(Dig Surg[TA])
2,024 results
  • The management of pancreatic fistula after pancreatic surgery. [Review]
    Dig Surg. 2026 Sep 09; :1. [Online ahead of print]Angles T, Alsfasser GDS
  • Postoperative pancreatic fistula is a complex and dreaded complication after pancreatic surgery. Its management is complex and dependent on clinical presentation and severity and clear guidelines are often lacking. This review aims to present the current evidence-based strategies for mitigating the deleterious effects of POPF in the peri- and postoperative setting. Therapy of pancreatic fistula c…
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  • Exocrine Pancreatic Insufficiency and Nutritional Status in Patients with Resectable and Borderline Resectable Periampullary Tumors: A Prospective Longitudinal Study. [Journal Article]
    Dig Surg. 2026 Sep 07; :1. [Online ahead of print]Herrero Fonollosa E, Sobrerroca Porras L, … García Domingo MIDS
  • CONCLUSIONS: Prospective observational single-center study. Thirty-two patients with potentially resectable periampullary tumors underwent nutritional assessment including fecal elastase-1 (FE-1), psoas muscle index (PMI) on CT, bioelectrical impedance analysis (BIA) with phase angle, and handgrip strength. Postoperative complications, Textbook Outcome (TO), and nutritional follow-up at 1, 3, and 6 months were assessed in 23 resected patients. EPI (FE-1 <200 mcg/g) was present in 76.9% (20/26). Prealbumin was <20 mg/dL in 62.1% and vitamin D deficient in 82.8%, despite normal albumin in most patients. Sarcopenia by PMI was detected in 53.1% (17/32) of the full preoperative cohort, substantially higher than handgrip strength alone (15-17%). After resection, universal EPI (100%) was confirmed. TO was achieved in 73.9% (17/23). Median weight declined from 64.0 kg preoperatively to 61.2 kg at 6 months; cumulative weight loss from pre-illness habitual weight reached 18.5% at 6 months, of which 9.2% had already occurred before surgery. Vitamin D deficit persisted throughout follow-up; sarcopenia was numerically higher at 1 month (68.8%), with values returning toward baseline by 6 months (65.2%).Patients with periampullary tumors present a severe, multidimensional preoperative nutritional burden more prevalent than recognized. Systematic assessment should be incorporated into standard protocols within a structured multidisciplinary perioperative pathway.
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  • Robotic Bariatric Surgery: A Critical Review of Clinical Outcomes, Learning Curves, and Economic Considerations. [Review]
    Dig Surg. 2026 Sep 07; :1. [Online ahead of print]Patel N, Glaysher MA, … van Boxel GDS
  • CONCLUSIONS: This review critically evaluates the current evidence comparing robotic Roux-en-Y gastric bypass (RRYGB) and robotic sleeve gastrectomy (RSG) with their laparoscopic counterparts. Recent meta-analyses and large registry studies demonstrate broadly comparable perioperative outcomes between RRYGB and laparoscopic RYGB (LRYGB) across major clinical endpoints. Modest advantages for RRYGB have been reported in selected intraoperative and postoperative measures, including reduced anastomotic stricture rates, reduced marginal ulceration, reduced blood loss, lower conversion rates, and improved recovery in higher-risk patient groups such as in revisional surgery and high-BMI patients. However, these findings are inconsistent and largely derived from retrospective observational studies with heterogeneous methodology and limited long-term follow-up. In contrast, current evidence does not demonstrate clear clinical advantages for RSG over laparoscopic sleeve gastrectomy (LSG), and in fact suggest inferiority in terms of short-term outcomes. Although temporal analyses suggest improvement in robotic outcomes over time, similar trends have been noted in laparoscopic cohorts, suggesting broader improvements in perioperative bariatric care. Economic analyses consistently report higher procedural costs for robotic approaches, driven primarily by operative time and consumable expenditure, although these differences may decrease with transition to totally robotic techniques, increasing institutional experience and workflow optimisation in high-volume centres.Robotic bariatric surgery achieves outcomes comparable to laparoscopy but currently demonstrates selective advantages primarily in complex procedures such as RYGB and revisional surgery. The role of robotics in routine sleeve gastrectomy remains uncertain. Higher procedural costs and limited high-quality comparative data spanning different time periods continue to limit the ability to draw definitive conclusions. Future research should prioritise multicentre randomised trials, standardised reporting frameworks, and comprehensive economic evaluation across different emerging robotic platforms with consideration of learning curve effects.
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  • Safety of Proctored Learning Curve in Upper Gastrointestinal Robotic Surgery. [Journal Article]
    Dig Surg. 2026 Jul 28; :1-11. [Online ahead of print]Badaloni F, Ramirez MG, … Nieponice ADS
  • CONCLUSIONS: This study reports the initial implementation of robotic upper gastrointestinal surgery in Argentina following the UGIRA structured training pathway enhanced by telementoring. Despite limited case volume and follow-up, the approach appears feasible and safe, with acceptable short-term perioperative and oncologic outcomes.
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  • The Clinical Dilemma of Vanishing Lesions after Systemic Therapy in Oligometastatic Esophagogastric Cancer: A Narrative Review. [Review]
    Dig Surg. 2026 Jul 14; :1-7. [Online ahead of print]Bronzwaer SFC, Haarlem IV, … van Rossum PSNDS
  • CONCLUSIONS: We searched PubMed for studies on vanishing metastases after systemic therapy in esophagogastric cancer. Complete disappearance of all metastases occurred in 1-3% of patients treated with chemotherapy alone and in 5-17% in trials using targeted or immune therapies. Series reported ≥1 vanishing lesion(s) in 8-44% of patients. Definitions relied on CT, without comparison to MRI or PET-CT. Lesion-level pathology was lacking; vanishing sites were not resected. Survival benefits were linked to radiologic complete response, but the impact of locally treating vanishing sites was not studied. Because esophagogastric data are scarce, colorectal metastases were reviewed for context: CT disappearance often overestimated cure, liver MRI frequently altered plans, 33-69% of CT/MRI-negative liver lesions still harbored viability or recurred, and survival was comparable between unresected vs. resected vanishing lesions.Current evidence does not support routine local treatment of vanishing lesions in oligometastatic esophagogastric cancer, although this conclusion is based on a very limited and retrospective evidence base. Imaging besides CT (e.g., MRI, PET-CT) may improve staging. Individualized benefit-risk assessment and studies addressing diagnostic and therapeutic strategies are needed.
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  • Surgical Management of Colorectal Cancer Peritoneal Metastases: Current Indications, Controversies, and Future Directions. [Review]
    Dig Surg. 2026 Jul 04; :1-15. [Online ahead of print]Horowitz M, Aquina CTDS
  • CONCLUSIONS: This narrative review presents the current indications, controversies, and future directions of CRS, HIPEC, and additional emerging treatment modalities in the surgical management of colorectal cancer peritoneal metastases.Peritoneal metastases in colorectal cancer signify a poor prognosis. Management of peritoneal disease includes CRS with or without HIPEC. The use of CRS has been established as an effective treatment modality with acceptable morbidity and long-term quality of life. However, the efficacy of HIPEC continues to be debated. Patient functional status, tumor biology, degree of disease burden, and the feasibility of achieving complete cytoreduction are central to the success of the operation. Emerging treatment options, such as pressurized intraperitoneal aerosolized chemotherapy, represent promising alternative treatment options for patients.
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  • Bacterial Colonization in Resected Lymph Nodes during Pancreatic Surgery: A Pilot Study. [Journal Article]
    Dig Surg. 2026 Jun 12; :1-10. [Online ahead of print]Coşkun Gürçınar S, Gürçınar IH, … Demir EDS
  • CONCLUSIONS: In this pilot study, bacterial colonization of PLNs was uncommon and was observed only in patients with a history of ERCP. Although no association with POPF was identified, a potential relationship with overall postoperative morbidity cannot be ruled out. Further studies with larger patient cohorts are needed to better define the clinical relevance and underlying mechanisms of lymphatic bacterial translocation.
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  • PIPAC for Malignant Peritoneal Mesothelioma: Current Insights and Future Directions. [Review]
    Dig Surg. 2026; 43(3):151-162.Castagna A, Fotiadou A, … Brandl ADS
  • CONCLUSIONS: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged as a novel technique improving drug delivery and penetration in the peritoneal cavity. This narrative review evaluates the role of PIPAC in the treatment of MPM, analysing data from clinical studies on its feasibility, safety, and efficacy. Evidence suggests that PIPAC is a well-tolerated procedure, with a manageable safety profile and potential to improve survival and tumour response in patients with unresectable or recurrent disease. Limitations in current studies include small cohorts and heterogeneous patient populations, underscoring the need for further research.PIPAC represents a promising therapeutic option, offering enhanced intraperitoneal chemotherapy delivery with minimal systemic toxicity. Future investigations should focus on optimizing treatment protocols and evaluating long-term benefits to better define PIPAC's role in clinical practice.
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