Introduction Soft tissue sarcomas are a diverse group of tumours located in various regions of the body. A particularly challenging diagnostic localization is the retroperitoneal space, due to the difficulties in accessing this area for biopsy and the associated challenges in selecting the appropriate technique to obtain reliable histopathological material that determines further treatment. Material The analysis data from 177 consecutive patients who underwent surgical intervention for sarcomas of the retroperitoneal space in the Department of Soft Tissue, Bone and Melanoma Tumors between 2017 and 2023. Results A total of 177 patients were subjected to biopsy analysis. Tissue material was obtained from all patients through biopsy in order to confirm the diagnosis of retroperitoneal sarcoma. Thirty patients underwent an open biopsy, two patients underwent a core-needle biopsy under CT guidance, and 144 patients underwent an ultrasound-guided biopsy. The histological subtype changed in 40% of cases, while the grade of malignancy changed in 30% in final postoperative diagnosis. Complications after biopsy requiring surgery occurred in one case. Furthermore, there was no alteration in the diagnosis from malignant to benign lesion in the postoperative material. Conclusions Computed tomography (CT-) or ultrasound-guided core-needle biopsy is preferred and safe procedure to establish pathologic diagnosis in soft tissue tumors, however still open biopsy can be considered in selected cases. Core needle biopsy can establish a preoperative diagnosis and does not involve surgery or general anaesthesia. The open biopsy procedure should be considered a last resort, to be used only when a minimally invasive core-needle biopsy cannot be performed safely. Further research is required to determine the most suitable biopsy site from the tumour to minimise the variation in the degree of malignancy and subtype in the final diagnosis.
Introduction: Postoperative bleeding is a relevant complication after sleeve gastrectomy (SG). Perioperative blood pressure may influence the detection of bleeding during surgery, but the relationship between haemodynamic patterns and postoperative haemorrhage remains unclear.Aim: To evaluate the association between perioperative blood pressure patterns and major postoperative intra-abdominal bleeding after SG, and to identify factors associated with intraoperative systolic blood pressure (SBP) changes >20% from baseline.Materials and Methods: This retrospective single-centre cohort study included 463 consecutive patients who underwent primary SG between 2024 and 2025. Demographic, clinical and perioperative haemodynamic variables were analysed. Major postoperative bleeding was defined as bleeding requiring reoperation or blood transfusion. Univariable logistic regression was used to assess factors associated with bleeding, while uni- and multivariable logistic regression analyses were performed for predictors of an intraoperative SBP decrease >20%.Results: Postoperative bleeding occurred in 8 patients (1.7%), all of whom required transfusion and relaparoscopy. Patients with bleeding had higher mean arterial pressure (MAP) at admission than those without bleeding (110.2 vs 105.7 mmHg; p=0.046), although this association was not significant in univariable regression (OR 1.06, 95% CI 1.00–1.14; p=0.056). Intraoperative MAP range and SBP deviations >20% were not associated with postoperative bleeding. In multivariable analysis, only age independently predicted an intraoperative SBP decrease >20% (OR 1.03, 95% CI 1.01–1.05; p=0.003).Conclusions: No single perioperative blood pressure parameter reliably predicted postoperative bleeding after SG. Higher MAP at admission to hospital may warrant further investigation, while advanced age appears to be associated with greater intraoperative SBP reductions.
Introduction: Metabolic bariatric surgery (MBS) remains the most effective treatment for severe obesity; however, insufficient weight loss and weight recurrence remain important clinical challenges. The increasing efficacy of anti-obesity medications (AOMs), particularly incretin-based therapies, has expanded opportunities for combining pharmacotherapy with surgical treatment.Aim: To summarize current evidence on the neoadjuvant and adjuvant use of AOMs in patients undergoing MBS and evaluate their potential role within multimodal obesity treatment.Materials and Methods: This review examines the available literature on the perioperative use of AOMs in patients undergoing MBS, with particular emphasis on preoperative and postoperative pharmacotherapy, treatment efficacy, safety, and clinical applicability.Results: Neoadjuvant AOMs can induce clinically relevant weight loss and may facilitate optimization before MBS, particularly in selected high-risk patients with very high body mass index. However, current evidence does not support their routine neoadjuvant use, and their impact on postoperative outcomes remains uncertain. More consistent evidence supports adjuvant pharmacotherapy for insufficient weight loss or weight recurrence after MBS, with glucagon-like peptide-1 receptor agonists and newer incretin-based therapies demonstrating meaningful weight reduction. Perioperative safety considerations include delayed gastric emptying and gastrointestinal adverse effects, while limited observational data suggest a possible increased incidence of intraoperative adhesions associated with preoperative liraglutide use.Discussion: Existing studies are limited by heterogeneous definitions, predominantly observational designs, small cohorts, and limited long-term follow-up. The optimal timing, duration, and patient selection for perioperative pharmacotherapy remain unclear.Conclusions: AOMs should be considered as an adjunct to rather than an alternative to MBS, with treatment individualized according to clinical indication and patient characteristics.Relevance of the Study to the Development of the Field: This review integrates evidence across the perioperative treatment pathway and identifies areas requiring prospective research to define the optimal integration of AOMs with MBS.
Background: Ultrasound (US) is a non-invasive imaging modality increasingly used in the evaluation of abdominal wall hernias. Its role relative to physical examination and cross-sectional imaging remains incompletely defined across hernia types and clinical settings.Objective: This systematic review aimed to summarize current evidence on the diagnostic value of ultrasound in the detection and assessment of abdominal wall hernias, with emphasis on groin and postoperative/incisional hernias, comparison with physical examination and/or other imaging modalities, and the reference standard.Methods: A systematic search was conducted across four electronic databases (PubMed, Web of Science, Scopus, and Cochrane Library) covering publications from January 1, 2000 to December 31, 2025. Studies evaluating US as a diagnostic tool for hernia assessment, published in English in peer-reviewed journals, were eligible for inclusion. The review followed PRISMA guidelines; methodological quality was assessed using the QUADAS-2 tool.Results: Twenty-eight studies met the inclusion criteria and were included in the qualitative synthesis. US demonstrated high diagnostic performance for inguinal hernia detection, particularly in equivocal clinical presentations, women with groin pain, and clinically occult femoral hernias. For incisional hernias, dynamic US protocols — including Dynamic Abdominal Sonography for Hernia (DASH) — showed accuracy comparable to CT in selected patients. Neither US nor physical examination alone achieved optimal sensitivity; combined use improved detection of small or early defects.Conclusions: Ultrasound is a valuable second-line diagnostic tool for abdominal wall hernias when clinical examination is equivocal or limited. It should be integrated into a stepwise pathway: clinical examination first, ultrasound as a dynamic problem-solving tool when findings are uncertain, and escalation to CT or MRI for complex, recurrent, or multi-defect hernias. Standardization of scanning protocols and formal operator training are prerequisites for reproducible results.
Introduction: Parastomal hernia is one of the most common late complications after stoma formation and may significantly impair quality of life, stoma care, appliance fit, and daily functioning. Despite numerous operative techniques, no universally accepted gold standard has been established, particularly for complex and recurrent parastomal hernias.Aim: The aim of this narrative review was to summarize current evidence on epidemiology, risk factors, prevention, classification, and surgical treatment of parastomal hernia, with particular emphasis on the Hybrid Parastomal Endoscopic Repair (HyPER) technique.Materials and methods: A narrative literature review was performed using PubMed/MEDLINE, Scopus, Google Scholar, and reference lists of relevant articles. Publications addressing parastomal hernia prevention, classification, operative techniques, recurrence, complications, quality of life, stoma function, and appliance-related outcomes were analyzed. Particular attention was given to randomized trials, cohort studies, case series, systematic reviews, meta-analyses, guidelines, and expert reviews, mainly from the last 20 years.Results: Conventional techniques, including local repair, stoma relocation, keyhole, Sugarbaker, sandwich, retromuscular, Pauli-type have specific advantages and limitations. Their interpretation is limited by heterogeneous study design, inconsistent recurrence definitions, variable follow-up, and insufficient use of standardized classification. HyPER combines laparoscopic adhesiolysis and mesh reinforcement with open peristomal reconstruction, including hernia sac excision, fascial narrowing, stoma revision or relocation, bowel loop shortening, and soft-tissue remodeling.Conclusions: Parastomal hernia repair should be evaluated not only by recurrence, but also by functional outcomes and quality of life. HyPER may represent an important evolution toward comprehensive anatomical and functional reconstruction, particularly in complex and recurrent cases. Further multicenter comparative studies are needed.
