therapy, or pregnancies during follow-up. Patient outcomes, including weight loss, comorbidity resolution, and surgical complications, were assessed.

Among 192 eligible patients, 43 received GLP-1 therapy before bariatric surgery, while 149 did not. Baseline characteristics, including age, BMI, and surgery timing, were similar, though diabetes prevalence was higher in the GLP-1 group. No significant differences in weight loss, resolution of arterial hypertension, dyslipidemia and OSAS, or complication rates were observed during the three-year follow-up. Diabetes remission rates were significantly higher at three months in patients without prior GLP-1 treatment, but no differences were observed beyond this point. Both groups achieved "Fair response" SF-Bari Scores at all time points, with similar complication rates and severity. Patients in the GLP-1 group transitioned to surgery for definitive treatment, due to side effects or unavailability of medication.

Preoperative GLP-1 therapy does not appear to affect long-term weight loss outcomes, resolution of comorbidities or complications rates following bariatric surgery.

Over the last decades, obesity and its co-morbidities have reached pandemic dimensions. Nearly 60 percent of European adults are overweight. This disease leads to decreased quality of life, high mortality and immense socio-medical and socio-economic burden. Bariatric surgery, i.e. Roux-en-Y gastric bypass (RYGB), is still the most effective therapy with excellent long-term results. Nonetheless, weight regain and dumping syndrome occur in a relevant number of patients, often due to a dilatation of the gastrojejunal anastomosis. Transoral outlet reduction (TORe) as well as implantation of a MiniMIZER Ring (IMR) are less invasive treatment options than bypass revision which has been the standard treatment in the past.  

The aim of the study was to compare the effectiveness of IMR with TORe in patients concerning weight regain or insufficient weight loss and dumping syndrome after RYGB. 

A single-center retrospective data analysis of 105 patients who underwent IMR, TORe or both from January 2018 to March 2024 was performed. 56 patients underwent TORe only, ten IMR only and 39 both interventions (Table 1). Primary endpoint was weight stabilization or weight loss for subjects with weight regain and remission of symptoms for those with dumping syndrome. Secondary endpoints were length of hospital stay, perioperative complications and revisional procedures.

Patients after IMR more often accomplished weight loss or maintenance than those treated endoscopically (Figure 1: Follow-up at 48 months: 75 % after IMR versus 22 % after TORe). After IMR, more patients had a rapid and persisting dumping improvement compared to after TORe (Figure 2). Due to dysphagia after IMR ten patients needed surgical revision.  

IMR is a safe and effective therapy for weight regain and dumping syndrome after RYGB. IMR showed better mid-term results compared to TORe, but some patients suffered from dysphagia. A prospective randomized controlled trial for long-term results is recommended.  

Bariatric surgery is a well-established treatment for morbid obesity. However, primary bariatric surgery may not always succeed in weight loss and can cause relevant side effects. Current literature lacks clarity on which bypass method is superior in redo operations for weight loss and gastroesophageal reflux.

This study aims to compare the effectiveness of converting SG to either RYGB or OAGB in terms of weight loss and reflux control.

A multicenter retrospective study was conducted on 72 adult patients who underwent conversion from SG to RYGB or OAGB between February 2014 and June 2023. The primary endpoint was the reasons for reoperation following SG — specifically, reflux or weight gain —and to evaluate which reoperation technique, either RYGB or OAG, results in the best outcomes for reflux relief and weight loss. Secondary endpoints included changes in weight, BMI, surgery duration, overall complication rate, and postoperative endoscopic findings. 

Patients’ characteristics showed no difference. RYGB was performed on 34.7% of patients for reflux and 47.2% for excess weight, while 18.1% underwent OAGB for excess weight. There were no intraoperative complications, and six postoperative complications occurred.   Reflux symptoms significantly remitted in 95.8% of cases. The Kaplan-Meier analysis revealed no significant difference in weight loss between RYGB and OAGB procedures (RYGB HR 0.747, 95% CI 0.207-2.693, p=0.656). A Cox regression analysis showed no correlation with excess weight loss either (HR 1.863, 95% CI 0.479-7.253, p=0.369), even after adjusting for confounding variables.

Our study showed that conversion of SG to RYGB was effective for gastroesophageal reflux symptoms remission. For weight loss, both RYGB and OAGB seem to be equally effective during the follow-up.

Although sleeve gastrectomy (SG) is a commonly performed bariatric procedure, conversion to revisional Roux-en-Y gastric bypass (rRYGB) is a widely used method to treat patients who experience inadequate weight loss or recurrent weight gain. However, the long-term outcomes of rRYGB remain poorly studied.

This study aimed to evaluate the 10-year weight efficacy and outcomes of patients who underwent revisional RYGB after SG (Cohort 1; C1) and compare these results with those of patients who underwent primary RYGB (Cohort 2; C2).

This retrospective cohort study analyzed a 10-year follow-up of bariatric patients. Patients who experienced insufficient weight loss (<20% total weight loss [TWL]) or recurrent weight gain) underwent revisional RYGB (rRYGB) after SG (n=28). These patients were propensity score-matched (1:1 nearest neighbor matching, caliper = 0.2) with primary RYGB patients (n=105) based on age, BMI, and sex. The primary endpoint  was TWL%.

After matching, 27 patients were included in each cohort. The median follow-up time was 10.9 years for Cohort 1 (C1) and 10 years for Cohort 2 (C2). The mean TWL% was 27.8 ± 10.7 for C1 and 31.7 ± 17.7 for C2, while the median TWL% values were similar at 28.8 for C1 and 29.4 for C2. Statistical analysis revealed no significant difference between the cohorts (Wilcoxon rank sum test, p = 0.6672; Cliff’s Delta = -0.073, 95% CI: -0.370 to 0.237), indicating a negligible effect size.

This 10-year follow-up demonstrated that rRYGB after failed SG achieves comparable long-term weight loss outcomes to primary RYGB.

Carpal tunnel syndrome is the most common entrapment syndrome of a peripheral nerve and is causing pain, sensory deficits and atrophy of the thenar.

The functional deficit due to paralysis of the median nerve is not yet fully understood. For a better knowledge of the impact due to carpal tunnel syndrome, the force and contact area of the fingers, thumb and palm in addition with the load distribution of patients with carpal tunnel syndrome were subjected to a differentiated analysis.

For this clinical study, 30 patients with carpal tunnel syndrome were analysed by Manugraphy (Figure 1). The manugrahy sytem consists of 3 cylinders covered with pressure sensor matrices. The cylinders had circumferences of 100, 150, and 200 mm, corresponding to 32, 48, and 64 mm diameters, respectively. The grip strength and the contact area of the affected hand were compared to the healthy opposite hand with regard to the median difference for three different cylinder sizes. In addition, the areal forces of seven anatomical areas of the hand (thumb, four fingers, thenar and hypothenar) were analysed.

The grip force of the affected hand was significantly reduced with 11-16% compared to the opposite hand for the 100 and 200 mm cylinder, and 4% for the 150 mm cylinder. The contact area between hand and cylinder was reduced by 5% (100 mm), 3% (150 mm) and 2% (200 mm) due to muscle atrophy (Figure 2). Analysis of the areal forces showed the most significant deficit in the middle and ring finger (Figure 3).

Although the thumb and thenar are considered most severely affected by carpal tunnel syndrome, the force deficit was most severe in the middle and ring finger. This is probably caused by sensitive impairment and the fact, that the stabilisation of the thumb is affected by the carpal tunnel syndrome and therefore results in a reduced force transmission.

Distal radius fractures belong to the most common fracture type. Injuries to the triangular fibrocartilage complex (TFCC) can occur as an associated injury and are a predictor of a worse outcome. They are a cause of persistent (ulnocarpal) papin, decreased grip strength, and limited range of motion. In particular, the foveal insertion of the TFCC plays a crucial role in the stability of the distal radioulnar joint (DRUJ).

There is still no unified guideline for the treatment of TFCC injuries. This presentation aims to draw attention to TFCC injuries, provide an overview, and offer possible treatment recommendations.

The PubMed database was searched using the keywords "distal radius fracture, TFCC." A total of 73 studies were identified in the past 10 years. Of these 73 studies, 19 were included in this review.

The majority of studies based solely on MRI diagnostics showed a prevalence of TFCC injuries ranging from 54% to 97%. Arthroscopy-based studies observed TFCC injuries in 17% to 90% of cases. Additionally, DRUJ instability was found in 26% of cases.

Two studies described arthroscopy performed during follow-up. A reoperation was conducted due to ulnocarpal pain. Lesions of the TFCC were found in up to 80% of cases.

Diagnosis and treatment of distal radius fractures and TFCC injuries require careful consideration of the patient's individual needs and the selection of the most suitable treatment options to achieve optimal functional outcomes. Early diagnosis and tailored therapeutic approaches are essential for reducing the risk of chronic pain and functional limitations. Not every TFCC injury requires surgical intervention but an accurate diagnosis and the initiation of conservative treatment measures benefit the patient and improve postoperative care. Against this background, a protocol like the "WRIST" protocol (published by Goorens) could provide assistance in clinical practice.

Carpal tunnel syndrome (CTS) and trigger finger (TF) may be early symptoms of transthyretin amyloidosis (ATTR), which can lead to cardiac involvement (CA) with heart failure, atrial fibrillation and bundle branch block within 5-10 years. Previous studies reported, 2.3 % to 34 % of ATTR positive biopsies in the context of carpal tunnel release.  

The data collected in our clinic in 2022 was low for ATTR positive samples compared to the literature. We are looking for the causes, re-analysing our patient population based on risk factors and aim to make recommendations on when to do a biopsy. 

Our previous data showed ATTR positivity in biopsies in 3 out of 34 patients (9 %) due to increased synovial tissue in carpal tunnel and A1 pulley release. In this paper re-analysis was performed for risk factors (RF) such as bilateral CTS or TF in men > 50 and women > 60 years. 

12 out of 34 patients fulfilled the RF of bilateral CTS/ TF and the defined age limits. 3 out of these 12 patients were ATTR positive (25 %). Other risk factors identified in the literature include spinal stenosis, distal biceps tendon rupture, hearing loss, atrial fibrillation, heart failure, cardiomyopathy (as sign of occult CA) and positive family history. In middle-aged and older patients, the ATTR wild-type (also known as senile systemic amyloidosis) is usually common, so that the incidence of the hereditary types was negligible.  A specimen size of > 1 cm² of synovia is recommended.

Analysis by RF showed an ATTR positivity of 25 % like those in the literature. Amyloid deposition does not cause synovial proliferation, so biopsy should be performed in men > 50 and women > 60 years with bilateral CTS or TF. RF-based patient selection helps to diagnose ATTR amyloidosis early, specific and cost-effectively.

Malunions of Bennett fractures can cause deformities and functional impairments. Intra-articular corrective osteotomy, though demanding due to the small fragment size, is the only reconstructive treatment. 3D planning and patient-specific guides can enhance accuracy and aid in such cases.

This study evaluated the feasibility, post-op joint congruency, and functional outcomes of first metacarpal base corrective osteotomies using three-dimensional (3D) planning and 3D-printed patient-specific instruments (PSI).

We report outcomes of 14 patients who underwent corrective osteotomies at the base of the first metacarpal for malunited Bennett’s fractures. Computer-assisted 3D preoperative planning, using the contralateral hand as a template, facilitated the creation of 3D-printed patient-specific guides for intraoperative navigation. Articular step correction and reduction of first metacarpal subluxation were assessed on follow-up CT scans. In addition, clinical assessments, including range of motion (ROM), pain, and grip and pinch strength, were performed at 6 months or the final follow-up. Postoperative complications were also documented.

14 patients (mean age 29.1 ± 11.9 years, range 14–56) underwent corrective osteotomy at the base of the first metacarpal, with a mean follow-up of 18.1 ± 16.8 months (range 2–60 months). Follow-up CT scans in 13 patients confirmed successful corrections, good joint congruency, and regular osseous consolidation. The mean articular step-off decreased significantly from 1.9 ± 0.4 mm preoperatively to 0.2 ± 0.1 mm postoperatively. One patient required revision surgery with a carpometacarpal (CMC) I arthrodesis due to screw cut-out. At 6 months or final the follow-up, ROM improved significantly, and strength returned to levels comparable to the contralateral side.

Our results suggest that precise reductions for corrective osteotomies of the first metacarpal base, following malunion of Bennett fractures, can be achieved using 3D planning and PSI. This technique also leads to significant clinical improvements and high patient satisfaction.

Unwanted e-mails (UEM) constitute a futile burden for academic surgeons. However, data investigating the magnitude of this concern and its determinants are lacking.

To assess the burden of UEM in academic surgery and to identify factors associated with a high burden of UEM.

This was a prospective cross-sectional study conducted in a division of visceral surgery of a tertiary center, between May 1-31, 2024. Participants included physicians of the division; UEM received in the institutional e-mail box by the participants during the study period were collected and examined.
The primary outcome was the absolute number of UEM whereas secondary endpoint was the ratio of UEM/total number of e-mails. High burden of UEM was defined as participant UEM number ≥percentile 75 of overall UEM number.

Participants included 36 physicians: 13 residents, 14 fellows and 9 consultants. A total of 2934 UEM were examined; among them, 1707 (58.2%) solicited scientific contributions, including invitations to submit manuscripts (n=910, 31%). Number of UEM per participant was heterogenous, ranging from 0 to 601, with a median of 16 (0-106). The latter also showed differences between residents 0 (0-1), fellows 34 (5-70), and consultants 147 (101-402) (p<0.001). Finally, high burden of UEM was associated with surrogates of experience and research activity, such as age (OR, 1.21; 95% CI, 1.04-1.41; p=.011), board certification in visceral surgery (OR, 11.50; 95% CI, 2.01-65.91; p=.006), number of peer-review publications (OR, 1.12; 95% CI, 1.01-1.24; p=.027) or H-index (OR, 1.36; 95% CI, 1.07-1.73; p=.012).

UEM represent a major burden for academic surgeons. Exposure to UEM varies proportionally to professional experience and research activity.

Switzerland’s aging population and evolving healthcare demands are expected to increase the need for specialized surgeons. Meanwhile, ongoing discussions about reduced working hours for residents and a growing trend toward minimally invasive and outpatient procedures may influence training opportunities and inpatient procedural volumes.

The aim of this study was to evaluate workforce, training, and procedural volumes in surgery to predict the future demand for visceral surgeons in Switzerland.

This study analysed national datasets from 2009 to 2023 to assess trends in medical school enrolments, recognised medical diplomas, residency positions, and the availability of general and visceral surgeons. Additionally, surgical procedure volumes were evaluated, with a particular focus on pancreatic surgery as a proxy for complex cases. Linear regression models projected developments up to 2040, incorporating Swiss population growth forecasts.

The number of medical diplomas - both Swiss-issued and foreign-recognized - showed an increase from 2’725 in 2011 to 4’647 in 2023. Projections indicate a further rise, reaching over 6,000 by 2040. The overall pool of general surgeons increased from 1’127 in 2009 to 1’557 in 2023, with the proportion of women rising from 10.6% to 24.9% in the same interval. Visceral surgeons numbered 303 by 2023 (11% female), and forecasts suggest a 50% increase to approximately 462 by 2040. Pancreatic surgery cases grew by 14.5% between 2016 and 2023 and are projected to increase by an additional 25% by 2040. However, the number of surgeries per visceral surgeon is projected to decline steadily over the next years.

The projected expansion of the surgical workforce seems to overcompensate for the growth in Switzerland’s population. In combination with a shift towards outpatient care and reduced working hours, procedural exposure could become critical in visceral surgery. Ensuring that training pathways and practice models adapt to these evolving demands will be vital to maintaining high standards of surgical care.

Accurate identification of intraoperative behaviors is crucial for assessing surgical performance, improving patient outcomes, and supporting surgical training. Traditional methods for evaluating intraoperative behaviors rely on experts' on-site observations or assessments of video recordings. Although these methods have been shown to be reliable, they are time-consuming, prone to bias, and limited in scalability. Video recordings of the operating room (OR), combined with methodological advancements in computer vision and machine learning, offer promising opportunities for automated, objective, and scalable behavior analysis.  

This study explores the feasibility of automated approaches for assessing teamwork-related intra-operative behaviors in the OR. In a stepwise approach, we aim to automatically: 1) detect the positions and poses of the OR team members, 2) analyze movements and distribution patterns of the OR team, 3) determine their roles and functions, and 4) recognize structured team communication (e.g. team timeouts, briefings).

A multi-view OR dataset with over 100 hours of video recordings was created at a Swiss university hospital, featuring annotations of team interactions during real surgical procedures. Using deep learning-based video techniques, a multidisciplinary team of work psychologists, computer scientists, and surgeons detects and analyzes key events of interest.

A framework for automatic video analysis was developed and validated using the created dataset. The experimental results show that our framework provides a valuable and efficient alternative to existing state-of-the-art approaches for both surgical role classification and team communication detection tasks.   

We present a novel pipeline that automatically classifies the roles of the OR team members and detects behavioral team interactions. This work highlights the potential of automated approaches to revolutionize surgical practice and education by providing scalable, objective insights into non-technical skills. 

Efficient reporting of medical consultations is a persistent challenge in healthcare, with traditional methods such as manual note-taking and dictation tools often leading to inconsistent report quality and interruptions in doctor-patient interaction. 

To address this, we developed DocNote, an application that generates structured medical reports from audio recordings using cutting-edge speech-to-text and natural language processing (NLP) technologies. 

DocNote aims to accelerate admin tasks, improve report quality, and enable physicians to focus more on patients during consultations.

This work presents the design and development of DocNote, emphasizing its innovative features and potential contributions to medical practice. 

Interviews and surveys with physicians identified pain points in reports accuracy and user experience. The tool underwent iterative prototype testing in clinical settings, with feedback driving refinements.

DocNote employs local audio recording, followed by speech-to-text conversion using advanced natural language processing (NLP) algorithms to transcribe conversations into structured text. Then, we use state of the art Generative Pre-trained Transformers models, trained on medical data, to generate the most accurate report, respecting specialized medical jargon.

The application enables standardization through customizable templates, automatically formatting reports into predefined layouts to follow local requirements.

Reports are stored locally and securely sent to physicians’ professional email, ensuring compliance with privacy regulations. Ethical considerations include patient consent for recordings, confidentiality through local storage and secure transmission, and hosting on Swiss servers. 

As DocNote is not classified as a medical device, physicians must review and validate reports before signing. 

Implementation challenges, such as ensuring transcription accuracy in noisy environments and addressing linguistic nuances, were overcome through collaboration among developers, physicians, and security experts.

DocNote offers a novel approach to medical reporting, reducing administrative burdens and enhancing report quality while improving doctor-patient interactions. This study highlights how collaborative, user-centered innovation can address longstanding challenges in healthcare. Future studies will assess the tool’s real-world impact on medical practice.

Five years after its 2019 validation, the avian tissue model for neonatal minimal access surgery (MAS) training was reassessed to evaluate its sustained effectiveness and realism. Unlike the original study, this evaluation included participants from paediatric and other surgical specialties.

The study aimed to reassess the model’s realism and effectiveness for neonatal MAS training and explore its potential for broader applications in surgical training.

The study occurred during two events: an international MAS Skills Lab in August 2024 and a national MAS Skills Lab in September 2024. Twenty-six participants (16 females, 10 males) took part, including 17 paediatric surgeons and 9 from other specialties. Using 3 mm MAS instruments on fresh chicken cadavers with balloon trocars, participants performed laparoscopic exercises such as adhesiolysis, cholecystectomy, and intestinal anastomosis. Feedback on the model was gathered via a 5-point Likert scale (MiSSES).

Participants had varied experience levels: 23% had performed over 100 MAS cases, 15.4% between 50–100 cases, and 61.5% fewer than 50 cases. The model’s perceived realism averaged 4.05 ± 0.10. Scores for specific features included 3.66 ± 0.09 for the abdominal wall, 3.85 ± 0.10 for the abdominal cavity, and 4.86 ± 0.09 for tissue dissection. Participants rated the model highly for improving laparoscopic knowledge (4.3 ± 0.90) and skills development (4.77 ± 0.07). Satisfaction scores highlighted its effectiveness in addressing challenges like trocar placement (3.64 ± 0.12), pneumoperitoneum (3.5 ± 0.10), and confined-space suturing (4.99 ± 0.08). Overall satisfaction with the model was rated at 4.9 ± 0.09.

The avian tissue model remains an effective and realistic tool for neonatal MAS training, reaffirming the findings of the 2019 study. Positive outcomes across multiple disciplines demonstrate its versatility, highlighting its potential as a valuable training tool extending beyond paediatric surgery to other specialties.

Despite a steady increase in the number of women trained in medicine, their representation remains significantly low at the head of department level, particularly in surgery. This disparity extends to academic careers.

This study aimed to determine if gender plays a role in the composition of editorial boards.

Surgical (digestive and general surgery) and gastroenterology journals were selected for inclusion from the Clarivate database. Editorial board Data for these journals were extracted from searches on open-source websites. The H-index of editors-in-chief was obtained via Google Scholar and Scopus. Journal Impact Factors were found on Clarivate InCites 2023. 

Of 2’542 editorial board members from 124 journals included for analysis, 18% of all editors (456/2542) and 10% (16/155) of editors-in-chief were women. No difference was found in editorial board composition across journals by specialty. The proportion of female editorial board members increased significantly with the journal impact factor (p<0.05). The average H-index of male editors-in-chief was 56.69, whereas it was 38.13 for female editors-in-chief (p<0.05).

Women are significantly underrepresented on surgical journal editorial boards, particularly in leadership positions such as editor-in-chief. While this disparity improves in high-impact journals, journal speciality has no apparent influence on composition. Differences in H-Indexes do not explain this disparity at editor-in-chief level.

Surgeons face a risk of work-related musculoskeletal disorders (WMSDs). Repetitive movements and poor ergonomic conditions cause pain, particularly in the back, neck, arms, and shoulders. WMSDs not only impact surgeons' quality of life but also affect surgical performance, absenteeism, and healthcare costs. Intraoperative microbreaks (MBs) with active stretching exercises have been proposed to reduce WMSDs, fatigue, and to improve performance.

The aim of this review is to study the effects of ergonomic intraoperative microbreaks and to define the most efficacious intervention (length of MBs, interval duration, specific stretching exercises).

A systematic review of clinical trials evaluating physical or psychological impacts of microbreaks on surgeons, with a control group, was conducted in MEDLINE, Embase and Google Scholar from September to October 2024. Outcomes of interest included pain, discomfort, fatigue, dexterity, mental focus, and stress.

Ten clinical trials were retained for final analysis (8 crossover trials and 2 randomized controlled trials), for a total of 284 participants. Methodology and assessed outcomes varied considerably between studies. 6 out of the 10 trials showed at least one improved outcome with the implementation of microbreaks. The most frequently assessed outcomes were pain and discomfort (improved in 5/8 studies), mental focus (improved in 3/3 studies), and accuracy (improved in 1/3 studies). Five studies evaluated operative duration, all showing that microbreaks did not prolong the overall time. No specific duration, interval, or set of exercises was identified as the most effective approach for microbreak implementation.

Most of the studies included show that microbreaks appear to have a positive impact on surgeons’ well-being and performance. There is a need for standardization of interventions and outcome measures. The long-term effects of microbreaks remain yet to be studied, and more data is also required to identify the most efficacious intervention.

Tumor boards are an integral part of modern medical practice, fostering multidisciplinary collaboration, however little is known about how trainees perceive their participation, how it benefits their training, or how they evolve into active contributors by the end of their training. Understanding these questions is essential for optimizing the educational value of tumor boards for future specialists.

This study aims to explore the experiences of trainees with thoracic tumor boards, to better understand their needs and thus help in improving the learning curve.

Using a constructivist paradigm and qualitative descriptive methodology, we interviewed trainees from thoracic surgery and pulmonology using an interview guide with open-ended questions. Data sufficiency was attained after six interviews. We used thematic analysis on the verbatim transcriptions to extract relevant themes capturing their experiences.

We identified six main themes: (1) "The formal and standardized structure", which gives the trainees reassurance, as they can hold on to something familiar and relatable; (2) "Watching a play", portraying the feeling of being a passive observer; (3) "Being in a tornado", suggesting the gap in understanding, and rapid flow of information; (4) "The experts who already have the answer", highlighting the daunting nature of becoming an active participant; (5) "Struggling with the pace and information quantity", reflecting being overwhelmed with the complexity of tumor boards; and (6) “Losing the thread and feeling it’s a waste of time”, which implies that quantity without quality is noticeable and undesirable.

Trainees frequently struggle to understand and engage in tumor boards, often feeling like passive spectators in a complex, unfamiliar environment. These challenges impact their motivation and hinder the learning process. To improve trainee involvement, enhance their learning experience, and better prepare them for active participation in multidisciplinary care, educational interventions should be tailored based on real world information and the local context.

Acquiring basic surgical skills is a critical component of a physician's training, yet many medical students graduate with insufficient to none surgical competencies in suturing.

This study investigated the effectiveness of peer-assisted learning on suturing skill progression and its influence on students’ engagement with surgery.

Data were collected as part of an ongoing prospective study (2023–2024) conducted in Lausanne, Switzerland. second to fifth year medical students attended three 2-hour suturing courses (e-learning and hands-on). They were required to record videos of their suturing performance and complete self-assessments at the beginning and end of the program. Videos were evaluated by surgeons using the OSATS scale with a minimal score of 1 point and a maximal score of 5 points. Multivariable linear regression was performed to identify independent predictors of progression.

A total of 81 medical students (mean age: 24.5 ± 2.4 years; 59 % women) completed the study. Participants demonstrated significant skill improvement across all evaluated domains after the 3 suturing courses. With an average progression of 0.850 points out of five (p-value < 0.0001), the greatest improvement was observed in instrument handling (average progression 1.020 points, t-test 11.4, p-value < 0.0001), while the smallest improvement was noted in tissue handling (average progression 0.519, t-test 6.9, p-value < 0.0001). On multivariable analysis, progression was positively associated with age (coefficient 0.11; 95% CI: [0.009; 0.214], p-value: 0.033) and perceived competence in suturing (coefficient 0.29, 95% CI: [0.049; 0.538], p-value: 0.020). However, prior attendance at a suturing course and self-reported perception of improvement (coefficient -0.465, 95% CI: [-0.923; -0.007], p-value 0.047, and coefficient -0.369, 95% CI: [-0.701; -0.037], p-value 0.030, respectively). were negatively associated with progression.

Peer-assisted learning is an effective approach for teaching basic suturing skills to medical students, Demonstrating measurable improvements in technical performance after participating in a 6-hours suturing course.

Cytoreductive Surgery (CRS) with or without hyperthermic intraperitoneal Chemotherapy (HIPEC) is the preferred treatment of peritoneal carcinomatosis of various cancer types such as ovarian, gastric or colorectal cancers. Usually, these often complex procedures are performed using an open approach. In patients with limited peritoneal cancer index or in the prophylactic setting according to recent studies, minimally invasive techniques are possible. Robotic-assisted CRS and HIPEC - first described in 2019 - has not yet found its way into daily practice.

A 63-year-old male patient presented with anemia and abdominal pain. Further investigation revealed a cT4 adenocarcinoma of the cecum without distant metastasis. Multidisciplinary tumorboard recommended prophylactic CRS including right hemicolectomy, right parietal peritonectomy, omentectomy and HIPEC according to results of the recent HIPECT4-trial.

We performed robotic-assisted CRS and HIPEC as follows (video sequences):

(1) right parietal peritonectomy from right inguinal region to hepatic flexure,

(2) inferior approach of right hemicolectomy, mobilization of right hemicolon and small bowel until Ligament of Treitz and Pancreas including Gerota’s fascia,

(3) complete omentectomy until small gastric vessels, omentum is left at hepatic flexure, superior mobilization of transverse colon entering lesser sac,

(4) central ligation of ileocolic vessels,

(5) dissection of transverse colon and distal ileum, en-bloc removal of the specimen via Pfannenstiel laparotomy

(6) intracorporal side-to-side anastomosis, closure of mesentery,

(7) placing of HIPEC tubes,

(8) hyperthermic (41-43°C) chemotherapy (Mitomycin C) for 90 minutes,

(9) rinsing of the abdomen (saline) and closing of incisions.

Postoperatively, the patient was monitored for one night at the Intermediate Care Unit. Discharge was at day 7 after surgery. Adjuvant chemotherapy was given for 6 months. Until today, no recurrent disease has been diagnosed.

Robotic-assisted surgery is gaining importance in the surgical treatment of cancer. Using the advantages of a robotic approach such as improved dexterity, better 3D visualization and increased precision could also improve outcomes in cytoreductive surgery and HIPEC.

Ileostomies are created primarily to reduce complications of anastomotic leakage, for example after low anterior rectum resections. Although named diverting or “protective” ileostomies, they themselves are associated with significant complications and a high readmission rate. It is therefore essential to provide patients with comprehensive information about stoma care. It is well known that patients do not fully absorb the information from lengthy surgical consenting’s and often have difficulties implementing instructions. According to the cognitive theory, multimedia education is therefore more suitable. In particular, educational videos are an effective method of communicating complex content.

For these reasons, we have created a patient education video on the subject of ileostomy.

On the basis of a detailed literature search and years of clinical experience, as well as in interdisciplinary discussions with ostomy nurses, the most important points of patient education were identified and a storyboard written. Illustrations were done in collaboration with the experts of the multimedia team.

The patient education video on ileostomies covers the topics of nutrition with an ileostomy and early warning signs of impending complications, especially dehydration due to high-output ileostomy. It also refers to effective initial measures and provides general tips for maintaining a balanced fluid intake.

Videos offer the opportunity to access information in a visually comprehensible way and to retrieve it independently and repeatedly. Our video is now being distributed to patients and the impact on postoperative complications, patient safety and the promotion of independence in dealing with the ileostomy is being analyzed. The aim is for patients to be able to recognize stoma-related problems at an early stage and, ideally, to solve them without medical assistance, thereby obviating the need for readmission.

The evolution of robotic-assisted surgery offers new opportunities for precise and effective treatment of sigmoid colon cancer. The Dexter Robotic System™ is a versatile and compact robotic platform featuring a three-arm setup with a sterile console, enabling full integration into standard laparoscopic workflows while offering benefits like robotic precision, wristed instrument articulation and ergonomics.

To demonstrate the feasibility, surgical technique, and clinical outcomes of robotic-assisted sigmoid resection using the Dexter Robotic System™ for the treatment of sigmoid adenocarcinoma.

A 53-year-old woman (BMI 21 kg/m²) with no prior abdominal surgery presented with a stenosing sigmoid mass confirmed as adenocarcinoma (cT3-4 cN+ cM0) following an episode of diverticulitis. The procedure commenced with laparoscopic mobilization of the sigmoid colon due to adhesions to the lateral abdominal wall. The Dexter robotic platform was then docked, utilizing previously used laparoscopic trocars. Robotic-assisted steps included precise medial-to-lateral dissection, central vascular dissection of the inferior mesenteric artery and vein, and mobilization and division of the mesocolon. Laparoscopic instruments, including an advanced energy sealer and stapler, were employed for division of the rectum and creation of the colorectal anastomosis. Dexter was subsequently used to secure the anastomosis with additional sutures. The video illustrates the surgical technique.

The surgery was completed successfully without complications or the need for a blood transfusion. Estimated blood loss was 100 mL, and the total operative time was 271 minutes. The patient had an uneventful recovery, with a hospital discharge on postoperative day 3. Histopathological staging revealed pT3a pN1a (1/15) L1 V1 Pn0 R0.

This case demonstrates that robotic-assisted sigmoid resection with the Dexter Robotic System™ is a safe and effective technique for sigmoid adenocarcinoma. It offers precise tissue dissection, reliable suturing capabilities, and favourable short-term outcomes, underscoring its potential in minimally invasive oncological surgery.

The key benefits of robotics are improved precision and control, thanks to fully articulated robotic instruments and enhanced, stable endoscope control.

The herein video demonstrates a fully robotic anterior mesh rectopexy in a 53-year-old patient with obstructed defecation syndrome (ODS).

Standard laparoscopic 3-D camera, insufflator, trocars and energy devices, available in all hospitals performing laparoscopic surgery, were used in combination with the Dexter System from Distalmotion SA. Dexter is a compact, multiport platform which includes two robotic instrument arms, one robotic endoscope arm and an open, sterile surgeon console. Four trocars and three single-use instruments (scissors, Maryland dissector and needle holder) were used for this robotic procedure.

After dissection of the recto-vaginal septum a DynaMesh®-PRR (FEG Textiltechnik mbH, Aachen, Germany) was sutured to the anterior rectal wall and fixed to the promontory. The peritoneum was closed entirely covering the mesh.

The procedure lasted 107 minutes with no intraoperative adverse event. No conversion to standard laparoscopy was necessary in this procedure. The patient was discharged at postoperative day two and had an uneventful recovery. At 3 months, no post-operative adverse event was noted and the ODS symptoms improved with an ODS score before the operation of 22 to 12 post-operatively.

Dexter is a valid open platform robotic solution combining the best of two worlds: robotics where precision and enhanced dexterity are required and standard laparoscopy (with all the equipment already present at every hospital) where it is at its best. The surgeon remains scrubbed-in at all times, allowing a switch between robotics and laparoscopy within seconds.

Hepatocellular carcinoma presents significant surgical challenges due to its anatomical complexity and proximity to vital structures. Traditional open approaches have been associated with considerable morbidity and laparoscopy has its limitations due to the limited range of motion. The advent of robotic surgery offers enhanced precision and dexterity, potentially improving outcomes in complex hepatobiliary procedures.

We present a case of a 70-year-old male diagnosed with hepatocellular carcinoma located in the right posterior section of the liver measuring 6cm. Preoperative imaging, including MRI and CT scans, confirmed the tumour's resectability. The patient underwent a robotic right posterior sectionectomy using the da Vinci Xi Surgical System. The procedure was performed with the patient in a supine position tilted to the left. Four robotic ports and two assistant ports were utilised. Key steps included complete mobilisation of the right liver, identification and precise division of critical vascular and biliary structures, and precise parenchymal transection using vessel sealer and the “scissor hand” technique. Intraoperative ultrasound was employed to delineate tumour margins and critical vessels. The operation was completed successfully with a total operative time of 240 minutes and an estimated blood loss of 200 ml. The patient had an uneventful postoperative course and was discharged on postoperative day 7. Histopathological examination confirmed clear resection margins (R0).

This case demonstrates the feasibility and safety of robotic right-posterior sectionectomy for hepatocellular carcinoma. The robotic approach provides superior visualisation and precision, facilitating complex liver resections with minimal morbidity. According to the IDEAL stages of surgical innovation, more randomised trials are now warranted to compare long-term outcomes of robotic versus conventional techniques in hepatobiliary surgery.

Precise vascular dissection during liver surgery is mandatory. Specific instruments for parenchymal transection, however, are lacking in robotic hepatectomy (RH) compared to laparoscopy or open. In particular, the lack of CUSA has been an issue of debate. Thereby surgeons adopted alternative hybrid solutions (CUSA used by the table-assistant) or fully robotic ones with bipolar and robotic sealers versus double bipolar.

In the present video, we show some technical examples of precise portal and hepatic veins dissection, and dealing with the hepatocaval confluence, performed with robotic sealer and bipolar forceps, for tumors in close relationship with main biliary/vascular pedicles within the liver.

Case 1 (Left hepatectomy extended to segment 1 and middle hepatic vein, HCC with left portal thrombosis)

Confluence of the left (LHV) and middle hepatic vein (MHV) exposition. US confirmed tumor invasion of the MHV and left portal thrombus. Hilar approach with left portal vein isolation, thrombus management.

Case 2 (Right hemihepatectomy for iCAA after right portal embolization)

Hilar approach of the plate which is dissected from the porta, hilar plate section to expose right portal branch for section.

Case 3-4 (Right-posterior sectionectomies, HCC close to RHV and iCCA)

Full right liver mobilization with exposure of inferior vena cava (IVC) and right hepatic vein (RHV). Intraparenchymal isolation and dissection of pedicles for posterior section. Tumor detachment from the RHV.

Case 5-6 (Wedge resections in segment 8 at the hepatocaval confluence, CRLM)

Confluence of RHV and MHV exposed from above. Dissection of the tumor from major vessels upon US-guidance up to vena cava.

Case 7 (HCC recurrence after open left-lateral sectionectomy, at the confluence of LHV-MHV and vena cava)

Tumor dissection from hepatocaval confluence in cirrhotic liver. R1vascular for necessity.

Case 8 (S2 segmentectomy, CRLM)

Full LHV exposition during parenchymotomy.

Robotic sealer and bipolar forceps is safe for precise anatomical vascular dissection.

Robotic right hemihepatectomy  has emerged as a highly effective, minimally invasive alternative to traditional open surgery for the resection of liver lesions. This approach combines the precision and dexterity of robotic systems with the benefits of laparoscopic surgery, offering improved visualization, reduced blood loss, and faster recovery times. 

We presents the case of a 33-year-old patient with a 6 cm inflammatory adenoma, who underwent robotic-assisted right hemihepatectomy. The procedure was performed using the robotic platform. The adenoma was situated on the portal vein bifurcation of the right anterior and posterior branches. Key surgical steps included: 

1. Positioning and Trocar Placement: The patient is placed in a supine position. Four robotic and two laparoscopic trocars are placed.

2. Initial Exploration and Mobilization: The liver is carefully explored with intraoperative ultrasound to assess the location of the adenoma and any surrounding structures. The right lobe is mobilized.

3. Hilar disection: The right hepatic artery, right portal vein, and right biliary duct are identified. These structures are dissected, clamped and cut.

4. Parenchymal Transection: After administration of 3mg ICG, the cutting plane on the right side of the middle hepatic vein is marked. Using robotic scissors the liver parenchyma is transected along the demarcated line, near the middle hepatic vein.  The right hemi liver is extracted through a Pfannenstiel incision. 
   
   The surgery lasted 4 hours, with a blood loss of 50 cc. There were no intraoperative complications. Postoperative recovery was uneventful, with the patient being discharged within 5 days

This case highlights the potential of robotic right hemihepatectomy as a safe and effective option for the resection of liver lesions. The technique offers significant advantages over traditional open surgery, with favorable outcomes in terms of blood loss, recovery time, and patient satisfaction. This video abstract will provide a detailed demonstration of the robotic procedure, showcasing key steps and technical considerations.

Cystic Echinococcosis (CE) is a very rare zoonotic infection in Western Europe caused by Echinococcus granulosus, predominantly affecting the liver (approximately 80%). Symptoms often merge only after cyst rupture. Treatment options include antiparastitic medications and invasive interventions such as PAIR (puncture, aspiration, injection, and reaspiration) and open or minimally invasive surgery depending on the extent and the location of the disease.

We aim to present the video of a laparoscopic liver resection of a large hepatic CE in Segment VIII, highlighting procedural steps and potential pitfalls.

The patient was positioned in the French position, slightly raised to the right, and with the right arm abducted overhead. Trocar placement included 5 12mm trocars along the right subcostal line and a 5 mm trocar for the Pringle tourniquet in the left hemi-abdomen. The right liver was fully mobilized, and intraoperative ultrasound guided resection margins. Liver resection was performed using (CUSA®) and (Harmonic^TM) devices.

We report a case of a 38-year-old female with hepatic CE, pre-treated with a stereotactic PAIR procedure. Our center has treated 61 CE patients with 36 undergoing hepatic resections. In this case, a laparoscopic atypical liver resection of segment VIII was completed without significant bleeding. Preoperative PAIR and resection of the cyst with surrounding liver tissue instead of only an enucleation minimized rupture risk. Intraoperative medical prophylaxis against anaphylaxis was performed, as well as peri-operative treatment with Albendazol. The patient recovered uneventfully and was discharged on postoperative day three. Figure 1A shows the resection site, Fig. 1B/C the resected specimen.

Despite its technical challenges, laparoscopic resection of a segment VIII liver lesion represents an effective surgical approach for managing liver tumors including CE. The potential benefits include reduced postoperative morbidity, shorter hospital stay and faster recovery.

Minimally invasive surgery (MIS) has progressively become the standard for various procedures, with robotic surgery playing an increasingly important role in this evolution. Robotic platforms are having a growing impact on complex procedures, such as pancreatic surgery, by providing enhanced dexterity, precision and ergonomics. The Dexter robotic system allows smooth transitions between standard laparoscopy and robotic assistance, providing greater flexibility during surgery. This feature enables surgeons to maximize the advantages of both techniques and facilitate intraoperative teaching.

To demonstrate the feasibility of a Dexter-assisted distal pancreatectomy and highlight its advantages.

We present a clinical case of a patient undergoing a Dexter-assisted distal pancreatectomy, highlighting the advantages of combining standard laparoscopy with the Dexter robotic platform.

We present the case of a 63-year-old patient with a history of coronary artery disease treated with stenting and previous open appendicectomy. The patient presented with a pulsatile abdominal pain, and an ultrasound showed a 20 mm hypervascular lesion in the body of the pancreas. Subsequent CT scan and MRI confirmed an 18 mm lesion. A PET/CT was also performed and showed an increased uptake of the pancreatic lesion measuring 33 mm, with no other fixations. Endocrinological evaluation revealed slightly elevated chromogranin and glucagon levels. Biopsy confirmed a well-differentiated grade 1 neuroendocrine tumor.
Following a multidisciplinary tumor board discussion, surgical resection was indicated due to the uncertainty of the tumor size. The patient successfully underwent a laparoscopic distal pancreatectomy assisted with the Dexter robotic system, achieving a complete resection with preservation of splenic vessels and spleen. 
The surgery was complicated by a pancreatic fistula, which was manages conservatively. 

The Dexter robotic system provides an innovative and effective approach for complex pancreatic surgery, combining the advantages of laparoscopic and robotic surgery. Its flexibility enhances surgical precision and facilitates intraoperative teaching. 

Open liver surgery is increasingly being replaced by minimally invasive surgery, especially using robot-assisted liver resections (RLR).

Along the learning phases of a surgical procedure intraoperative, postoperative, and oncologic outcomes improve at different stages.

The aim of this study is to evaluate the learning phases of RLR in a large retrospective international multicentre setting to determine the number of procedures required to achieve competency, proficiency and mastery.

Consecutive patients from 5 international expert centres who underwent elective RLR were included. Three thresholds were used to define the learning curve based on the first 150 RLRs in each centre: Operative time for competency, major complications (Clavien-Dindo ≥III) for proficiency, and textbook outcome for mastery. Clinical outcomes before and after the thresholds were compared.

The learning curve analysis was performed on 662 RLRs. From competency to proficiency 23 cases and from proficiency to mastery 63 cases were required. The rate of technically major/major resections increased significantly throughout the three phases (p<0.001), while the rate of  major complications (8.4% to 7.1%) and length of hospitalisation (4 to 3 days) remained stable. RLRs were associated with an excellent rate of patients reaching textbook outcome from the beginning (87%).

Competency, proficiency and mastery of RLR were achieved after 23 and 63 cases respectively. Robotic liver surgery was associated with excellent perioperative results while the indications towards major liver resections were expanded gradually.

Enhanced Recovery After Surgery (ERAS) pathways have been shown to be safe in cirrhotic patients undergoing hepatectomy. However, due to cirrhosis-induced complications, specific or additional items might need to be implemented.

This study systematically reviewed the literature to assess specific items for the perioperative management of cirrhotic patients undergoing hepatectomy.

A systematic review was performed until September 2024. Evaluated items were prevention and management of perioperative ascites, perioperative anticoagulation, perioperative nutrition, prophylactic abdominal drainage, encephalopathy prevention, postoperative analgesia, and vascular filling. Levels of evidence were given for each specific item based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system.

A total of 2983 articles were screened, and 79 articles were included in the final analysis of the 7 evaluated items. Four items had a moderate or high level of evidence. Summary of the 4 items with moderate/high evidence level were I) preoperative ascites should be controlled before surgery, II) mechanical and pharmacological venous thrombo-embolism prophylaxis is recommended postoperatively if coagulation tests are within normal range, III) systematic drainage among patients with chronic liver disease or cirrhosis is not recommended, and IV) acetate-buffered solutions should be preferred over Hartmann solutions or 0.9% saline.

This systematic review comprehensively evaluated specific perioperative items for cirrhotic patients undergoing liver surgery. Level of current evidence remains weak, and future research are still needed to develop specific recommendations for ERAS in cirrhotic patients undergoing liver surgery.

Textbook outcome (TO) is a novel composite outcome to measure quality and postoperative results. Data on TO in elderly patients undergoing liver surgery remain scant. 

This study aimed to assess the percentage of elderly patients achieving TO compared to young patients.

A cross-sectional, single-center study was performed. All consecutive patients undergoing liver surgery (2013-2023) were included. All patients followed an ERAS pathway. Patients ≥70 years were defined as elderly. TO achievement was defined as absence of intraoperative grade 2/3 event, grade B/C biliary fistula, grade B/C liver failure, 90-day major complication (>3a Clavien), 90-day readmission and R1 resection margin. Predictive factors of TO achievement were calculated using multivariable binary logistic regression.

A total of 618 patients were included (men 359/618=58%, median age 64, major hepatectomies 271/618=44%). One hundred-and-seventy-nine (29%) patients were ≥70 years. Overall complication rate was 281/618 (45%) and major complications occurred in 117/618 patients (19%). TO was achieved in 354 patients (57%). TO in elderly patients (101/179=56%) was similar as in younger patients (253/439=58%) (p=0.783).

On multivariable analysis, operation time (OR 1, p=0.039), preoperative total bilirubin (OR 1, p=0.031), preoperative prothrombin time (OR 1, p=0.036), and compliance to Enhanced Recovery After Surgery (ERAS) items >60% (OR 1.9, p=0.006) were independent predictors of TO achievement, while age (OR 1, p=0.312) and minimally invasive surgery (OR 1.4, p=0.112) were not.

This study found that TO achievement after liver surgery was similar in elderly and young patients. Age was not a TO predictor contrarily to operation time, bilirubin, prothrombin time, and compliance to ERAS.

Robot techniques have gained traction in the field of hepatobiliary surgery with previous studies demonstrating feasibility and safety of the robotic approach. However, a majority of major liver resections are still performed by laparotomy in Switzerland.

This study aims to evaluate the robotic approach for complex liver resections in the Swiss setting.

In this case-control study, propensity score matching (PSM) analysis was performed to minimize selection bias. Patients undergoing either robotic or open major hepatectomy at a single academic medical center were included. Data on patient demographics, tumor characteristics, and perioperative outcomes were collected and analyzed.

A total of 59 patients were included; 17 robotic and 42 open cases. After PSM, 51 patients (17 robotic and 34 open) were analyzed. Baseline characteristics were comparable between groups, including age (64 vs. 66 years; p > 0.9), BMI (23.7 vs. 25.0; p > 0.9), and ASA score distribution (p = 0.6). Robotic cases demonstrated significantly shorter length of stay (median, 9 vs. 13 days; p = 0.025) and lower comprehensive complication index (median, 0 vs. 26; p = 0.004). No significant differences were observed in postoperative complications (47% vs. 50%; p = 0.8) or length of ICU stay (p = 0.083). Conversion occurred for two patients in the robotic group (11.7%). Median operative time was longer in the robotic group (473 vs. 362 minutes; p = 0.053). Although bile leaks occurred more frequently in robotic cases (12% vs. 0%; p = 0.13), the difference was not statistically significant.

Robotic major hepatectomy was associated with reduced length of stay and lower complication severity compared with the open approach. Both techniques demonstrated similar rates of postoperative complications, confirming the safety and feasibility of robotic hepatectomy in experienced centers. Future research should focus on collaborative efforts between Swiss centers performing complex robotic liver surgery to further improve outcomes and expand the evidence base.

Repeat hepatectomies can often be challenging operations due to altered anatomy and adhesions from prior surgeries. Thanks to the enhanced dexterity, better vision and stability, the robotic approach could expand the feasibility of minimally invasive liver surgery in the setting of repeat hepatectomies.

To explore the surgical safety and oncologic efficacy of repeat robotic liver resection (RLR) compared to repeat laparoscopic (LLR) and open liver resection (OLR).

All repeat liver resection performed from January 2019 to December 2024 were retrospectively reviewed. Primary endpoints were complications (Comprehensive Comorbidity Index, CCI), conversions and rate of negative surgical margin (R0) or equivalent (R1 vascular).

Forty-two patients underwent repeat hepatectomy (OLR=15, LLR=13, RLR=14). The main indication to surgery was colorectal liver metastases (55%) followed by hepatocellular carcinoma (21.4%). Preoperative patients characteristics were similar: mean age of 68 years, ASA score of 3 and Charlson Comorbidity Index of 9.

Only two patients in the LLR group required conversion to laparotomy vs none in the RLR group. Mean operative time was 466, 314 and 277 minutes (p=0.02) with mean blood loss of 320, 275 and 95 mL (p=0.01) in OLR, LLR and RLR, respectively.

Post-operative overall complications occurred in 40% of OLR and 7.6% of LLR patients while none occurred in RLR (p=0.02) with mean CCI of 29.2, 8.7 and 0, in the respective order. There was no overall mortality in the 90 days after surgery.

R0 was 73%, 100% and 77% (p=0.04) and R1 vascular was 13.3%, 0% and 23% (p=0.08) in the OLR, LLR and RLR groups.

Repeat RLR was not only safe but better in outcome, and ensured adequate oncologic results compared to LLR and OLR.

Enhanced recovery after surgery (ERAS) programs showed benefit by improving patient’s outcomes in liver surgery. However, obtaining high compliance with ERAS may be challenging for patients with major hepatectomy. 

The aim of the study was to investigate the challenges related to the implementation of ERAS in major hepatectomy by assessing the compliance in detail.

All consecutive major hepatectomies (≥3 Couinaud segments) within an ERAS program from 2013 to 2023 were reviewed. The primary endpoint was the proportion of patients achieving high compliance (≥70%) with ERAS protocol. Secondary endpoints included the institutional learning curve for improving compliance measured with the cumulative sum method (CUSUM), and the clinical outcomes of patients with high vs low compliance. Predictors of high ERAS compliance and of postoperative complications were assessed by a binary logistic regression model.

Two-hundred-eighty-six patients were included, median ERAS compliance was 59% (IQR 54-67) and 49 patients (17.1%) had a high compliance The CUSUM analysis identified an institutional learning curve of 143 cases encompassing the first 5 years of activity. High compliance patients increased 10-fold from during the learning curve to once the learning curve was completed (8.2% vs 91.8%; p<0.001) The improvement was mainly related to better compliance with intra- and postoperative ERAS items. High compliance was associated with less complications (53.1 vs 69.1%; p=0.045) and shorter hospital stay (8 vs 12 days; p=0.002). In multivariable analysis, the strongest independent predictor of high ERAS compliance was the use of MILS. High compliance was protective only against minor complications (Clavien-Dindo<IIIa).

The implementation of an ERAS program with high compliance is challenging in major hepatectomy and needed more than 140 cases in our experience. A MILS policy, when feasible, should be pursued to increase compliance, which is associated to less complications and shorter hospital stay.

The methodology for learning curve assessment in laparoscopic (LLR) or robotic (RLR) liver resections is debated and heterogeneously reported. Several studies didn’t account for patient’s and procedure complexity, thus lacking generalizability.

The aim of the study was the assessment of the learning curve in LLR and RLR considering both patient’s and procedure complexity.

Consecutive LLR and RLR from 2019 to 2024 by a single surgeon trained sequentially in LLR then in RLR were reviewed. The learning curve was analyzed with the cumulative summation (CUSUM) method after adjusting for patient- and procedure-related confounders (age, sex, BMI, comorbidities, previous hepatectomy, portal hypertension, Iwate score, multiple resection areas, extension to neighbor organs, lymphadenectomy, associated local treatment). The primary endpoints were the learning phases for significant changes in operative time, blood loss, complications, and conversions.

One-hundred-forty-eight patients were included (LLR=94; RLR=54). In LLR vs RLR, mean age was 66.8±12.4 vs 66.4±10.4 (p=0.827), Charlson comorbidity index was 7 (IQR 5-9) in both groups. Median Iwate score was 6 (IQR 3-7) vs 5 (IQR 4-7) (p=0.694), conversions to laparotomy were 10 (10.6%) vs 1 (1.9%) (p=0.051) and complications were 16 (17%) and 14 (26%) (p=0.295) in LLR vs RLR respectively. CUSUM analyses showed that the adjusted operative time dropped after 45 LLRs vs 18 RLRs, blood loss dropped after 45 LLRs vs 25 RLRs. A composite endpoint of operative time and blood loss confirmed these results. No learning curve effect was seen for complications or conversions in either group.

The robotic platform showed to have a significant impact on a faster learning curve in terms of operative time and blood losses. The sequential experience can play a role in faster learning. In liver surgery, patient’s and disease’s complexity can influence the outcomes alongside technical experience and must be considered for reliable learning curve assessments.

The role of robotic liver resection (RLR) is under-explored in patients with cirrhosis complicated by portal hypertension (PH).

The objective of the study was to explore the safety (complications and post-hepatectomy liver failure, PHLF) and oncologic efficacy (R0 and disease-free interval, DFI) of RLR in patients with cirrhosis and portal hypertension.

Consecutive RLRs in patients with cirrhosis were retrospectively reviewed. Surgical and oncologic outcomes were compared between patients with and without PH. Recurrence-free survival was defined as the time between RLR and tumor recurrence or last follow-up.

Eighty patients underwent RLR for liver malignancies (males: 71.3%, median age: 70 years, Child-Pugh score A: 95%, history of HCV: 45%, single nodule: 90%). Median size of the tumor was 23 mm (IQR 18-30 mm). Twenty-three patients had PH (28.7%); preoperative characteristics were otherwise similar between patients with and without PH. All the 23 patients with PH underwent non-anatomic resection vs 48 (84.3%) in the group without PH (p=0.63), without any major hepatectomy.

Surgical outcomes were also similar except for PHLF which occurred in 21.7% of patients with PH and none without PH (grade A: 8.7%, grade B: 13.0%, no grade C; p=0.0059). Complications occurred in 30.4% of patients with PH vs 15.8% without PH (p=0.24), conversion rate to open surgery was 8% in both groups, median blood loss was 150 vs 100 cc (p=0.07). Post-operative mortality was nihil in the series. R0 rate was obtained in 100% vs 88% (p=0.63) and RFS was equal in patients with and without PH (median of 19 months, p=0.86). In multivariable analysis PH was not associated with recurrence.

In this small cohort of minor and mostly non-anatomic RLRs, the presence of PH was associated with a higher rate of PHLF (grade A and B, without grade C) but not with other surgical or oncologic outcomes.

Postoperative frequency of bowel movements and impaired fecal continence (FI) has a negative impact on quality of life following ileal pouch-anal anastomosis. Sacral neuromodulation (SNM) is a validated treatment of FI but its effectiveness in IPAA patients has been poorly reported.

The aim of this study was to evaluate the effectiveness of sacral neuromodulation (SNM) in improving the functional outcomes and quality of life of patients with pouch dysfunction following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. In particular, the study sought to compare the outcomes of SNM treatment in patients with IPAA suffering from fecal incontinence (FI) with those of patients routinely treated with SNM for FI.

A 3 weeks test-phase was performed before definitive implantation of the pulse generator. Patient’s data were prospectively gathered in a dedicated registry. IPAA patients were then compared to a matched-paired control group of patients routinely treated by SNM for FI.

Between 2007 and 2020, 14 IPAA patients were tested and 12 (85%) were implanted. This group was compared to a matched group of 20 patients implanted for FI. After a mean follow-up of 4.8 [0.5-16] years, there was a significant decrease of weekly leaks (29 vs 2 ;p=0.01), Wexner score (15 vs 10.8 ;p=0.01) and an improvement of quality of life (FIQOL 1.853 vs 2.42 ;p=0.01). IPAA patients evolved equally as compared to the control group in terms of Wexner score and quality of life at 6 months, 1 year and 2 years.

SNM provides a significant decrease of leaks and improves Wexner scores and quality of life in IPAA patients. The effectiveness seems comparable to these of patients routinely treated by SNM for FI. SNM indications could be extended to IPAA patients presenting bad functional outcome.

The treatment of perianal fistula, particularly in patients with Cohn's disease (CD), remains challenging. Analogous to the Admire trial published in 2016, a new therapy was established using mesenchymal stem cell injections (MSC).

Eight years after approval, this treatment has now been withdrawn from the market due to no longer significantly demonstrable advantage in terms of closure rate compared to the treatment with placebo. We report our series of patients treated at one of two national centers to determine real world efficacy.

In total, we have treated 35 patients with CD and complex perianal fistula between February 2019 and July 2024 with a local injection of 120 million allogeneic MSC at a tertiary hospital.

Of the 35 patients who were treated, 22 patients (63%) were male. The median age was 37 (18 to 82) years. On average, the patients suffered from fistulas for 5 years and from Crohn's disease for 12 years. The mean follow-up time was 46 months (5 to 70 months). Overall, fistula closure was found in 20 patients (57%). In 4 (27%) of the 15 patients in whom MSC treatment failed, closure was achieved by subsequent reoperation. A total of 8 (22%) patients developed perianal abscess which had to be treated surgically. Six of the patients treated are smokers. Of these, 5 patients did not experience any fistula healing.

After almost six years of complex fistula treatment with MSC, we were able to confirm the initial results of the Admire trial with a fistula closure rate of 57%. Despite the small number of 35 patients, this is one of the largest available series on MSC treatment for CD fistulas. The closure rate of 57% compares to classic surgical fistula treatments, thereby questioning the high cost of MSC treatment and supporting its cessation.

Incidence of Anal Carcinoma (AC) and its precursor lesion, HSIL, is rising. After incidental or planned resection of HSIL, surgeons are facing the question of whether a follow-up is necessary and how long. Given the fact that HSIL is induced by the Human Papilloma Virus (HPV), similarities to gynaecological dysplasia that can request life-long follow-up may exist.

To find out when recurrence occurs after resection of HSIL.

All patients who received surgical excision for HSIL in our institution from 1.1.2013 to 31.12.2018 were retrospectively extracted from our prospective database. Only those with R0 resection margins were included. Time to recurrence was collected, as well as patient characteristics.

24 patients (14 female, 7 male with HIV) received R0-resection of HSIL. 12 primary surgeries (50%) included skin transposition. 8 patients (33%) needed more than one surgery, either to achieve R0-resection (4 patients, 1-3 surgeries) or due to complications (4 patients, 2-5 surgeries) . 12 of the patients (50 %) had a recurrence (1 Carcinoma, 6 HSIL, 5 LSIL) which occurred after a median 63 months (3-131). The recurrence rate of HSIL/Carcinoma alone (without LSIL) was 29% and always occurred more than 60 months after initial resection (median 72, range 62-131).

After resection of HSIL, even when performed quite radically needing plastic surgery, recurrence is common and occurs usually more than five years after the initial resection. Therefore, longtime follow-up is mandatory, possibly life-long. We recommend following the patients in specialized clinics, if possible with high resolution anoscopy.

We might considered Ancient Egypt as the cradle of surgery, and Egyptian coloproctological surgery may have a crucial role of influence in the practice of surgery in neighbouring cultures, including Greeks and Romans.

Egyptian influence spread beyond Europe, thereby affecting Western civilization significantly. We keep ancient documents on western countries describing as the Smith's Papyrus and Eber’s Papyrus, demonstarting allegations regarding proctological surgery from the ancient Egypt have a main role until today.

Study Design consisted in an exhaustive review of original sources, modern literature papers regarding proctological surgery (7) and proctologists in the ancient Egypt. We had compiled documentation during 15 years (2009-2024), that we found in Saqqara, Cairo,  Vienna and London.

We found in 34 literature sources, 24 archaeological / proctologic sources, 117 medical libraries and 8 personnel explorations on-site: We found “two main surgeons in proctology” called the treat anal entities. 94% of pictographs demonstrated that two great proctologists existed in ancient Egypt, however, this is open to interpretation because there were named “shepherds of the anus” and not surgeons (Figure No. 1). Therapeutic options were mentioned in the literary sources, while the specimens suggested demonstrating such treatments were credited to those physicians and not to sorcerers. The outstanding surgeons identified were : Ir En Athky and Khouy Hwi. Both distant one to each other about 150 years. We verified their knowledge and the conventional level of Egyptian colorectal surgery possibly performed under uncommon circumstances. 

The ancient Egyptians certainly treated proctological diseases of various kinds, and with varying degrees of success. Concerning surgical procedures and therapeutic drainages, there is no clear evidence for the existence of such procedures as demonstrated for example in Greece. It would, however, be surprising if malignant entities were not treated, even though they have not left traces in the surviving sources.

Pruritus ani a complex syndrome, generally idiopathic, often accompanied by a psychogenic component, very difficult for colo-proctologist to identify primary and secondary etiology's and very hard to diagnose.

Transmit to young surgeons, strength specialist's knowledge to identify primary+secondary causes of pruritus ani and guide choosing the best hygienic-dietary meassures and treatments. Clues and Algorythm for diagnosis. Figure No 1.

Updated-umbrella review towards diagnosis & treatment, non-meta-analytical, thus a comprehensive review of the international literature. Accessed through software research programs, dividing the study in 3 phases: 1^st Analysis, 2^nd Cataloging, 3^rd Responses, spanning time 20 years (2003 to 2023).

By Google Scholar we yielded 8,160 results : pruritus ani (scratching, itching, diagnosis & treatment). Bing 41,500 results and Yahoo 364,000 results. We limited analysis of medical literature in English at PubMed 136 : Pruritus ani, 121 : itching, 275 : scratching, 70 : diagnosis-treatment. Odds Ratio (OR 0:1.1) Figure No.2

Pruritus ani frequently refractory to initial treatment, in case of a therapeutic failure, the patient should be send to the dermatologist (second opinion). Definitively frustrating for both, patient and surgeon, not being able to find an objective cause for anal pruritus  is a reason to avoid any unnecessary surgical procedures. The presence of concomitant lesions conduct to proceed to excision-biopsy.

Perineal wound complications following abdominoperineal resection (APR) for anal or low rectal cancer remain a significant clinical challenge, frequently leading to high rates of surgical site infections (SSIs), wound dehiscence, and prolonged healing. These complications not only increase patient morbidity but also contribute to extended hospital stays and greater healthcare costs. Negative pressure wound therapy (NPWT) has emerged as a potential intervention to improve wound outcomes in this setting, yet its clinical effectiveness remains uncertain.

This systematic review aims to evaluate the effectiveness of NPWT in managing perineal wounds after APR. Specifically, it focuses on the impact of NPWT on reducing SSIs, decreasing wound dehiscence, and enhancing overall healing.

A comprehensive literature search was performed in MEDLINE, Embase, and the Cochrane Library following PRISMA guidelines. Eligible studies included randomized controlled trials, cohort studies, and case series investigating NPWT for perineal wounds post-APR. Data on SSI rates, wound dehiscence, healing time, and related complications were extracted. Due to heterogeneity in study designs and reported outcomes, a narrative synthesis was undertaken.

Nine studies met the inclusion criteria, representing a range of study designs and sample sizes. NPWT use was generally associated with lower SSI rates, with some studies reporting up to a 30% reduction compared to conventional dressings. Evidence also suggested potential benefits in reducing wound dehiscence and improving healing times. However, variability in patient populations, study quality, and NPWT application protocols, as well as device-related complications (e.g., vacuum malfunctions), limit the overall strength and generalizability of the current evidence.

NPWT shows promise in improving the management of perineal wounds following APR, particularly among high-risk patient groups. Nonetheless, existing evidence is constrained by methodological heterogeneity, small sample sizes, and technical challenges. Larger, well-designed randomized controlled trials are needed to confirm the efficacy of NPWT and to establish standardized guidelines for its integration into clinical practice.

Limiting the sport practice is routinely recommended for patients with perineal symptoms, but little is known on the prevalence of perineal complaints and the real negative impact of sport practice in the active population.

To assess the prevalence of pelvi-perineal symptoms (fecal incontinence, urinary incontinence, sexual dyscomfort and prolapse) in an active female population and to evaluate the impact of sports practice on these symptoms.

A cross-sectional study was performed by administering a online-questionnaire addressing 25 questions on physical activity and pelvi-perineal symptoms in various gym centers and universities across Geneva during a 4 month period.

Two-hundred and eighty questionnaires were collected from 264 women and 16 men, leaving 264 questionnaires for analysis. Most of responders (70.8%) were younger than 50 years. The mean BMI was 23.1+/-3.9, 22.7% met the criteria for obesity. One hundred thirty-eight responders (52.3%) experienced pregnancy. In terms of physical activity, one hundred and sixty-nine responders practiced some kind of regular sports. Of note, 187 of them reported exercising at least twice weekly (77.3%). In terms of pelvi-perineal symptoms, 89 (34%) responders suffered from dyspareunia, 107 (40.5%) from anal incontinence (gas: 34.9%, feces: 5.7%), and 120 (45.5%) from urinary incontinence. Fifty-one responders (24.1%) reported suffering from pelvic prolapse. As expected, childbirth were predictive of perineal symptoms (both urinary and fecal incontinence). On the contrary, physical activity did not predict a worsening of anal incontinence (p=0.578), urinary incontinence (p=0.787) or prolapse (p=0.353). Frequency of sport practice did not modulate these results nor the type of sport.

Based on our findings, prevalence of perineal symptoms is high among an active population of female; the sport practice seems not to be of negative impact on the perineal comfort

Minimally invasive techniques, including laparoscopic and robotic-assisted rectopexy, have become the standard of care for rectal prolapse repair. However, there is ongoing debate regarding the comparative effectiveness of these approaches, particularly in terms of recurrence, and functional outcomes.

The study aimed to compare the perioperative, short-term, and long-term outcomes of robotic-assisted versus conventional laparoscopic rectopexy in a single high-volume tertiary care center

This retrospective cohort study included 157 patients who underwent laparoscopic (n=130) or robotic (n=27) rectopexy for rectal prolapse between 2013 and 2023. Exclusion criteria included recurrent cases, open procedures, or multiple concomitant interventions. Baseline characteristics, perioperative outcomes, and long-term results were analyzed using descriptive statistics and bivariate tests. Recurrence rates were evaluated using Kaplan-Meier survival analysis.

Baseline characteristics, including age, gender, and ASA scores, were similar between groups. Robotic rectopexy was more frequently associated with mesh implantation (96.3% vs. 72.3%, p=0.006). Operative time was significantly longer for robotic cases (150 ± 55 minutes vs. 120 ± 51 minutes, p=0.011). Intraoperative complications and conversion rates were comparable. Postoperative recovery profiles, including length of hospital stay and laboratory markers, did not differ significantly. Recurrence rates were lower in the robotic group (3.7% vs. 21%, p=0.049), and reoperations were exclusively reported in the laparoscopic group (13%, p=0.048).

Robotic-assisted rectopexy demonstrated comparable safety to laparoscopy, with advantages in recurrence and reoperation rates. While operative time remains longer, robotic surgery is a promising modality, particularly in complex cases. Prospective multicenter studies are warranted to further investigate long-term functional and patient-reported outcomes.

Hirschsprung associated enterocolitis (HAEC) is one of the most severe known complications of Hirschsprung’s disease, both pre- and postoperatively. Current understanding of the pathogenetic mechanism is dysmotility with microbial dysbiosis, altered intestinal barrier function and impaired mucosal immune response. Typical clinical findings of the intestinal inflammation are fever, abdominal distention, diarrhea and sepsis.

To explore the efficacy of consequent postoperative bougienage and consequent long-time follow-ups to reduce the frequency of HAEC.

A retrospective analysis involving 53 patients who underwent transanal pull through (with and without laparoscopic mobilization) between 1999 and 2023 at our institution was conducted. Rigorous follow-up protocols were implemented, incorporating regular bougienage sessions during the initial three months postoperatively. Patient records, including clinical notes and diagnostic tests, were carefully reviewed to assess the incidence of HAEC.

Among our cohort, out of the 53 children, only one confirmed case of postoperative HAEC was documented. Another case was suspected but never confirmed. This remarkably low HAEC rate of 4% in postoperative cases highlights the potential benefits of our implemented bougienage strategy and consequent regular follow ups with early detection of stenosis and constipation as well as its treatment in preventing HAEC following transanal pull through.

Consequent postoperative bougienage, implemented in a meticulous follow up regimen, has proven to be a promising approach to reduce the risk of Hirschsprung Associated Enterocolitis following transanal pull through procedures.

Spinal anaesthesia (SA) as an adjunct to general anaesthesia has been shown to improve perioperative pain management after colorectal surgery. A subsequent reduction of opioid analgesics might further shorten postoperative ileus and costs in colorectal surgery.

We aimed to assess the impact of spinal anaesthesia on pain control, postoperative ileus and costs after colorectal surgery.

Starting in June 2021, all patients undergoing colorectal surgery at our center were offered SA in addition to general anesthesia in order to improve pain control. Patients with contraindications to SA or patients refusing SA were commonly managed with opioids in addition to basic analgesics. Data of consecutive patients undergoing elective, laparoscopic colorectal resections not receiving an ostomy between October 2021 and April 2024 were entered into a prospective database.

Our analysis includes a total of 170 patients (112 with SA and 58 patients without SA). The majority of patients was female in both groups (54% vs. 60%, p=0.399). Laparoscopic sigmoid resection was most frequently performed in both groups (66% vs. 67%, p=0.938) followed by right hemicolectomy (21% vs. 19%, p=0.850). Spinal anaesthesia was associated with a decreased median numeric rating scale for pain at 3h (0 vs 5, p= 0.009), 6h (2 vs. 3, p=0.004) and 24h (2 vs. 5, p=0.012) following surgery. There was no difference in median time-to-flatus (27h vs. 27h, p=0.355), time-to-stool (67h vs. 71h, p=0.245) and time-to-normal diet (62h vs. 67h, p=0.155) after surgery. SA was associated with a decrease in hospital length of stay (6 days vs. 7 days, p=0.038) and total hospitalization costs (16 485 CHF vs. 18047 CHF, p=0.044).

Spinal anesthesia improves postoperative pain control and is associated with a decrease in hospitalization costs and length-of-stay. There was not impact of SA on return of bowel function.

Coffee is a simple, safe, and inexpensive method to prevent post-operative ileus (POI) after digestive surgery. However, uptake of coffee in clinical routine is variable, standardization challenging and compliance unknown.

This study aimed to determine whether serving freshly brewed, high-quality, and flavorful coffee could improve patient compliance and support the routine implementation of coffee as a post-surgical intervention.

In this prospective monocentric single arm study, we proposed to every patient undergoing elective colorectal surgery 3 daily doses of freshly made coffee with a capsule system over 3 days. Primary endpoints were compliance (x/total possible doses) and reasons for non-compliance. Secondary outcome was satisfaction of patients using a visual analogue scale (VAS: 0-10).

50 patients were included for analysis. Median postoperative coffee consumption was 6 (IQR 5-8) during the first three post-operative days (POD), and was not modified after exclusion of patients with POI (n=5). Median compliance was 78% (IQR 56-100) and 35 patients (70%) drank more than 2/3 of possible doses. Compliance decreased post-operatively by POD 2 (Figure 1). The main reason for non-compliance was nausea (n= 28) (Table 1). Patients’ satisfaction with the coffee was high (mean VAS 8.2 ±1.6).

We achieved high levels of compliance and satisfaction by offering a standardized yet personalized and freshly brewed coffee, paired with an enjoyable moment. Integrating therapeutic interventions with positive and enjoyable experiences demonstrates a promising strategy to enhance adherence to postoperative measures.

The side-to-end colorectal anastomosis technique is widely used in robotic colorectal resections. The colon is incised, the circular stapler anvil is inserted antimesenterically, and the colon is closed and transected distally with a linear stapler. The anastomosis is completed laparoscopically by transanal introduction of the circular stapler and docking it to the anvil. Standard laparoscopic linear staplers are commonly used for colon closure.

This study evaluates the feasibility and safety of using the da Vinci Xi Sureform-60 linear stapler extracorporeally for side-to-end anastomoses and assesses its potential to reduce complications and costs by eliminating the need for an additional laparoscopic stapler.

The da Vinci Xi Sureform-60 linear stapler was routinely used for rectal transection and side-to-end colorectal anastomoses in robotic left colectomies/high anterior resections (for colon cancer or diverticulitis) and low anterior resections (for rectal cancer). A modified technique enabled the extracorporeal use of the stapler for colon closure and transection. This method was applied in 139 robotic colorectal resections performed between April 2018 and August 2024.

The cohort included 74 females (mean age 61.46 years) and 65 males (mean age 60.58 years). No intraoperative complications occurred. Postoperative complications included 2 cases of anastomotic bleeding (1.44%) and 7 anastomotic leaks (5.04%), all associated with the circular staple line. No complications were attributed to the linear staple line.

The extracorporeal use of the da Vinci Xi Sureform-60 linear stapler for side-to-end anastomoses is feasible, safe, and cost-effective. Further studies with larger patient cohorts are needed to validate these findings.

Low-grade appendiceal mucinous neoplasms (LAMN) are rare appendiceal tumors characterized by a wide spectrum of clinical presentations and prognoses. Although the prognosis for LAMNs confined to the appendix is generally favourable, there remains a potential risk of progression to pseudomyxoma peritonei (PMP) and metastases. Historically, this risk has often led to extensive surgical resections for localized LAMNs, including ileocecectomy or right hemicolectomy.
The rarity of these neoplasms has contributed to the absence of standardized surgical management guidelines, often leaving decisions to the surgeon’s discretion.

The aim of this study was to assess the necessity of performing a right hemicolectomy in the management of localized LAMNs.

A comprehensive literature search was conducted across PubMed, Cochrane Library, Web of Science and Google Scholar databases to identify articles reporting cases of localized LAMNs treated with right hemicolectomy and with histopathological assessment of lymph node status. Studies involving cases without right hemicolectomy, with PMP or tumors other than LAMN, or lacking lymph node involvement data were excluded.

A total of 21 articles published between 2009 and 2024 were included, reporting 99 cases of right hemicolectomy (44% open, 28% laparoscopic, 28% not reported). None of the cases had lymph node involvement upon histopathological examination. Only one patient underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) after the right hemicolectomy.

This is the largest systematic review of localized LAMNs treated with right hemicolectomy and with histopathological assessment of lymph node status. Based on our results, right hemicolectomy may not be necessary in the treatment of these tumors.

Oncologic colorectal surgery has evolved significantly, leading to increasing surgical complexity necessitating subspecialty training. Concepts such as total mesocolic excision, D2/D3 lymphadenectomy or the widespread acceptance of robotics are known factors driving centralization.

The aim of the present study is to analyze the distribution of colorectal cancer surgery by level of complexity and size / case numbers of hospitals involved. We sought to test whether a shift towards specialized cancer care with improved access to minimal-invasive techniques has occurred following political initiatives to centralize cancer care.

The national BFS (Swiss federal statistic office) database was queried including the years 2012-2022. Parameters of interest included case numbers per center, complexity of resections, patient age, cancer site, type of access and available outcome parameters including in-hospital mortality, morbidity, surgical site infections or reoperations.

A total of 34’106 colorectal cancer resections (44.2% female) were performed during the study period. The majority of resections were performed in large, non-academic centers. Only three centers performed a median of more than 100 resections per year during the study period. The percentage of patients operated in smaller hospitals declined from 38% to less than 20%, with the greatest increase in oncologic resections noted in large cantonal hospitals (50% to 71%). 6.7% of resections were performed in patients <50 years of age (early-onset colorectal cancer) with a 30% increase in absolute terms over the analyzed period. A late but notable trend towards robotic access occurred on a national level.

Despite the previous acceptance of general surgery care for colorectal cancer patients, a paradigm shift towards centralized treatment has occurred in the past 10 years in Switzerland. This shift is accompanied by higher rates of robotic access and growing numbers of early-onset colorectal cancer, underscoring the increased complexity and contemporary expectance of specialized care in this frequent disease.

The aim of benchmarking is to compare one's own data with the published benchmark and to identify possible weaknesses in one's own practice. This comparison provides the basis for subsequent procedural changes to improve quality of outcomes, such as those in low anterior resections for rectal cancer.

The aim of this project is to establish an algorithm to analyse and compare data with benchmark values and to systematically analyse deviations and initiate change within a quality improvement cycle (Fig1). We tested the methodology with the previously published benchmark for low anterior resections [doi:10.1093/bjs/znac300].

All consecutive patients meeting inclusion criteria and treated surgically for a low and mid rectal adenocarcinoma in our department from January 2018 - December 2023 were analysed. The subgroups of ideal and non-ideal patients were formed according to the definitions.

Each benchmark for ideal and non-ideal patients was displayed in a separate diagram. The moving median was calculated from our results for recurrent periods of 12 months with the calculation was repeated in intervals of 3 and 6 months resulting in 21 and 11 periods, respectively (Fig2).

A total of 98 patients was analysed (16.3% ideal patients). For each of the 27 benchmarks in ideal and non-ideal patients, moving medians were calculated. The example of readmission rate within is shown in Fig3. Deviations from the benchmark (ideal patients: periods 8-11; non-ideal: 3-7 and 16-17) were highlighted for step 4 of the improvement cycle. Root cause analyses were carried out to understand the underlying problem when there were deviations observed.

The methodology presented here enables surgeons to compare their data with published benchmarks in order to implement improvement initiatives where needed. Repeated cycles of comparison will ultimately lead to an optimization of outcome.

Computed tomography-based sarcopenia is a predictor of complications and recovery after major surgery. Little is known about sarcopenia markers in the long term after oncological surgery and their predictive potential regarding long-term survival.

The aim is to study the evolution of sarcopenia markers after colon cancer surgery.

This is a retrospective single-center cohort study including patients undergoing curative-intent surgery for colon cancer. Skeletal muscle attenuation (SMA), Skeletal muscle index (SMI), skeletal muscle radiation attenuation (SMRA), intermuscular adipose tissue (IMAT), and index (IMATI) were determined on axial CT slices at the level of the third lumbar space, before surgery and at 6, 12 and 24 months thereafter. Descriptive statistics were employed to describe the evolution of sarcopenia. Statistical correlation of sarcopenia markers and survival was analysed through Cox regression analysis.

The final cohort consisted of 102 patients, with a mean age of 66 years old (SD:13), 65.7% males and 34.3% females. The mean overall survival in the observation period of 24 months was 22 months. Eighty-five patients were alive at 24 months (83.3%), and forty-five (44.1%) had a CT scan at all times. Sarcopenia markers remained stable over time, except SMRA, which diminished: mean DSMRA at 24 months: -1.1 (SD:5.3, p-value: 0.549) and -3.5 (SD: 4.5, p-value 0.179), in males and females, respectively. Age (HR 1.07, 95% CI: 1.00 - 1.14) and ASA score (HR 2.4, 95% CI: 1.00 - 5.7) were independent factors correlated negatively with survival. A positive correlation was found with the DIMAT and DIMATI at 12 months, HR: 0.79 (95% CI: 0.67 - 0.93) and 0.49 (95% CI:0.30 - 0.80).

The markers of muscle quantity (SMA/SMI) remained largely stable in the long-term follow-up after curative-intent colorectal surgery. SMRA, the marker of muscle quality, diminished in our cohort; Neither of the preoperative sarcopenia markers was predictive for survival.

Simple ovarian cysts in girls are common and typically occur during phases of hormonal stimulation. While small cysts are treated conservatively, surgical intervention is required in cases of cyst growth or complications. The most common laparoscopic ovarian-sparing methods are laparoscopic cyst enucleation and cyst deroofing. Adult studies have shown low recurrence rates and a reduction in ovarian reserve following cyst enucleation compared to cyst deroofing. However, no studies have been found on this topic for girls.

We aimed to compare laparoscopic cyst enucleation with laparoscopic cyst deroofing regarding postoperative recurrence rates and ovarian reserve in girls.

We conducted a retrospective multicenter study in two Swiss institutions. Pre- and postoperative demographic, clinical, and sonographic parameters were analyzed. Recurrence was defined as the presence of an ipsilateral ovarian cyst within 3 months postoperatively, while estimation of ovarian reserve was assessed using sonographic ovarian volume and the adnexal ratio. Descriptive statistics of demographic data were performed. Endpoints were analyzed using unadjusted risk differences, odds ratios, and linear regression models.

From 2012 to 2022, 129 patients underwent surgery for simple ovarian cysts (enucleation: n=42, deroofing: n=65). The mean age at surgery was 13.6 years, and the mean preoperative cyst size was 53 mm. Postoperative recurrence rates were similar for both methods (deroofing: 9.5%, enucleation: 7.5%, p=0.786). However, ipsilateral ovarian volume and the adnexal ratio were lower after cyst enucleation, indicating a potential decrease in postoperative ovarian reserve.

We demonstrated that laparoscopic cyst enucleation and cyst deroofing showed no difference in postoperative recurrence rates. Laparoscopic cyst enucleation appeared to have a more negative impact on postoperative ovarian volumes. The findings of our study will serve as basis for a planned prospective study and will help to standardize the surgical management of simple ovarian cysts in girls based on evidence, with the goal of preserving ovarian reserve.

Hepatic alveolar echinococcosis (HAE) is a rare, chronic, potentially life-threatening parasitic disease caused by Echinococcus multilocularis. Its clinical progression closely resembles that of a slow-growing malignant liver tumor. Symptoms typically emerge 10-15 years after infection, mostly leading to diagnoses in adulthood. However, pediatric HAE cases are being increasingly reported, presenting unique challenges in diagnosis and management due to limited awareness and available data. In Switzerland, the rising incidence of HAE highlights the need to improve understanding and refine management strategies in pediatric patients.

This study aims to review the clinical characteristics and treatment outcomes of pediatric HAE through the analysis of four cases.

We retrospectively analyzed pediatric patients diagnosed with HAE between 12/2016 and 4/2023, treated in collaboration with the national Pediatric Liver Center. Data on clinical presentation, diagnostic approaches, treatment modalities, and outcomes were reviewed.

Four pediatric patients (two male, two female), age at initial presentation 10 to 17 years, follow-up duration after diagnosis 18 to 95 months. Two underwent surgical R0-resection and antiparasitic therapy for two years postoperatively with no signs of relapse at the end of follow-up; the other two are receiving antiparasitic therapy alone, with regular follow-up imaging confirming lesion stability. Of the two patients managed conservatively, one declined surgical intervention despite it being offered, while the other is rescheduled for operability assessment at the two-year follow-up, as the current surgical approach carries a high morbidity risk.

Pediatric HAE can be effectively managed with patient-tailored approaches based on disease severity and patient-specific factors, including a combination of surgery and time-limited antiparasitic therapy, or antiparasitic therapy alone. The creation of an international centralized pediatric HAE database will facilitate refining management strategies, and improving outcomes for this rare but serious condition.

Autologous Blood Patch Pleurodesis (ABP) represents an established treatment method of PAL in the adult population. However, despite its low complication rate, the role of ABP among the pediatric population remains unclear regarding evidence of success.

Over the course of 5 months, we treated two children with persistent air leak (PAL) due to complicated pleuropneumonia.

Case 1:

Four-year-old boy, diagnosed with complicated pleuropneumonia and septated pleural empyema in the right chest. VATS was performed, a chest drain was placed, and intravenous antibiotic treatment was initiated. On POD 15, radiological diagnosis of a serous pneumothorax with mediastinal shift led to thoracic tube reinstallment. Due to recurrent unsuccessful attempts to reduce suction, tachypnea and persistent collapse of the right lung, ABP was performed. ABP was repeated once on POD 5. The postoperative course was uncomplicated, with gradual suction reduction and well-tolerated removal of the chest drain. The patient could be discharged on POD on oral antibiotic treatment.

Case 2:

Two-year-old girl with complicated pleural-pneumonia, underwent VATS, chest drain placement and intravenous antibiotic treatment. Despite improving symptoms, a septated pneumothorax was diagnosed on POD 5. Due to persistent air leak, ABP was performed on POD 12 and 15. The postoperative course was then uncomplicated, and the patient could be discharged on POD 10 on antibiotic treatment.

In our presented case series, the effectiveness of ABP in children with PAL as complication for pleural pneumonia could be seen. Therefore, we consider ABP a safe and promising treatment option of persistent air leaks in children.

Laparoscopic Palomo varicocelectomy is a widely adopted surgical approach for treating pediatric varicocele. This study evaluates the use of indocyanine green (ICG)-enhanced fluorescence imaging to preserve lymphatic vessels during surgery.

To describe our experience with ICG-guided laparoscopic varicocelectomy, focusing on its safety, feasibility, and outcomes.

We retrospectively reviewed the records of six patients who underwent laparoscopic left varicocelectomy at our unit between February 2022 and February 2024. The patients’ mean age was 16 years (range 14–17). All cases involved high-grade varicocele with left testicular hypotrophy or clinical symptoms. The procedure was performed laparoscopically with a 2 mL intratesticular injection of ICG. Fluorescence imaging allowed for clear identification and preservation of lymphatic vessels, followed by clipping of the spermatic bundle according to the Palomo technique.

The mean operative time was 55 minutes (range 43–65). No intraoperative complications, conversions to open surgery, or adverse reactions to ICG were reported. At a 6-month follow-up, no recurrences of varicocele or postoperative hydroceles were observed. The small sample size and retrospective design represent limitations, emphasizing the need for further validation in larger cohorts.

ICG fluorescence imaging is a safe and effective tool for lymphatic-sparing laparoscopic Palomo varicocelectomy in pediatric and adolescent patients. This technique consistently allowed identification of lymphatic vessels with no reported complications. Future studies are recommended to validate these findings in broader populations

Radial fractures are among the most common fractures in children and adolescents. While surgical intervention is effective in correcting significant deformities, it is inherently invasive and associated with higher risks, including infection or anesthesia-related complications. Non-surgical approaches, such as immobilization in the Schede casting position, offer a potentially less invasive alternative, though evidence supporting its use remains limited.

This study aimed to evaluate the effectiveness of the Schede casting position in improving deformity correction in pediatric radial fractures and to assess its acceptance and clinical experience among pediatric trauma surgeons.

A survey was conducted among pediatric trauma surgeons to assess their experience with the Schede casting position. Additionally, a retrospective analysis compared radiographic outcomes between immobilization in the Schede casting position and standard casting positions in pediatric radial fractures. The primary outcome was the improvement in radiographic alignment, particularly in the sagittal plane.

The retrospective analysis demonstrated an improvement in fracture alignment with the Schede casting position compared to standard positioning, particularly in the sagittal plane on lateral radiographs. Survey responses revealed that many pediatric trauma surgeons reported positive clinical experiences with this technique, emphasizing its efficacy in reducing deformities and avoiding surgery in selected cases.

The Schede casting position represents a promising, non-surgical approach for managing pediatric radial fractures, achieving significant deformity correction and potentially reducing the need for surgical intervention. These findings highlight the need for further prospective studies to validate these results and establish clear clinical guidelines.

The challenges are immense when it comes to enhancing the development of children surgery in low- and middle-income countries, in line with current recommendations for holistic and sustainable approaches. Our program, entitled Pediatric Surgery Development Plan in Burkina Faso, was specifically designed to respond to these challenges by tackling the pediatric surgical ecosystem, based on partnership, research and interventions at all levels of the healthcare system.

We herein present our unique experience by reporting on the first four years of the program, focusing on the main actions and monitored indicators.

This program has been designed using the Global Initiative for Children's Surgery main pillars and preserving a fundamental health system strengthening approach.

The country's capacity for pediatric surgery has meaningfully been increased: i) A new infrastructure has relieved congestion in pediatric surgical care at the national level, ii) hundreds of professionals have benefited from skills enhancement, iii) the quality of care in the partner hospital has been optimized, iv) collaboration with traditional practitioners and families have been strengthened, v) research has enabled us to move forward in an evidence-based way, and vi) pediatric surgery in Burkina Faso has enjoyed a new impulse thanks to advocacy work. Quantitative results are summarized in Table 1.

This program has not only helped to create a major impulse for the expansion of pediatric surgery in Burkina Faso, but also enriched the community of interest with a concrete implementation program to confirm the main challenge to overcome: integrating this most essential discipline into the wider framework of global health.

Traumatic injuries to the pancreas present a challenge in blunt abdominal trauma in children. The management include both surgical and non-surgical treatment options with an increasing preference towards non-operative management (NOM). Our aim is to illustrate the current concepts of surgical treatment for pancreatic injury in children.

We present a case series of three pediatric patients with traumatic pancreatic injuries. 

Patient 1 (10-year-old male) presented with a proximal subtotal pancreatic rupture (grade IV, AAST) and acute hemorrhage, necessitating emergency laparotomy. Hemostasis was achieved, the proximal pancreatic duct was sutured, and a distal pancreatico-jejunostomy with a Roux-en-Y-anastomosis was performed.

Patient 2 (8-year-old female) underwent emergency laparotomy for complete pancreatic rupture (grade IV, AAST) and acute hemorrhage. Hemostasis was achieved and a distal pancreatectomy was performed, with suture of the proximal pancreatic duct.

Patient 3 (8-year-old male) sustained a traumatic pancreatic rupture (grade IV-V, AAST) and was transferred to our institution five days post-injury. Initially managed conservatively, the patient now presented with an acute abdomen. Emergency exploratory laparotomy was performed. Intraoperatively, a drain was placed in the Douglas pouch, and a chest tube was inserted to address pleural effusion. Subsequently, a functional duodenal stenosis due to a pancreatic pseudocyst developed, necessitating an upper gastrointestinal endoscopy with endoscopic ultrasound and endoscopic cystogastrostomy. 

All patients recovered quickly with full return to normal activities.

While NOM has demonstrated efficacy in select cases, early surgical intervention remains crucial in specific scenarios, particularly those with acute hemorrhage or involving pancreatic duct injuries, highlighting the necessity for individualized treatment concepts.

Isolated Fallopian tube torsion (IFTT) is a relatively rare condition affecting young female patients, presenting as nonspecific abdominal pain (acute or chronic), often associated with vomiting. Diagnosis through standard procedures is not always conclusive, and for most patients, the definitive diagnosis is achieved through minimally invasive surgical exploration.

To share our experience in managing IFTT, focusing on the challenges of the diagnostic process and evaluating the role of minimally invasive surgery as a primary approach

We performed a retrospective case review series of pediatric patients with IFTT treated at our institution between 2021 and 2024. Clinical presentations, ultrasound efficacy, the utility of secondary imaging exams (CT and MRI), and types of surgical treatment were analyzed.

Four cases of IFTT were included, all of whom with an associated paratubal cyst. Two patients underwent laparoscopic hemi-salpingectomy with ovarian preservation, while two required laparoscopic tubal de-rotation and fenestration of the cyst. MRI was used in all cases to complete the diagnostic process.

Due to its low frequency and the lack of clear guidelines, diagnosing IFTT remains challenging. MRI appears to facilitate the diagnostic process. A laparoscopic approach is safe, feasible, and remains the gold standard for treatment. We propose our protocol to enable prompt diagnosis and avoid extensive surgical interventions.

Spigelian hernia (SH) is a rare abdominal wall defect in infants. SH can be associated with ipsilateral cryptorchidism, with the testis located within the hernia – referred to as Spigelian-cryptorchidism syndrome.

A male preterm infant born at 28 weeks of gestational age developed at 11 weeks of age a painless right abdominal wall swelling. The location was consistent with a SH. The right hemiscrotum was empty and an ectopic testis was palpable within the swelling. Abdominal ultrasound confirmed a SH containing a loop of small bowel and the right testis of appropriate size. At the time of diagnosis the infant was requiring respiratory support for bronchopulmonary dysplasia, therefore surgery was postponed.

At 11 months of age, a laparoscopic assisted right orchidopexy and open hernia repair were performed. Laparoscopy allowed very good recognition of a 2 cm wall defect above a closed deep inguinal ring, lateral to the right rectus abdominis muscle. The right testis, with normal looking vas deferens and blood vessels, as well as the right colon were contained within the hernia sac. The SH was repaired by open herniorraphy. The recovery was uneventful, and the patient was discharged on postoperative day 1. Follow-up up to now (3 months) showed no complication.

A laparoscopic guided approach allows for better understanding of the location and the size of the wall defect, length of the testicular vessels and presence of inguinal canal and gubernaculum. To our knowledge, this is the first reported case of Spigelian-cryptorchidism syndrome in a preterm infant.

In Spigelian-cryptorchidism syndrome, preoperative abdominal ultrasound can help assess the presence of the testis within the SH and guide surgical planning.

Robotic epigastric hernia repair using the transabdominal preperitoneal (rTAPP) approach is a well-established technique in adult patients. The robotic approach enhances precision, improves ergonomics, and reduces complication rates. However, there is limited evidence regarding its application in the pediatric field. This report describes the case of a 16-year-old female patient who underwent rTAPP surgery for an epigastric hernia.

To highlight the feasibility and efficacy of robotic transabdominal preperitoneal repair in managing epigastric hernias in pediatric patients, particularly in the presence of obesity

We present the case of a 16-year-old Caucasian female with a history of chronic supraumbilical abdominal pain lasting over five years. The patient’s medical history included Cornelia de Lange syndrome with developmental delay, exogenous obesity, insulin resistance, and pilonidal disease. An ultrasound revealed an epigastric hernia defect. Robotic transabdominal preperitoneal repair was performed using standard rTAPP technique

The robotic repair successfully addressed the epigastric hernia, resulting in significant post-surgical pain relief. The approach was effective in overcoming the challenges posed by the patient’s obesity, demonstrating the precision and adaptability of robotic techniques in complex pediatric cases.

The experience gained from rTAPP in adults can be effectively translated to the pediatric population. This case highlights the potential of robotic surgery to address complex pediatric hernias. Further research is needed to build a robust case series and establish appropriate criteria for surgical indications in pediatric patients

Penetrating head injuries are not common in children but can represent major trauma.

We present a 14-year-old girl with penetrating head injury after horse riding injury. During transportation she was always awake and responsive, however developed monocular hematoma. On arrival at our emergency department, we found a left frontal laceration, the frontal bone visible and horsehair contaminating the wound. A CT scan revealed a 2 cm depressed skull cap fracture involving the frontal sinus, the roof and floor of the orbita and the left maxillary sinus.

The open fracture was explored through coronal incision. We performed a cranioplasty of the orbital roof, microsurgical dural plasty, reconstruction of the periorbita and osteosynthesis of the orbital roof and the frontal bone with lactosorb re-absorbable plates and screws.

Postoperative transfer to the pediatric intensive care unit for one day, then transfer to the normal pediatric surgical ward. The patient received antibiotic treatment for five days, drains could be removed after three days. Glasgow-Coma-Scale (GCS) monitoring was always 15. Ophthalmologic examinations revealed regular findings both initially and during hospitalization. The patient could be discharged on postoperative day 8, outpatient rehabilitation was carried out. Two months postoperative, there are no postoperative complications, but the patient is still not able to attend school for a full day.

The patient always revealed a GCS score of 15, however proved to have a significant open traumatic brain injury, whose true extent could only be seen in cCT. Scandinavian guidelines suggest a further subdivision of mild traumatic brain injury; in the presence of risk factors such as clinical signs of an impression fracture, CT imaging is primarily indicated.

Nonoperative management (NOM) of isolated solid organ injury in pediatrics is an established way of treatment in hemodynamically stable patients. However, close monitoring and reevaluation are indicated, as complications may occur and may need diagnostic or therapeutic adjuncts. Among them, traumatic bile leak (TBL) requires a multidisciplinary approach.

We report a 13-year-old male with AAST grade IV liver injury qualifying for NOM after initial hemodynamic stabilization. The clinical course was complicated with increasing amounts of intra-abdominal free fluids leading to laparoscopic exploration and later on diagnosis of biliary leak. The patient was then treated with biliary stenting and iterative ERCP procedures, documenting a successful management of the biliary leak.

A high index of suspicion of complications must be maintained in patients selected for nonoperative management, including TBL. ERCP may be considered as an adjunct in the NOM in appropriate cases.

Traction tables are widely used in orthopedic procedures. Although rare, potential complications include nerve injuries, fractures, and soft tissue damage. This case report documents the first reported case and management of extensive genitoperineal necrosis in a pediatric patient following femoral fracture fixation related to a traction table.

This case report aims to describe the presentation, management, and long-term implications of genitoperineal necrosis related to the use of an orthopedic traction table as well as to raise awareness, and to propose strategies for prevention in the pediatric population.

A 10-year-old girl underwent closed reduction and intramedullary nail fixation of a femoral shaft fracture using a traction table with standard padding and positioning. Operative time was 183 minutes. At the end of the procedure an extensive full thickness pressure necrosis in the genitoperineal area was observed. Postoperatively, a multidisciplinary team involving plastic surgery, urogynecology and orthopedic surgery managed the wound conservatively including topical antiseptics, local steroids and estrogens. No surgical intervention was needed but several sedations for wound care. A transurethral catheter was left in place for 25 days for pain and wound management. The patient was hospitalized for 28 days. Full wound epithelialization was achieved after 44 days. At seven months follow-up, the patient did not exhibit any urinary complaints or pain, however synechiae involving the clitoral hood and labia minora had developed. Further follow-up is planned and surgical correction of synechiae will most likely be necessary during puberty.

This case highlights the vulnerability of pediatric soft tissue to ischemic damage during prolonged traction table use. Preventative strategies should include increased awareness, team education, minimizing operating time, optimizing padding, and considering intraoperative tissue perfusion monitoring. Multidisciplinary care and long-term follow-up are essential to address such complications. Genitoperineal injuries usually respond well to conservative management without need for a primary surgical approach.

Button battery ingestion with esophageal impaction can result in severe, potentially life-threatening complications, including long-term sequelae.

A case of a 22-month-old boy with a button battery impacted in the upper esophagus, immediately removed after an impaction time of 4 hours is presented. The patient was treated with a naso-gastric tube, maintained npo, and given intravenous antibiotic treatment and a PPI.

Subsequent MRI revealed reactive mediastinitis, which resolved within 8 days. On day 10, a fibrin patch persisted on the dorsal wall at the site of impaction. Antibiotic treatment were discontinued, oral liquids were started and well tolerated, and the patient was discharged on day 13.

On day 17, the esophageal mucosa was fully restored. However, after 6 weeks a polypous structure was noted at the impaction site, limiting the patient to soft foods or small portions. An MRI at 10 weeks revealed spondylodiscitis of T1/T2, with a fistula between the esophagus and the intervertebral disc. However, the patient remained asymptomatic except for dietary limitations. He was treated with a 6-week course of antibiotic treatment, including 14 days of intravenous therapy at the beginning. Systemic inflammation markers became apparent only 6 days after initiating the antibiotic treatment. The spondylodiscitis resulted in a bony defect at the ventral edge T1/T2 accompanied by mild kyphosis.

At 12 months post-ingestion, the patient recovered to full without clinical symptoms.

Spondylodiscitis is a rare but severe complication of button battery ingestion that can develop subclinically. While the immediate removal of an impacted button battery is crucial to minimizing severe and potentially life-threatening complications, such as for example esophageal-aortic fistulas, long-term follow-up is equally crucial. In cases of abnormal findings, endoscopic and magnetic resonance imaging is indicated to evaluate and manage these patients effectively.

Trauma-related epidural haematoma dorsal to the clivus down to the level of C1 following sports related TBI in infants and children is a rare condition.  

We present a 5 ½ year old boy who presented with sub-febrile temperatures three days after traumatic brain injury with brief unconsciousness following a skiing accident. Initial clinical assessment showed a left abducens and hypoglossal palsy. There was also latent strabismus, persistent neck pain, as well as increased fatigue. A low dose CCT revealed an epidural haematoma with compression of the medulla oblongata and a cranio-cervical dissociation.

A surgical cranio-cervical fixation and a suboccipital decompression of the foramen magnum was performed.

Post-traumatic cerebrospinal fluid circularisation disorder later developed at the level of the posterior fossa potentially accentuated by the Chiari I malformation, therefore a ventricular-peritoneal shunt was placed.

This case represents a rare and complex post-traumatic injury related to a previously not apparent and undiagnosed malformation. Children suffering from TBI with cranial nerve deficit should be carefully observed for clival fractures and hematomas and/or consecutive traumatic instability of the cranio-cervical junction respectively.

Obesity and gastroesophageal reflux disease (GERD) often coexist, posing clinical challenges. Fundoplication is the standard treatment for GERD refractory to medical therapy. Managing obesity after fundoplication is complex and while RYGB is preferred for addressing both obesity and GERD, its use post-fundoplication requires further evaluation.

To assess the outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in patients with prior fundoplication.

Retrospective analysis of a national French database of patients undergoing RYGB and SG between 2013 and 2023. Patients were grouped according to prior fundoplication (PriorF) or no fundoplication (NoF). Baseline demographics and 90-day postoperative outcomes were assessed. Univariate and multivariate analyses identified risk factors; 1:5 matching was applied based on sex, age, body mass index, comorbidities, surgery year, and procedure type.

Among 372'464 patients, 337 (0.1%) had prior fundoplication. PriorF patients had higher rates of severe postoperative complications (Dindo ≥ IIIa: 8.9% vs. 3.7%, p < 0.001), longer hospital stays (4.5 ± 4.9 vs. 3.7 ± 2.9 days, p < 0.001), and higher readmission rates (17.8% vs. 9.9%, p < 0.001). Multivariate analysis for RYGB showed no significant association between prior fundoplication and complications (OR 1.66, 95% CI 0.98–2.62, p = 0.059). Prior fundoplication was independently associated with increased complications after SG (OR 2.83, 95% CI 1.59–4.66, p < 0.001).

Prior fundoplication increased postoperative complications after SG but not after RYGB. RYGB appears to be the a safer bariatric procedure in patients with prior fundoplication. Management should be performed in high-volume centers with bariatric expertise.

In the past, studies have indicated a better prognosis in women with gastric cancer. Nevertheless, gender differences in gastric cancer treatment and survival, especially regarding postoperative outcomes, remain poorly investigated.   

The aim of this retrospective cohort study is to evaluate gender-related differences in patient characteristics and postoperative outcomes following oncological gastrectomy.

We analyzed 9351 oncological gastrectomies performed between January 1, 2017, and December 31, 2021, across 43 centers on five continents. The primary endpoints were gender-related differences in postoperative complications and morbidity, assessed using multivariable logistic regression. Propensity score matching was employed to balance baseline characteristics.

The cohort consisted of 3516 female and 5835 male patients. Male patients were older (66 (IQR 57-74) vs 64 (IQR 54-73)), had higher BMI, ASA scores and more advanced tumor stages, while females had more diffuse tumors and R+ resections (Table 1). Male patients had significantly more overall (27.3% vs. 22.4%) and major (15% vs. 10.8%) complications. Similarly, escalation of care, reoperations, readmissions and 90day mortality (2 vs 1.3%, Table 2) were decreased in women. In crude multivariate analysis, male gender was a risk factor for specific complications such as anastomotic leakage (3.4% vs. 2.0%) and pulmonary complications (6.0% vs. 4.1%). After matching 1685 patients of both genders, male gender remained a predictive factor for overall and major complications, anastomotic leakage, and pulmonary morbidity. In contrast, male gender was not associated with mortality, infectious complications and R+ status (Figure 1).

This large, multicenter cohort study highlights significant gender-related disparities in postoperative outcomes after oncological gastrectomy. Male gender is an independent risk factor for major complications, anastomotic leakage, and pulmonary complications. These findings underscore the need for gender-specific risk stratification and tailored perioperative management strategies in gastric cancer surgery.

Median arcuate ligament syndrome (MALS) is a rare and complex condition with both vascular and neurologic components. Surgical repair is the treatment of choice; however, the proximity of the surgical field to the aorta and celiac trunk presents significant challenges.

This study aims to evaluate symptom improvement and postoperative quality of life (QoL) in patients undergoing minimally-invasive median arcuate ligament release (MALR) at our institution.