Background: Candy cane syndrome represents a rarely described complication that presents after gastric bypass surgery. An excessively long blind side of the alimentary limb just below the gastro-jejunal anastomosis configured into a shape that resembles a “candy cane” is the cornerstone of the clinical picture. Upper gastrointestinal symptoms are frequently associated. Suboptimal weight loss has rarely been described in medical literature as a relevant component of the syndrome. Case Description: We present the case of a 34 years old female with a Body Mass Index of 46.7 kg/m2 in which a laparoscopic gastric bypass was performed without any immediate postoperative complications. During follow up unexpected suboptimal weight loss accompanied with gastrointestinal complaints were documented. An intensive workup which included an upper endoscopy and fluoroscopy with oral contrast demonstrated an exceptionally long blind side of the alimentary limb. Increased anastomosis diameter was also identified. The patient was offered surgical revision. A laparoscopic reconfiguration of the gastro jejunal anastomosis accompanied with a proper resection of the excessive length of the blind side of the alimentary limb was performed. The patient experienced improved weight loss and complete resolution of upper gastrointestinal complaints during clinical follow up. Conclusions: Clinical suspicion and diagnosis of this clinical entity accompanied with laparoscopic surgical revision reversed symptoms including suboptimal postoperative weight loss in this patient.

: Social media (SM) has dramatically changed the way surgeons interact and communicate in both private and public spheres. Similar to other medical specialties, novel technologies and techniques (NTTs) are continually being introduced. In this respect, SM provides an avenue for surgeons to communicate in an unimpeded manner. In particular, the ability to exchange clinical vignettes and videos has paved the way for rapid developments in laparoscopic and robotic-assisted surgery. These practices are evident through events such as grand rounds, morbidity and mortality conferences, and national symposia which are now increasingly hosted online. Overall, this ability to engage in global discourse, incorporate diverse perspectives, and foster collaboration increases accessibility and enhances professional development, which in turn improves patient care. Exciting new advancements taking advantage of recent developments in virtual reality (VR) and augmented reality (AR) are also being applied to further lower logistical and geographical barriers to increase surgical knowledge and benefit health outcomes. Beyond the clear advantages and opportunities afforded by SM, however, lie practical and ethical concerns, some of which pertain to bias and misinformation as well as professionalism. Ultimately, while SM may not entirely replace in-person interactions, it holds significant promise to change how surgeons connect in the future.

Background: Surgical gastroesophageal reflux disease (GERD) therapy is conceptually based on the hypothesis of a deficient lower oesophageal sphincter (LES). Consequently, the focus is on a variety of internal or external oesophageal constrictions, with Nissen and Toupet surgery considered the gold standard. However, clinical outcomes still show wide variations in terms of recurrence and complications and, in particular, there are still unresolved fundamental inconsistencies regarding the function and actual existence of the LES. In this work, a new surgical procedure, laparoscopic oesophagohiatal DeltaMesh enhancement (LOEHDE), was used, based on the emerging pathophysiological suggestion that reflux is instead significantly controlled by a complex cardioesophageal pumping system that decisively depends on the intact hiatal architecture. Accordingly, the surgical focus was solely on the anatomical correct reconstruction of the oesophagohiatal unit without any fundoplication or other conventional anti-reflux measures. Methods: In a 10-year prospective clinical single arm cohort study from January 2007 to December 2016, all consecutively admitted patients with symptomatic hiatal hernia who met the inclusion criteria underwent the DeltaMesh enhanced oesophagohiatal reconstruction. Patients follow-up was recorded by standardised questionnaires given preoperatively on admission (T0; 43 questions), postoperatively at 1 year (T1; 24 questions) and 5 years (T5; 22 questions). There was no randomisation and no control group, as all patients refused any other form of surgery, especially fundoplication. Results: A total of 1,351 patients were included and operated on. The follow-up rate was 96% at T0 (1,297/1,351), 68.6% at T1 (927/1,351), and 14.8% at T5 (200/1,351). The Visick score, symptom score, and patient rating significantly improved postoperatively at T1 and T5 (P<0.0001) compared with the situation under medical treatment at T0 in all symptom categories: A (reflux, heartburn); B (hoarseness, coughing); C (palpitation, dyspnoea); and D (belching, nausea). Recurrence was observed in 91 of the 1,351 (6.7%) patients. DeltaMesh penetration was observed in the oesophagus (n=2) and stomach (n=3). Mortality (n=1) was 0.07%. Conclusions: Anatomical reconstruction of the oesophagohiatal unit alone resulted in significant restoration of oesophageal function without fundoplication, confirming the new pathophysiological approach. LOEHDE proved to be a safe, efficient, and standardisable procedure for symptomatic hiatal hernia.

Background: Significant data exists to support the use of transversus abdominus plane (TAP) blocks to reduce post-operative pain and opiate consumption following laparoscopic abdominal surgery, although whether this reduced usage corresponds to a reduction in the development of ileus is not known.

Abstract: The role of margin status as a prognostic factor in gastrointestinal stromal tumour (GIST) remains a matter of debate. It is clear that R2 resection is predictive of poor outcomes, but the impact of R1 versus R0 surgery on survival varies among studies. The occurrence of spontaneous or iatrogenic rupture may explain this heterogeneity in survival and recurrence rates in the literature. Even if residual disease and rupture do have an impact on the prognosis of GIST patients, their role needs to be better clarified, also in the perspective of introducing one or both of these parameters in a proper staging system. Again, the role of margin status should be deeply investigated in order to give clinicians a reliable safety when planning peri-operative strategy. Although GIST should be managed by a multidisciplinary team in a referral center and there is no doubt that R0 surgery without rupture of the tumour is the gold standard, in everyday clinical practice this result is not always reasonably achievable: in some cases surgery may leave a microscopic residual and manipulation of large tumours may result in spillage of neoplastic cells in the abdominal cavity. In this review article, the effect of margins itself and the existence of other possible factors influencing prognosis of GIST patients are explored.

Objective: Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) has grown since the early minimally invasive liver surgery (MILS) reports. The advantages of this approach in the treatment of HCC are well known today. However, the indication for LLR for HCC is not yet well defined. Background: The resection of tumors located in the posterosuperior segments and the caudate lobe is still debated. Many techniques have been described, focusing on the trocar introduction and the patient’s position. Methods: A literature search was performed using the PubMed database. Thirty-seven publications, including 331 patients, were relevant to laparoscopic or robotic resection for HCC in unfavorable liver segments. All the articles with no clear indications about the histology of the tumor or the precise posterosuperior or caudate localization were excluded. The present review aims to report the experience of laparoscopic and robotic resection for HCC in unfavorable segments. Based on technical approaches, the resections of tumors located in the segments IVa, VII, VIII, and the caudate lobe have been discussed analyzing preoperative and intraoperative features; in a separate section, the resections performed through robotic approach have been discussed. Conclusions: According to the current literature, LLR for HCC is feasible and safe in unfavorable segments. It is necessary to gradually increase the skills of laparoscopic or robotic surgery according to the experience level before performing technically demanding procedures.