BACKGROUND AND AIMS:Esophageal foreign body (FB) impaction demands timely gastroscopic extraction, yet the need for preoperative radiographic imaging (PORI) varies by patient. To date, no validated risk-stratification tools exist to guide clinicians in determining the necessity of PORI before gastroscopic FB extraction. This study aims to fill this gap by developing a novel esophageal FB symptom score (EFBSS) to stratify patients at risk of severe complications, thereby providing a personalized approach to PORI decision-making. METHODS:Patients with suspected FBs were retrospectively categorized into PORI or non-PORI groups. Gastroscopic success rate, complications, and survival prognosis were compared and analyzed between the 2 groups. Logistic regression was used to identify risk factors for FB-related perforation or surgical complications. A risk stratification system (low-risk: 0 to 3; moderate-risk: 4 to 6; high-risk: 7 to 9 points) was then built based on the likelihood of such complications to guide PORI decision-making. RESULTS:There was no statistically significant difference between the PORI group (n=749) and the non-PORI group (n=1751) in the main outcome indicators, such as disease characteristics, FB types, incidence of complications, gastroscopic success rate, and survival prognosis (P>0.05). However, the PORI group had a longer duration of FB impaction and higher outpatient costs than the non-PORI group (P<0.05). The EFBSS includes swallowing FBs with pain, intentional ingestion of FBs, and cervical/chest/abdominal pain, with good discriminative power. The total score had an area under the receiver operating characteristic curve (AUC) of 0.822 (95% CI: 0.736-0.908), while the AUCs for the 3 components were 0.716, 0.699, and 0.894, respectively. The EFBSS system stratified the risk of FB-related perforation or surgical complications into 3 tiers: low (0.41%), moderate (2.95%), and high (39.29%). A significantly increasing risk trend was observed across tiers (P<0.001). CONCLUSIONS:We developed a risk scoring system incorporating swallowing FBs with pain, intentional ingestion of FBs, and cervical/chest/abdominal pain. This system preoperatively stratifies patients by the risk of FB-related perforation or surgical complications to facilitate PORI decision-making and maximize benefits.
BACKGROUND:In minimally invasive surgery for upper gastric and esophagogastric junction cancers, linear staplers are commonly used, and reports of circular‑stapled reconstruction have declined in parallel with the decrease in open surgery. Lower mediastinal reconstruction during robot‑assisted gastrectomy also remains technically challenging. This study describes our surgical technique and preliminary experience with transhiatal lower mediastinal anastomosis using a circular stapler. METHODS:Twelve patients who underwent robot‑assisted total or proximal gastrectomy with lower mediastinal reconstruction between March 2023 and December 2025 were included. Total operative time, blood loss, reconstruction time, length of hospital stay, postoperative complications, and esophageal transection length were evaluated separately for robot‑assisted total gastrectomy (RTG) and robot‑assisted proximal gastrectomy (RPG). RESULTS:No patient required conversion to open surgery.In the RTG group (n=6), the operative time, reconstruction time, blood loss, and hospital stay were 498.0 ± 61.1 minutes, 36.2 ± 8.4 minutes, 175 ± 117.3 g, and 14.3 ± 2.7 days, respectively.In the RPG group (n=6), these values were 345.8 ± 51.5 minutes, 75.6 ± 14.0 minutes, 75.0 ± 98.7 g, and 14.3 ± 2.7 days.Postoperative complications included one anastomotic stricture and one Grade B pancreatic fistula, both in the RPG group. No anastomotic leakage occurred in either group. The esophageal transection length was 35.2 ± 14.0 mm in the RTG group and 25.5 ± 7.9 mm in the RPG group, and all resection margins were negative. CONCLUSION:Circular staplers are feasible and safe for lower mediastinal reconstruction in robot‑assisted total and proximal gastrectomy.
BACKGROUND:The standard laparoscopic hiatoplasty with Toupet fundoplication is widely regarded as a safe treatment for giant hiatal hernia; however, it is often associated with a high incidence of posterior mediastinal seroma. To address this issue, a modified approach combining sac excision and negative pressure posterior mediastinal drainage has recently been introduced. This study compares clinical outcomes between the conventional and modified techniques to identify the optimal surgical strategy for managing giant hiatal hernia. METHODS:Patients who underwent laparoscopic hiatoplasty with sac excision and posterior mediastinal drainage between January 2013 and September 2020 were included. Demographic information, operative time, intraoperative blood loss, complication rates, length of hospital stay, and treatment outcomes were prospectively collected and assessed during follow-up. RESULTS:A total of 68 patients with giant hiatal hernia underwent the modified procedure without any conversions to open surgery or intraoperative complications. Compared with a historical cohort of 66 patients treated with the conventional approach (laparoscopic hiatoplasty with Toupet fundoplication), the modified group had significantly lower rates of postoperative posterior mediastinal seroma, as well as shorter overall and postoperative hospital stays. No significant differences were observed between the 2 groups regarding operative time, blood loss, ICU transfers, or incidence of postoperative pulmonary atelectasis. Median duration of long-term follow-up was comparable between the groups. There were no significant differences in the rates of early satiety, anatomic recurrence, diarrhea, acid regurgitation, or proton pump inhibitor (PPI) usage. In addition, no cases of dysphagia or reoperation occurred in either group. CONCLUSIONS:Laparoscopic hiatoplasty with sac excision and posterior mediastinal drainage is a safe and effective minimally invasive technique for treating giant hiatal hernia. This approach significantly reduces the risk of mediastinal seroma without increasing complication rates.
Introduction:Postoperative pancreatic fistula (POPF) is a serious complication that can lead to potentially fatal outcomes; therefore, early intervention with drainage is warranted whenever clinically feasible. Endoscopic ultrasound-guided transmural drainage (EUS-TD) is becoming an alternative to percutaneous drainage for managing POPF. While EUS-TD is increasingly used, there is no consensus on stent type or the need for external drainage in early postoperative EUS-TD for POPF. This study aimed to evaluate the feasibility of EUS-TD using multiple plastic stents (PSs) without external drainage for managing POPF within postoperative day 15.Methods:This retrospective case series included 11 patients who developed POPF and underwent EUS-TD within postoperative day 15 between January 2021 and June 2024. The primary outcome was clinical success of EUS-TD with multiple PSs without external drainage. Secondary outcomes included technical success, complications, length of hospital stay, and recurrence rate.Results:Eleven POPF patients underwent EUS-TD. Two or more PSs were successfully placed in all cases, with clinical success achieved in 10 of 11 cases. One case required additional percutaneous drainage. A pseudoaneurysm rupture occurred in one case and was successfully managed with interventional radiology. The mean length of hospital stay was 19.1 days. No recurrences were observed during a median follow-up period of 26.0 months. Stents were removed after 6 months or later.Conclusions:EUS-TD using multiple PSs without external drainage may be a feasible approach for managing POPF within postoperative day 15. Further prospective studies are needed to validate these findings and optimize early postoperative management strategies for POPF.
Background:Single-incision laparoscopic cholecystectomy (SILC) offers excellent cosmetic results but is technically challenging. Robotic systems can overcome these limitations, and although the da Vinci Xi is designed for multiport surgery, it can be adapted for single-port procedures. This study reports our experience performing single-port robotic cholecystectomy (SPRC) with straight instruments, emphasizing technical optimization and perioperative outcomes.Methods:SPRC was performed using an optimized umbilical port configuration and docking technique. Surgical steps were standardized to ensure stable traction and precise dissection, with a crossover method applied in difficult cases to improve exposure (see Supplemental Videos 1, Supplemental Digital Content 1, http://links.lww.com/SLE/A507, and 2, Supplemental Digital Content 2, http://links.lww.com/SLE/A508). Eleven patients underwent SPRC, and demographic, operative, and perioperative data were analyzed.Results:All procedures were completed without conversion to open or multiport surgery. The mean operative time was 116.7 +/- 22.2 minutes, with minimal blood loss (13.8 +/- 7.5 mL). No intraoperative complications or gallbladder perforations occurred, and only one patient required temporary drainage for minor oozing. Postoperative VAS scores averaged 3.1 +/- 1.0 on day 0 and 1.6 +/- 0.5 on day 1, with a mean hospital stay of 2.2 +/- 1.1 days. No readmissions or port-site complications were observed.Conclusions:SPRC with the da Vinci Xi system using straight instruments is feasible and safe. Optimized port placement and instrument coordination yield outcomes comparable to those reported for the SP system or single-site platform, providing an accessible alternative for centers without these platforms.
