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BACKGROUND: The sustained administration of deep neuromuscular blockade (NMB) improves surgical conditions compared to moderate NMB and might be effective in the laparoscopic Roux-en-Y gastric bypass (LRYGB). This study aimed to evaluate the effect of sustained intravenous deep NMB on improving surgical conditions and pain intensity following LRYGB. METHODS: This randomized, double-blind clinical trial was conducted in São Luís, Maranhão, Brazil, between October 2021 and December 2023. Patients undergoing LRYGB were randomly assigned to moderate (reversed with 2 mg/kg of sugammadex) or deep NMB (reversed with 4 mg/kg of sugammadex). RESULTS: Seventy-one patients were evaluated in the study, divided into moderate NMB with 37 patients and deep NMB group with 34 patients. There was no difference between the groups regarding gender, age, weight, height, and comorbidities. Also, in the duration of anesthesia (moderate, 2 h 26 min; deep, 2 h 27 min; p = 0.876), duration of surgery (moderate, 1 h 39 min; deep NMB: 1 h 40 min; p = 0.931), time to extubation (moderate, 5 min; deep, 7 min; p = 0.252), time to the first morphine request (moderate, 30 min; deep, 25 min on average; p = 0.776), mean morphine consumption in 24 h (moderate, 14 mg; deep, 10 mg; p = 0.133), and sevoflurane consumption (moderate, 50 mL; deep 50 mL; p = 0.884). There was no significant difference between the groups in pain scores at none of the evaluated moments. The Leiden-Surgical Rating Scale revealed a significant difference between the groups at 20/30 min (p = 0.015) and 60/70 min (p = 0.027), respectively. CONCLUSION: This study demonstrated improved surgical field visibility with deep compared to moderate NMB, without significant differences in other evaluated variables.

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BACKGROUND: Laparoscopic Roux-En-Y Gastric Bypass (LRYGB) contributes significantly to higher weight loss at 6 to 12 months when compared to Laparoscopic Sleeve Gastrectomy (LSG) in patients with severe obesity (SO-body mass index (BMI) ≥ 50 kg/m2). However, there is still no consensus regarding the best procedure in terms of mortality and complication rates. We performed a systematic review and meta-analysis to compare the complication rates between these two surgical procedures. METHODS: PubMed, EMBASE, and Cochrane Central were searched for studies that compared LRYGB and LSG in SO patients. We pooled outcomes for mortality and complications, defined as bleeding, cardiovascular events, conversion to open procedure, and a composite endpoint of leak, abscess, fistulas, and reoperation. Length of stay and operative time were also pooled. A random-effects model was used, and statistical analyses were performed using R version 4.4.0. RESULTS: A total of 156,767 patients from 28 observational studies were included, of whom 79,324 (50.6%) underwent LRYGB and 77,443 (49.4%) LSG. Length of stay (MD 0.45; 95% CI 0.42-0.48; P < 0.01) and operative time (MD 58.88; 95% CI 37.88-79.87; P < 0.01) were lower in the LSG group. Overall, there was no difference in mortality (OR 1.28; 95% CI 0.80-2.04; P = 0.311) and in complication rates (OR 1.22; 95% CI 0.85-1.76; P = 0.287). A subgroup analysis showed lower conversion to open procedure for patients who underwent LSG (OR 2.75; 95% CI 1.90-3.98; P < 0.001), and no difference was noted in bleeding (OR 0.98; 95% CI 0.47-2.07; P = 0.965), cardiovascular events (OR 0.99; 95% CI 0.43-2.29; P = 0.983), and a composite endpoint of leak, abscess, and fistulas (OR 0.82; 95% CI 0.67-1.01; P = 0.066). CONCLUSION: Our meta-analysis suggests that there is no difference in mortality and complication rates between the two groups. However, length of stay and operative time were lower in SO patients who underwent LSG.

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BACKGROUND: An advanced curriculum for training Total Laparoscopic Gastropexy (TLG) was developed using the CVLTS-composed simulator based on an ergonomic model of a canine abdominal cavity. The performance of Veterinary surgeons trained in basic laparoscopic surgical skills during 15 training TLG sessions (experimental group, n = 10) was compared to the TLG performance of veterinary surgeons with intermediate (n = 10) or advanced (n = 6) laparoscopic skills. The transfer of surgical skills to a live model was assessed by performing TLG in fattening pigs under operating room conditions using barbed sutures. Experimental group performance after accomplishing the TLG training curriculum and all groups' performance during TLG in the in vivo model were videotaped and evaluated by external Minimally Invasive Surgery (MIS) experts using the GOALS and TLG-specific ranking (SRS) scales. Also, a quantitative assessment comprising time, smoothness of movements, and angular displacement using a Hand Movement Assessment System (HMAS) was performed. Besides, a postmortem biopsy recovered from the gastropexy site three months after surgery to evaluate gross and microscopic characteristics by histopathology was analyzed. RESULTS: GOALS and SRS scores (P < 0.05), and time, smoothness of movements, and angular displacement during TLG (P < 0.01) significantly improved in the Experimental group after training. They also compared their performance with expert and intermediate groups (P < 0.05) performances. The learning curve for intracorporeal suture stabilized since the tenth (out of 15) training session. Besides, trainees achieved significant TLG skills' in vivo transfer, with no significant difference from the intermediate and expert group performances. The presence of mature collagen (100% of cases), cartilage and bone metaplasia, and foreign body reaction (25% of cases) were found at histopathology evaluation of the gastropexy site, evidencing normal healing. CONCLUSION: The TLG training curriculum supported the acquisition of TLG surgical skills in the training box and their transfer to the in vivo model. The experimental group's TLG performance in vivo did not significantly differ from the intermediate and expert groups. The clinical outcome and histopathological findings evidenced complete gastropexy-site healing.

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BACKGROUND: Gastric cancer remains a major global health challenge, ranking fourth in cancer-related deaths. Total gastrectomy with lymphadenectomy is the standard treatment, with advancements in surgery shifting towards minimally invasive techniques to reduce surgical trauma and metabolic response. Esophagojejunal anastomotic leak is a frequent complication of gastrectomy, significantly increasing morbidity and mortality rates by up to 64%. MATERIALS AND METHODS: A retrospective cohort study reviewed adults undergoing total gastrectomy for gastric cancer who developed esophagojejunal anastomotic leaks. The study described patient characteristics, diagnostic methods, and management at Clinica Universitaria Colombia from 2013 to 2023. RESULTS: Among 500 patients who had total gastrectomy, 54 developed esophagojejunal leaks. The cohort was 64.8% male, average age 55.2 years (± 14.87), and average BMI 24.5 kg/m². Notably, 18.5% smoked, 11.1% had lung disease, and 9.3% had heart disease or diabetes. Chest tomography was used in 60% of cases, followed by endoscopy in 35.2%. Endoscopic management with fully covered stents was the main strategy, used in 84% of cases. Average hospitalization was 18 days, with 33% needing intensive care, and overall hospital stay was 23.31 ± 16.33 days. Patients undergoing neoadjuvant and elective laparoscopic surgeries had a significant 30-day mortality risk. CONCLUSIONS: Despite advances in surgical techniques and perioperative management, esophagojejunal anastomotic leaks continue to represent a serious complication, increasing morbidity and mortality. Therefore, early postoperative detection, based on the patient's clinical signs that allow confirmatory studies to be performed, is crucial. This facilitates the implementation of timely treatments, whether conservative, through the use of endoscopic or percutaneous strategies, or surgical procedures. The next step for the scientific community will be to conduct studies with long-term follow-ups to ensure consistency of the high-quality results reported so far.

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BACKGROUND: Immunometabolism is the interaction between immune system and nutrient metabolism. Severe obesity is considered a state of meta-inflammation associated with obesity that influences the development of chronic-degenerative diseases. OBJECTIVE: We aimed to establish the immunometabolic differences in bariatric patients and to determine whether cellular immunity is associated with metabolic changes. METHODOLOGY: We conducted an observational study in patients who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB). We explored the differences in the immunometabolic profile before and after surgery in the study group, by surgical technique, and we evaluated the changes in immunological variables as a function of metabolic variables with correlation analysis. RESULTS: The follow-up rate was 88.7%. After the intervention, there were changes in cellular immunity, with a decrease in effector T lymphocytes (CD8+CD28-) and an increase in B lymphocytes, memory helper T cells, and cytotoxic T lymphocytes. LSG resulted in a greater decrease in (CD4+CD62-) T lymphocytes compared with LRYGB. Patients who underwent surgery with LRYGB presented greater clinical and metabolic improvements, as well as improvement of obesity-associated medical problems. Women who underwent LRYGB showed a greater reduction in fat-free mass compared with women who underwent LSG. CONCLUSION: Bariatric surgery, mainly LRYGB, leads to immunometabolic changes and improves associated medical problems.

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BACKGROUND: Obesity is a significant risk factor for chronic kidney disease (CKD), with metabolic bariatric surgery offering potential renal benefits. However, there is limited comparative data on the impact of Roux-en-Y gastric bypass (RYGB) versus laparoscopic sleeve gastrectomy (LSG) on renal function in individuals with obesity without end-stage renal disease (ESRD). The objective of this study was to compare renal function outcomes following RYGB and LSG in patients with obesity, focusing on estimated glomerular filtration rate (eGFR), serum creatinine, albumin-creatinine ratio (ACR), and serum cystatin C. METHODS: A systematic review and meta-analysis were conducted following Cochrane and PRISMA guidelines. Data from 17 observational studies (n = 3339) were analyzed. Primary outcomes included changes in eGFR, ACR, serum creatinine, and cystatin C. Secondary outcomes included excess weight loss (%EWL) and total weight loss (%TWL). Statistical analysis involved fixed and random-effects models based on heterogeneity levels. RESULTS: RYGB demonstrated significant improvements in eGFR (SMD = - 0.71; 95% CI - 0.89 to - 0.52, p < 0.00001) and serum cystatin C (MD = - 0.10; 95% CI - 0.17 to - 0.03, p = 0.004) compared to LSG. No significant differences were found for serum creatinine (MD = - 1.06; 95% CI - 4.42 to 2.30, p = 0.54) or ACR (MD = 1.95; 95% CI - 0.39 to 4.29, p = 0.10). RYGB also showed greater long-term weight loss, particularly at 5 years (%EWL: MD = 22.00; 95% CI 6.56 to 37.44, p = 0.005). CONCLUSIONS: RYGB offers similar renal improvements with superior weight loss compared to LSG in individuals with obesity without ESRD. These findings emphasize the need for personalized treatment approaches and further research to validate these outcomes.

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BACKGROUND: The benefits of the totally laparoscopic right hemicolectomy have been established, but its adoption has been limited by the challenges of intracorporeal suturing. While simulation is effective for training advanced surgical skills, no dedicated simulation-based course exists for intracorporeal ileo-transverse anastomosis (ICA). This study aimed to develop and validate a simulation module for training in ICA. METHODS: This study employed a proof-of-concept design for an educational tool. Key aspects of the anastomosis were identified using the team's surgical experience, surgical videos, and existing evidence. Surgeons were recruited to test and refine successive simulation models through an iterative process until a functional prototype was achieved and assessed. Subsequently, surgeons with varying experience levels were invited to perform an ICA in the model. Performance was evaluated by two blinded surgeons through video recordings, utilizing a modified Objective Structured Assessment of Technical Skills (OSATS), a Specific Rating Score (SRS), and operative time measurements. Non-parametric descriptive and analytical methods were applied, with results presented as median [IQR]. RESULTS: An ex vivo based model was developed. Seventeen participants evaluated the model. Eighty-three percent declared acceptable or maximum fidelity regarding the colon. Resemblance to the surgical scenario in terms of ergonomic and anatomical similarity was highlighted. All participants found the model useful to train intracorporeal suturing. Thirteen subjects performed the ICA. Experts achieved significantly higher OSATS scores (22.3 [22-22.5] vs 18 [16-19.5]; p = .013), exhibited a trend toward higher SRS, and obtained shorter operative times (21.5 vs 36 min; p = .039). CONCLUSION: An ex vivo simulation module for ICA was developed, demonstrating acceptable fidelity in replicating the surgical environment. The simulated scenario could successfully distinguish between levels of surgical experience, as evidenced by significant differences in OSATS scores and operative times, thereby confirming its construct validity.

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Introducción. La herniorrafia inguinal es una cirugía ampliamente realizada a nivel mundial, con casi 20 millones de procedimientos anuales. En la literatura no se describen diferencias significativas en las tasas de recurrencia entre las técnicas laparoscópicas, pero estos resultados difieren en cuanto a la fijación de la malla. Métodos. Estudio retrospectivo observacional en el que se incluyeron los pacientes sometidos a herniorrafia inguinal por laparoscopia en una institución de cuarto nivel en Medellín, Colombia, entre enero de 2019 y junio de 2023. Se registraron los datos demográficos, como edad, género y comorbilidades, y los datos del procedimiento, como técnica utilizada, tipo de hernia, tipo de malla y fijación o no de la malla. Los desenlaces posoperatorios evaluados fueron dolor agudo y crónico, recurrencia y otras complicaciones. Resultados. De un grupo de 1106 pacientes sometidos a herniorrafia inguinal por vía laparoscópica, 69,0 % fueron sometidos a la técnica transabdominal preperitoneal, 23,1 % a la técnica totalmente extraperitoneal y 7,9 % a totalmente extraperitoneal extendida. La malla macroporosa de baja densidad fue la más utilizada (56,3 %). A 784 (70,9 %) se les fijó la malla y a 322 (29,1 %) no. La tasa de complicaciones fue menor al 8 %. Al final, 77 (7,0 %) pacientes experimentaron dolor agudo y 26 crónico (2,3 %). Hubo recurrencia de la hernia en 20 pacientes (1,8 %). Conclusión. El uso de prótesis sin fijación en la herniorrafia inguinal por laparoscopia pareciera ser un procedimiento seguro, con una tasa de recidivas equiparables a los procedimientos con fijación y con una leve tendencia a un menor dolor posquirúrgico agudo y crónico.

Introduction. Inguinal herniorrhaphy is a widely performed surgery worldwide, with almost 20 million procedures annually. The literature does not describe significant differences in recurrence rates between laparoscopic techniques, but these outcomes differ in terms of mesh fixation. Methods. Retrospective observational study that included patients undergoing laparoscopic inguinal herniorrhaphy at a fourth-level institution in Medellin, Colombia, between January 2019 and June 2023. Demographic data, including age, gender, and comorbidities were recorded, along with data related to the procedure details, such as technique used, type of hernia, type of mesh, and mesh fixation or not. Postoperative outcomes evaluated were acute and chronic pain, recurrences, and other complications. Results. Of a group of 1106 patients undergoing laparoscopic inguinal herniorrhaphy, 69.0% underwent the preperitoneal transabdominal technique, 23.1% underwent the totally extraperitoneal tecnhique, and 7.9% underwent the extended totally extraperitoneal tecnique. Low-density macroporous mesh was the most used (56.3%); 784 (70.9%) had the mesh fixed and 322 (29.1%) did not. The complication rate was less than 8%. In the end, 77 (7.0%) patients experienced acute pain and 26 (2.3%) developed chronic pain. There was hernia recurrence in 20 patients (1.8%). Conclusion. The use of prostheses without fixation in laparoscopic inguinal herniorrhaphy seems to be a safe procedure, with a recurrence rate comparable to procedures with fixation and with slight tendency towards less acute and chronic postsurgical pain.

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Introducción. El síndrome de arteria mesentérica superior o síndrome de Wilkie es una causa rara de obstrucción intestinal, con una incidencia aproximada de 0,1 a 0,3 %. El diagnóstico se hace mediante la sospecha clínica, sin embargo, tiene manifestaciones clínicas inespecíficas lo cual lo dificulta, y se confirma con tomografía abdominal con doble contraste, donde se aprecia obstrucción duodenal y un ángulo de salida aorto-mesentérico agudo. En los casos severos asociados a desnutrición proteico-calórica, el tratamiento suele ser quirúrgico.Caso clínico. Se reporta el caso de una paciente de 29 años con pérdida crónica de peso y dolor abdominal intermitente, que se agudiza, asociado a intolerancia a la vía oral y emesis. Resultados. El diagnóstico se hizo mediante tomografía computarizada de abdomen con contraste oral e intravenoso. Se llevó a manejo quirúrgico laparoscópico. Conclusión. La cirugía laparoscópica es una opción en el manejo del síndrome de Wilkie, resolviendo el proceso obstructivo con mínima invasión con excelentes resultados estéticos y rápida recuperación del paciente.

Introduction. Superior mesenteric artery syndrome or Wilkie syndrome is a rare cause of intestinal obstruction, with an approximate incidence of 0.1% to 0.3%. The diagnosis is made through clinical suspicion; however it has non-specific clinical manifestations which makes its diagnosis difficult. The diagnosis is confirmed with abdominal tomography with double contrast, where duodenal obstruction and acute aortomesenteric outlet angle are observed. In severe cases associated with protein-calorie malnutrition, treatment is usually surgical. Clinical case. The case of a 29-year-old patient with chronic weight loss and intermittent abdominal pain, which worsens, associated with oral intolerance and emesis, is reported. Results. The diagnosis was made by abdominal tomography with oral and intravenous contrast. Laparoscopic surgical management was performed. Conclusions. Laparoscopic surgery is an option in the management of Wilkie syndrome, resolving the obstructive process with minimal invasion with excellent aesthetic results and rapid patient recovery.

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OBJECTIVE: Pelvic organ prolapse affects women's quality of life through symptoms such as vaginal laxity, urinary incontinence, defecation and sexual dysfunction, and pelvic pain. Given the challenges in managing recurrent cases, understanding risk factors and the effect of surgical choices on recurrence is vital for guiding clinical decisions. This study explores how uterine preservation influences postoperative recurrence and develops predictive models to aid in assessing recurrence risk. METHODS: A total of 87 patients diagnosed with pelvic organ prolapse who underwent laparoscopic sacral fixation were included. Patients were classified into two groups based on the occurrence of pelvic organ prolapse recurrence within 3 years post-surgery (recurrence: n=22; no recurrence: n=65). Follow-up over 3 years was recorded. Factors including age, body mass index, birth order, occupation, and uterus preservation during surgery were evaluated. The relationship between pelvic floor muscle strength and pelvic organ prolapse recurrence was also examined. Logistic regression analysis assessed the correlation between pelvic organ prolapse recurrence and levels of serum elastase inhibitor and osteopontin. RESULTS: In a follow-up of 87 patients with pelvic organ prolapse, 22 experienced recurrences within 3 years, marking a 25.29% recurrence rate. Multivariate analysis identified older age, higher parity, and sustained contraction of type II muscle fibers as independent risk factors for recurrence (all p<0.05). Lower systolic blood pressure in type I and II muscle fibers was associated with decreased serum elastase inhibitor and osteopontin levels, increasing pelvic organ prolapse recurrence risk. Logistic regression identified age, multiple deliveries, and low systolic pressure in type II muscle fibers as independent recurrence factors. The constructed nomogram risk prediction model, incorporating these factors, showed good discrimination ability with an area under the receiver operating characteristic curve of 0.891 (95%CI 0.871, 0.921), indicating accurate predictions and high net benefit. CONCLUSION: Factors such as age, birth order, uterine preservation, and pelvic floor muscle strength impact postoperative pelvic organ prolapse recurrence. Older age, a higher number of deliveries, and reduced systolic pressure of class II muscle fibers are independent risk factors for pelvic organ prolapse recurrence after surgery.

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BACKGROUND: Obesity is a multifactorial disease affecting a significant portion of the population. Bariatric surgery emerges as a prominent approach in this context, representing an effective treatment both in the short and long term. The costs associated with bariatric surgery vary depending on the characteristics of the patients, current hospital practices, and available funding sources. AIMS: To analyze the costs of minimally invasive bariatric surgery for the treatment of obesity in a tertiary federal public hospital. METHODS: An observational and descriptive study aimed at assessing the costs associated with laparoscopic vertical gastrectomy (GV) and Roux-en-Y gastric bypass (RYGB) in a federal public tertiary service from 2018 to 2021. Data were obtained through the management of medical-hospital expenses related to surgical and anesthetic supplies, as well as the amount reimbursed by the funding source to the hospital. RESULTS: Over the analyzed period, a total of 177 minimally invasive bariatric surgeries were performed. In terms of the charges, since 2018, the hospital has been receiving an amount of R$ 6,145.00 for the "bariatric surgery by videolaparoscopy" procedure, which includes RYGB, and R$ 4,095.00 for "vertical gastrectomy." Regarding the average hospital cost of surgical supplies, RYGB incurred a total of R$ 9,907.54, while GV incurred a total of R$ 9,315.84. The average total cost of RYGB was R$ 10,799.23, and, for GV, it was R$ 10,207.53. These figures indicate that the hospital incurred a loss of approximately R$ 4,654.23 for performing RYGB and R$ 6,112.53 for GV. CONCLUSION: Despite the increasing number of eligible patients for surgical treatment of obesity and the consequent quantitative growth of these procedures funded by the Brazilian Unified Health System (SUS), the costs exceed the reimbursement from the funding source in federal public hospitals. There is a need for a precise assessment of financing in the fight against obesity.

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PURPOSE: To compare the indicators, postoperative pneumoretroperitoneum-related complications, and postoperative recovery of laparoscopic preperitoneal inguinal hernia repair under different CO2 pneumoperitoneum pressures. METHODS: The total of 187 adult patients with primary inguinal hernia who successfully underwent transabdominal preperitoneal prosthesis (TAPP) from September 2021 to September 2023 in the Department of General Surgery, Haimen People's Hospital affiliated to Nantong University, were collected. These patients were randomly divided into low abdominal pressure group (group A: pneumoperitoneum pressure = 8 mmHg), sub-low abdominal pressure group (group B: pneumoperitoneum pressure = 10 mmHg), moderate abdominal pressure group (group C: pneumoperitoneum pressure = 12 mmHg), and standard pressure group (group D: pneumoperitoneum pressure = 14 mmHg), with 40 patients each. RESULTS: The operation time in group C (43.90 ± 9.75) was significantly lower than group A (51.98 ± 12.65, p 0.001), group B (46.70 ± 10.59, p 0.001), and was higher than that in group D without significant statistical differences (38.15 ± 7.98, P = 0.05). The peritoneal suturing time in group C (5.03 ± 1.07) was significantly higher than group A (4.23 ± 0.70, p 0.001), group B (4.55 ± 0.85, p = 0.03), and was significantly lower than that in group D (6.95 ± 1.96, p 0.001). CONCLUSION: Selecting sub-low abdominal pressure (12 mmHg) can help to have a shorter operation time, with less blood loss, and it did not add pneumoretroperitoneum-related complications. Changing the pneumoperitonium pressure during different phases of the surgery is also an optimal option.

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INTRODUCTION: Although Clinical Practice Guidelines (CPG) highlight that laparoscopy is often used in the treatment of endometriosis, its diagnostic usefulness is not fully defined. Our objective was to evaluate the quality of CPGs for endometriosis that address the use of diagnostic laparoscopy in reproductive age women, and describe the recommendations and methods used to assess diagnostic test questions. METHODS: A comprehensive search of 5 databases (Trip Database, MEDLINE/PubMed, Web of Science, SCOPUS, and EMABSE) and websites of guideline development organizations and compilers was conducted from 2017 to 2023. A descriptive analysis of the recommendations was performed and the quality of the guidelines was assessed using the AGREE-II instrument. RESULTS: Four CPGs were included in the review, all exhibiting adequate methodological quality (scores ranging from 66.7% to 91.0%). Regarding the use of laparoscopy for endometriosis diagnosis, discrepancies in recommendations were observed. Two guidelines advised against it, one recommended either laparoscopy or medical empirical treatment, and one favored its use. GRADE guidance was employed for evidence assessment, but only one guideline transparently reported the certainty of evidence and the evidence-to-decision framework process. CONCLUSIONS: Variability in recommendations among different CPGs were found. To keep in mind, discrepancies arise from differing prioritizations of the assessment of clinical impact in patient important outcomes and methodological approaches. This underscores the need for more standardized and transparent guideline development processes, particularly in addressing the clinical utility of diagnostic tests.

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Objective: Included evaluation of the possibility of using the systemic inflammatory indices for preoperative screening for the presence and severity of endometriosis (EM) in comparison to the findings of the exploratory laparoscopy. Methods: 88 women with clinical manifestations suggestive of EM were evaluated clinically and by US and gave blood samples for estimation of serum cancer antigen-125 (CA125), platelet and total and differential leucocytic counts for calculation of inflammatory indices; the Systemic Immune-Inflammation index, the Systemic Inflammation Response Index (SIRI), the Neutrophil-Lymphocyte ratio (NLR), the Neutrophil-Monocyte ratio, the Neutrophil-Platelet ratio and the Platelet-Lymphocyte ratio. Then, patients were prepared to undergo laparoscopy for diagnosis and staging. Results: Laparoscopy detected EM lesions in 63 patients; 27 of stage I-II and 36 of stage III-IV. Positive laparoscopy showed significant relation with US grading, high serum CA125 levels, platelet and inflammatory cell counts and indices. Statistical analyses defined high SIRI and NLR as the significant predictors for positive laparoscopy and high serum CA125 and NLR as the most significant predictors for severe EM (stage III-IV) on laparoscopy. Conclusion: The intimate relation between EM and inflammation was reflected systematically as high levels of blood cellular components, but indices related to neutrophil especially NLR and SIRI showed highly significant relation to the presence and severity of EM and might be used as routine, cheap and non-invasive screening test before exploratory laparoscopy to guide the decision-making.

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INTRODUCTION: laparoscopic hepaticojejunostomy is a complex procedure indicated for different pathologies. Still, the laparoscopic approach is not the gold standard, but it is well known for its benefits regarding post operative recovery. We present our experience in 21 consecutive cases of laparoscopic hepaticojejunostomy done at King Fahad General Hospital in Jeddah. METHODS: 21 consecutives laparoscopic hepaticojejunostomies were done from January 2022 to December 2023. Gender: 10 male and 11 female, average age 46 years. The most common indication is due to multiple common bile duct stones. RESULTS: average surgical time: 180 minutes, average blood loss: 168 ml. According to Clavien-Dindo´s classification, we recorded one complication type: 3A. Average discharge days were 5.5; no mortality was reported. CONCLUSION: We believe that the success of laparoscopic hepaticojejunostomy is related to excellent knowledge of the biliary system and an experienced surgeon in advanced laparoscopic procedures.

Introducción: la hepaticoyeyunostomía laparoscópica es un procedimiento complejo con distintas indicaciones. Aun así, el abordaje laparoscópico no es aún el gold-standard, pero es bien conocido por sus beneficios en cuanto a la recuperación postoperatoria. Presentamos nuestra experiencia en 21 casos consecutivos de hepaticoyeyunostomía laparoscópica realizada en el Hospital General King Fahad en Jeddah. Métodos: se realizaron 21 hepaticoyeyunostomías laparoscópicas consecutivas desde enero de 2022 hasta diciembre de 2023. Sexo: 10 hombres y 11 mujeres, edad promedio 46 años. La indicación más común fue por múltiples cálculos en el colédoco. Resultados: tiempo quirúrgico promedio: 180 minutos, pérdida sanguínea promedio: 168 ml. Según la clasificación de Clavien-Dindo registramos un tipo de complicación: 3A. El promedio de días de internación fue de 5,5; no se informó mortalidad. Conclusión: Creemos que el éxito de la hepaticoyeyunostomía laparoscópica está relacionado con un excelente conocimiento del sistema biliar y con cirujanos experimentados en procedimientos laparoscópicos avanzados.

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BACKGROUND: Laparoscopic gastrectomy offers advantages in the postoperative period compared to the open approach. Most studies have been performed on distal gastrectomies; however, laparoscopic total gastrectomy (LTG) is not universally accepted. AIM: The aim of this study was to assess the results of LTG, on postoperative morbidity outcomes and long-term survival. METHODS: This is a retrospective cohort study from a prospective database of patients who underwent LTG, from 2005 to 2022, due to early and advanced gastric cancer. A totally laparoscopic technique was utilized, and the Roux-en-Y reconstruction was performed in all cases. Postoperative complications and long-term survival were evaluated. RESULTS: A total of 100 patients were included (men 57, age 64 years, and body mass index 26). A D2 lymphadenectomy was performed in 68 cases. The postoperative hospitalization period was 8 days (6-62 days). Postoperative complications occurred in 26%, with 7% esophago-jejunal anastomosis leak, 4% abdominal collections, and 2% gastrointestinal bleeding. In 7% of cases, the complication was considered Clavien 3 or greater. Operative mortality was 1%. The pathology findings confirmed advanced gastric cancer in 50 cases. The median lymph node count was 38, and surgery was considered R0 in 99%. The median follow-up was 50 months. Overall 5-year survival was 74%. Survival in T1 cases was 95% at 5 years. For stage I, survival was 95%, and for stages II and III, it was 52% and 43%, at 5 years, respectively. CONCLUSIONS: These results support the feasibility and oncological adequacy of minimally invasive total gastrectomy. Postoperative morbidity has an acceptable rate. Long-term survival was in accordance with the disease stage.

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Los miomas uterinos son los tumores benignos más frecuentes en las mujeres, los leiomiomas parasitarios son una variante poco común de la miomatosis uterina. Se han identificado en la pared abdominal, intestino delgado, muñón cervical o vaginal, vasos iliacos, ovarios, colon sigmoides y en el omento mayor. Se expone el caso de una femenina de 48 años, quien acudió a consulta por presentar sensación de pesadez en hipogastrio, y dolor abdominal de aparición progresivo que se fue intensificando; se realizaron estudios de imágenes, donde se evidenció tumoración uterina gigante. Se le realizó histerectomía abdominal total más salpingectomía bilateral con conservación de anexos, omentectomía total y resección de LOE abdominal. Egresó en condiciones clínicas satisfactorias

Uterine myomas are the most common benign tumors in women. Parasitic leiomyomas are a rare variant of uterine myomatosis. They have been identifiedin the abdominal wall, small intestine, cervical or vaginal stump, iliac vessels, ovaries, sigmoid colon and in the greater omentum. The case of a 48-year-old woman is presented, who presents a feeling of heaviness in the hypogastrium, abdominal pain of progressive onset that intensifies. Imaging studies are performed where the correct diagnosis of giant uterine leiomyoma is achieved. The treatment was surgical. She underwent total abdominal hysterectomy plus bilateral salpingectomy with preservation of adnexa + total omentectomy + resection of abdominal LOE and the evolution was satisfactory.

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Fertility preservation is a major concern for women with ulcerative colitis who require surgical treatment. Previous studies have shown that the risk of infertility after restorative proctocolectomy is approximately four times higher. However, this risk appears to be lower in patients who undergo minimally invasive approaches, such as laparoscopic surgery. The benefits of laparoscopy have led to a debate on whether robotic-assisted surgery could offer better results in terms of fertility. Surgical robotic platforms can provide improved visualization of the pelvis and more precise dissection of anatomical structures. In theory, this could reduce tissue damage and the inflammatory response, leading to lower adhesion formation and fallopian tube blockage, thereby preserving fertility.

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Background: RYDG is the second most prevalent bariatric operation worldwide in terms of surgical treatment for the management of obesity and its comorbidities; however, one of its complications is the development of Petersen's space hernia. Currently there is no specific cause for their development since, based on studies published worldwide, they have an unpredictable behavior in each individual. Objective: To establish the prevalence of Petersen's hernia and risk factors for its development. Material and methods: Retrospective cohort study that included patients who underwent laparoscopic gastric bypass from January 2015 to December 2020. All procedures were performed by a single surgeon using antecolic and retrogastric configuration. Study variables: weight, BMI, mesenteric gap closure, suture material used, post-surgical complications. Results: 00 patients were included, 64 women and 36 men, age 40.33 ± 2.08 years. The prevalence of Petersen's space hernia was 3% with a mean presentation time of 18 ± 7.54 months. The variables related to its development in the 3 cases were closure of the mesenteric gap, height, body mass index (BMI) and weight after the surgical procedure. All patients underwent reoperation, reducing the content and closing the mesenteric gap with non-absorbable suture material. Conclusion: The development of the hernia not only depends on the closure of the mesenteric gap, but also on the reduction of weight and loss of volume of the mesentery with the reopening of the space.

Introducción: la derivación gástrica en Y de Roux es la segunda operación bariátrica más prevalente en todo el mundo en cuanto a tratamiento quirúrgico para el manejo de la obesidad y sus comórbidos, sin embargo, una de sus complicaciones es el desarrollo de hernia del espacio de Petersen. Actualmente no existe una causa específica para su desarrollo ya que en base a los estudios publicados a nivel mundial, son de comportamiento impredecible en cada individuo. Objetivo: establecer la prevalencia de la hernia de Petersen posterior a derivación gástrica laparoscópica. Material y métodos: estudio de cohorte retrospectiva en el que se incluyeron pacientes sometidos a derivación gástrica laparoscópica durante enero del 2015 a diciembre del 2020. Todos los procedimientos fueron realizados por un solo cirujano utilizando configuración antecólica y retrogástrica. Variables de estudio: peso, IMC, cierre de brecha mesentérica, material de sutura utilizado, complicaciones postquirúrgicas. Resultados: se incluyeron 100 pacientes, 64 mujeres y 36 hombres, edad 40.33 ± 2.08 años.La prevalencia de hernia del espacio de Petersen fue de 3% con tiempo promedio de presentación de 18 ± 7.54 meses. Las variables relacionados con su desarrollo en los 3 casos, fueron, cierre de brecha mesentérica y el índice de masa corporal (IMC). Todos se reintervinieron, reduciendo el contenido y cerrando la brecha mesentérica con material de sutura no absorbible. Conclusión: el desarrollo de la hernia no solo depende del cierre de la brecha mesentérica, sino también a la reducción de peso y pérdida de volumen del mesenterio con la reapertura del espacio.

RESUMO

OBJECTIVE: We present a solitary fibrous tumor (SFT) of the abdominal wall treated laparoscopically. METHOD: We will discuss the clinicopathologic characteristics and will present a review of the literature. RESULTS: SFTs are rare neoplasms of mesenchymal origin. Its location in the abdominal wall is extremely rare. To the best of our knowledge, only 20 cases have currently been described in the literature. CONCLUSIONS: Complete surgical resection is the main therapy for all cases. A laparoscopic approach is safe. Clinical-radiological follow-up must be carried out due to its uncertain behavior, and perioperative treatment may be necessary in high-risk patients.

OBJETIVO: Presentamos un caso de tumor fibroso solitario de pared abdominal tratado por vía laparoscópica. MÉTODO: Se discuten las características clinicopatológicas y se presenta una revisión de la literatura. RESULTADOS: Los tumores fibrosos solitarios son neoplasias raras de origen mesenquimatoso. Su localización en la pared abdominal es extremadamente rara. Hasta donde sabemos, solo se han descrito 20 casos en la literatura. CONCLUSIONES: La resección quirúrgica completa es la terapia principal para todos los casos. El abordaje laparoscópico es seguro. Debe realizarse un seguimiento clínico-radiológico debido a su comportamiento incierto, pudiendo ser necesario un tratamiento perioperatorio en pacientes de alto riesgo.