Bariatric and metabolic surgery is one of the most effective treatments for severe obesity and type 2 diabetes mellitus (T2DM), promoting metabolic changes beyond weight loss. However, the biochemical determinants of postoperative glycemic response remain incompletely understood. A scoping review was conducted following PRISMA-ScR guidelines. PubMed/MEDLINE and Scopus were searched for studies published between 2016 and 2025 evaluating metabolic and biochemical variables associated with glycemic outcomes after bariatric surgery. Twenty-two studies were included, comprising eight randomized controlled trials and fourteen cohort studies. Bariatric surgery was consistently associated with reductions in HbA1c and significant rates of T2DM remission. Improvements in insulin resistance (HOMA-IR), beta-cell function, and incretin response—particularly GLP-1—were associated with better outcomes. Reductions in inflammatory markers, including IL-6, IFN-γ, and TNF-α, were also reported. Glycemic improvement after bariatric surgery is associated with complex metabolic interactions involving insulin sensitivity, incretin modulation, and inflammatory changes. These findings support the role of bariatric and metabolic surgery as a metabolic and immunometabolic intervention, although the descriptive design of a scoping review precludes causal inference.
For decades, open thoracotomy was the standard approach for pulmonary hydatid cyst (PHC). Although video-assisted thoracoscopic surgery (VATS) has gained popularity in the management of PHC, many surgeons remain concerned about its safety, particularly regarding long-term outcomes and recurrence. In this prospective cohort study, we compared VATS and thoracotomy in patients with PHC who underwent surgery between April 2007 and November 2013. To ensure comparability between groups, only patients with cysts located in the outer and middle thirds of the lung parenchyma were included, whereas patients with cysts in the inner third or near the hilum underwent thoracotomy. Short-term outcomes were assessed during the first six months after surgery, and long-term outcomes were evaluated 10 years postoperatively through clinical history, physical examination, and chest X-ray. A total of 67 operations in 60 patients met the inclusion criteria, comprising 33 VATS and 34 thoracotomy procedures. Short-term complication rates were similar between groups. Postoperative hospital stay (6.1 ± 2.3 vs. 8.1 ± 4.6 days) and chest tube duration (5.5 ± 2.1 vs. 7.3 ± 4.0 days) were shorter in the VATS group and remained significantly shorter after adjustment for age and cyst location (p = 0.038 and p = 0.049, respectively). At the long-term follow-up, 29 patients were available for evaluation, and no recurrence was observed. None of the VATS patients reported pain at the surgical site, whereas three thoracotomy patients described surgical site pain. VATS is a safe and effective approach for treating selected pulmonary hydatid cysts. It was associated with shorter postoperative hospital stay and chest tube duration after adjustment for age and cyst location. Surgical site pain was reported less frequently after VATS, while no recurrence was observed among patients available for long-term follow-up.
Identifying preoperative predictors of difficult thyroidectomy (DT) is essential for optimizing surgical planning, operative time, and postoperative outcomes. This study aimed to identify independent preoperative predictors of DT using operative time as a surrogate marker. A retrospective analysis was performed on 251 patients who underwent total cervicotomic thyroidectomy between January 2021 and June 2023. DT was defined as an operative time above the 75th percentile of the cohort. Univariate analyses were conducted to identify factors associated with DT, followed by multivariate logistic regression to determine independent predictors. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). The median operative time was significantly longer in DT patients (118.5 minutes) compared with non-difficult thyroidectomy (NDT) patients (87 minutes; p < 0.001. At univariate analysis, DT was significantly associated with male sex, body mass index, cervico-mediastinal goiter, tracheal narrowing, thyroid mass, and thyroid volume (p < 0.05). Multivariate logistic regression identified male sex (OR 2.96, 95
Emergency conversion during laparoscopic distal pancreatectomy (LDP) is associated with increased morbidity. We describe the Splenic Artery Last Approach (SALA) to manage critical intraoperative scenarios with the aim of reducing conversion rates and improving outcomes. This monocentric retrospective study included all patients who underwent LDP requiring division of the splenic vessels (Warshaw procedure or splenopancreatectomy) in our department between January 2008 and December 2025. The SALA emphasized preoperative anticipation of technical difficulties, particularly in obese patients or with lesions near major vessels or pancreatitis. Intraoperatively, we adopted a stepwise technique: initial division of the pancreas, followed by the splenic vein, and finally the splenic artery. In difficult dissections, progressive pancreatic division and extensive mobilization of the gland and splenic vessels were used to secure exposure and vascular control. Among 425 consecutive LDPs performed. Median operative time was 170 min (IQR 120–210), with a median blood loss of 130 mL (IQR 50–300). Major complications included grade B/C postoperative pancreatic fistula in 15
