Attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized among metabolic and bariatric surgery candidates and has been associated with affective burden, impulsivity, and difficulties with treatment adherence. This study assessed the prevalence of ADHD diagnosed with a structured clinical interview and examined its associations with depressive symptoms, anxiety, and impulsivity in adults undergoing preoperative psychological evaluation for metabolic and bariatric surgery. Seventy adults with obesity undergoing routine bariatric qualification were assessed for ADHD using the Diagnostic Interview for ADHD in Adults, DSM-5 version (DIVA-5), and completed the Beck Depression Inventory–II (BDI-II), Beck Anxiety Inventory (BAI), and Barratt Impulsiveness Scale–11 (BIS-11). Group comparisons were conducted between participants with and without ADHD. Two multivariable linear regression models examined predictors of depressive symptom severity and anxiety severity, including age, sex, BMI, ADHD diagnosis, and impulsivity. ADHD was diagnosed in 18.6

Objective: To estimate the prevalence of DSM-5 personality disorders (PDs) in bariatric surgery candidates and examine associations with depressive and anxiety symptoms, impulsivity, and binge eating disorder (BED). Method: Seventy adults undergoing preoperative psychological evaluation for bariatric surgery (58 women; mean age = 39.4 +/- 8.4 years; BMI = 43.2 +/- 11.5 kg/m2) completed validated self-report assessments. PDs were diagnosed with SCID-5-PD, depressive and anxiety symptoms with BDI-II and BAI, and impulsivity with BIS-11. BED was established via structured clinical interview. Groups of participants with and without PDs were compared. Results: PDs were identified in 37.1% participants, most commonly avoidant (17.1%) and borderline (11.4%). Participants with PDs reported higher depressive symptoms (mean difference, MD = 12.6 points, p < .001), higher anxiety symptoms (MD = 9.8 points, p < .001), and higher impulsivity (MD = 8.1 points, p = .004), and were more likely to meet criteria for BED (26.9% vs. 4.5%, p = .006). In regression models adjusting for age, sex, BMI, and impulsivity, PDs remained associated with depressive (beta = 0.61, p < .001), and anxiety symptoms (beta = 0.34, p = .007). Conclusions: PD diagnosis was associated with greater affective symptom severity and higher likelihood of BED.

Purpose Attention-deficit/hyperactivity disorder (ADHD) and affective symptoms are highly prevalent among bariatric surgery candidates, yet their role in postoperative weight-loss outcomes remains insufficiently understood. Previous studies suggest that neurodevelopmental traits and emotional dysregulation may influence adherence and long-term outcomes after bariatric procedures. This study aimed to examine associations between ADHD, affective symptoms, personality pathology, and weight-loss outcomes 12 months after sleeve gastrectomy. Methods Eighty adults undergoing sleeve gastrectomy were assessed preoperatively using structured diagnostic interviews and standardized self-report measures. ADHD was diagnosed using the Diagnostic Interview for ADHD in Adults (DIVA-5), personality disorders with the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD), and depressive symptoms, anxiety symptoms, and impulsivity were assessed using the Beck Depression Inventory–II (BDI-II), Beck Anxiety Inventory (BAI), and Barratt Impulsiveness Scale–11 (BIS-11), respectively. Weight-loss outcomes (%TWL, %EWL, %EBMIL) were calculated 12 months postoperatively. Group comparisons and multiple linear regression analyses were conducted to identify independent psychological predictors of postoperative weight loss. Results Patients with ADHD exhibited significantly higher levels of depressive symptoms, anxiety symptoms, impulsivity, and a higher prevalence of personality disorders at baseline. At 12-month follow-up, patients with ADHD achieved significantly lower postoperative weight-loss outcomes compared with those without ADHD. In multivariable regression analyses predicting %EBMIL from preoperative baseline, ADHD diagnosis and anxiety symptom severity emerged as independent predictors of postoperative weight loss, whereas depressive symptoms, impulsivity, personality disorder diagnosis, age, and sex were not significant. Conclusion ADHD and anxiety symptoms independently predict weight-loss outcomes after sleeve gastrectomy, highlighting the clinical relevance of neurodevelopmental and affective factors in bariatric care. These findings support the inclusion of targeted psychological assessment and tailored interventions for patients with ADHD traits and elevated anxiety prior to bariatric surgery. Level of Evidence Level III, welldesigned cohort study.

This document presents a comprehensive update to the Polish national recommendations on metabolic and bariatric surgery, developed by a panel of experts based on the latest clinical and scientific evidence. In light of a nearly 500% increase in the number of bariatric procedures in Poland since 2014 and significant technological advancements, it became necessary to revise national guidelines in line with international standards set by the International Federation for the Surgery of Obesity and Metabolic Disorders and the American Society for Metabolic and Bariatric Surgery. A pivotal development in Poland was the implementation of the Comprehensive Specialist Care in Bariatrics (KOS‑BAR) program in 2021, which ensured more accessible and safer care for patients with severe obesity through a structured and multidisciplinary approach. The consensus covers the full scope of care: from the epidemiology of obesity, surgical eligibility criteria, and preoperative preparation, to the choice of surgical technique, postoperative care, management of complications, and revisional procedures. The document also includes guidance on pharmacological treatment as an addition or alternative to surgery, and addresses the needs of specific patient groups, such as pediatric patients, elderly individuals, women of reproductive age, and those with comorbid conditions. The aim of this update is to provide Polish patients with access to safe, effective, and evidence‑based treatment for obesity, while also aligning the health care system with the growing public health challenge posed by the obesity epidemic.

BACKGROUND The following guidelines were developed at the initiative of the Association of Polish Surgeons. In preparing this paper, the authors conduct- ed a thorough analysis of the current literature on the management of acute surgical conditions. A summary was drawn up following a compre- hensive review of studies from the past sever- al years. The main object of the summary was to dissect current knowledge on the approaches to optimize the management of severe acute pan- creatitis (AP).

Sterile inflammation contributes to the development of many liver diseases including non-alcoholic fatty liver disease. Tumor necrosis factor alpha (TNFα) is a key cytokine driving liver inflammation primarily through pro-inflammatory activation of liver sinusoidal endothelial cells (LSEC). The knowledge of whether modulating LSEC activation can alleviate liver inflammation is scarce. This study aims to establish and validate an animal model mimicking LSEC dysfunction observed in obese patients with elevated plasma levels of TNFα, and explore whether vasoactive flavonoid diosmetin could serve as a therapeutic agent for liver inflammation by modulation of LSEC dysfunction. Obese patients with elevated plasma levels of TNFα, LSEC dysfunction and liver inflammation had also reduced Mcpip1 expression in peripheral blood mononuclear cells. Mcpip1 is a protein that negatively regulates the levels of pro-inflammatory cytokines. To model this, we generated mice with Mcpip1 knock-out in myeloid cells (Mcpip1fl/flLysMCre), which displayed systemic and liver inflammation like that observed in patients. Diosmetin treatment efficiently reduced TNFα-dependent LSEC activation in vitro and in vivo, and reduced liver inflammation in Mcpip1fl/flLysMCre mice without affecting systemic inflammation. Diosmetin's effects may stem from inhibiting NF-κB pathway in TNFα-activated endothelial cells. Our findings demonstrate that the Mcpip1fl/flLysMCre mouse model is useful for studying new anti-inflammatory therapies for the liver. We show that diosmetin, a vasoactive flavonoid used in the clinic to treat chronic venous insufficiency, also has strong anti-inflammatory properties in the liver. These results indicate that diosmetin has the potential to be further investigated as a supportive therapy for liver inflammation in humans.

Background: The need for safe and efficient dissemination of minimally invasive approach in liver surgery is among the current challenges for hepatobiliary surgeons. After the stage of innovators and pioneers, the following countries should adopt a laparoscopic approach. The aim of this study was to assess the national experience and trend in implementing laparoscopic liver resection (LLR) in Poland. Materials and methods: A national registry of LLR performed in Poland was established in June 2020. All LLR cases performed before were included retrospectively, followed by prospectively collected new cases. Baseline characteristics, preoperative and intraoperative data, short-term results and long-term follow-up were recorded. Results: Since 2010 up to the end of 2022 there were 718 LLRs performed in Poland. The national rate of laparoscopic approach has gradually increased since 2017 ( P <0.001), reaching the rate of 11.7% in 2022. There were 443 (61.7%), 107 (14.9%), and 168 (23.4%) LLRs performed in accordance to increasing grades of difficulty. The move towards more demanding cases had an increasing trend over the years ( P <0.001). Total intraoperative adverse event and postoperative severe complications rates were estimated for 13.5% ( n =97) and 6.7% ( n =48), respectively. 30-day reoperation, readmission and postoperative mortality rates were 3.6% ( n =26), 2.8% ( n =20), and 0.8% ( n =6), respectively. While the R0 resection margin was assessed in 643 (89.6%) cases, the total textbook outcomes (TO) were achieved in 525 (74.5%) cases. Overcoming the learning curve of 60 LLRs, resulted in an increasing TO rate from 72.3 to 80.6% ( P =0.024). Conclusions: It is the first national analysis of a laparoscopic approach in liver surgery in Poland. An increasing trend of minimizing invasiveness in liver resection has been observed. Responsible selection of cases in accordance with difficulty may provide results within global benchmark values and textbook outcomes already during the learning curve.

Introduction: Metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity, providing substantial weight loss and improvement in obesity-related comorbidities. In 2020, the MBS Chapter of the Association of Polish Surgeons issued the Bariatric and Metabolic Surgery Care Standards to guide patient management. Aim: The aim of the study was to asses implementation of the standards in Polish surgical departments and identify factors associated with better compliance. Materials and methods: An online survey was distributed between August and December 2022 to 46 Polish surgical departments performing MBS. The survey included 62 questions covering general center characteristics, and pre-, peri-, and postoperative care. Descriptive statistics summarized the center characteristics and linear regression models analyzed the factors influencing compliance. Results: Thirty-six centers completed the survey, with a mean (SD) compliance score of 86.8% (9%) (29.5 of 34 criteria), and individual scores ranging from 70.6% to 100%. As many as 66.7% of the centers answered at least 80% of the questions. The areas with compliance below 80% included availability of adapted radiology facilities, constant availability of emergency radiology diagnostics, screening for metabolic markers, assessment of obstructive sleep apnea risk, obtaining patient declaration of abstaining from smoking, providing dates for at least 1 dietary consultation upon discharge, requiring at least 2 consultations with an experienced dietician, and employing a surgeon with bariatric certificate of excellence. Significant predictors of better compliance included the number of surgeons performing MBS and participation in the KOS-BAR program (a program of complex specialist care over patient undergoing bariatric surgery). Conclusions: The Bariatric and Metabolic Surgery Care Standards are moderately well adopted by Polish surgical departments, with improvements needed in specific areas. Unifying the standards may enhance patient outcomes.

Introduction: Laparoscopic liver resection is a challenging surgical procedure that may require prolonged operation time, particularly during the learning curve. Operation time significantly decreases with increasing experience; however, prolonged operation time may significantly increase the risk of postoperative complications. Aim: To assess whether prolonged operation time over the benchmark value influences short-term postoperative outcomes after laparoscopic liver resection. Material and methods: A retrospective cohort study based on data from the National Polish Registry of Minimally Invasive Liver Surgery was performed. A total of 197 cases consisting of left lateral sectionectomy (LLS), left hemihepatectomy (LH), and right hemihepatectomy (RH) with established benchmark values for operation time were included. Data about potential confounders for prolonged operation time and worse short-term outcomes were exported. Results: Most cases (129; 65.5%) were performed during the learning curve, while the largest rate was observed in LLS (57; 78.1%). Median operation time exceeded the benchmark value in LLS (Me = 210 min) and LH (Me = 350 min), while in RH the benchmark value was exceeded in 39 (44.3%) cases. Textbook outcomes were achieved in 138 (70.1%) cases. Univariate analysis (OR = 1.11; 95% CI: 0.61-2.06; p = 0.720) and multivariate analysis (OR = 1.16; 95% CI: 0.50-2.68; p = 0.734) did not reveal a significant impact of prolonged surgery on failing to achieve a textbook outcome. Conclusions: Prolonging the time of laparoscopic liver resection does not significantly impair postoperative results. There is no reason related to the patients' safety to avoid prolonging the time of laparoscopic liver resection over the benchmark value.

BACKGROUND:Spleen preservation during laparoscopic distal pancreatectomy (LSPDP) should be pursued if safe and oncologically justified. The aim of the presented study was to compare surgical outcomes and identify risk factors for unplanned splenectomy during laparoscopic distal pancreatectomy and evaluate short and long-terms outcomes. METHODS:The following study is a retrospective cohort study of consecutive patients who underwent laparoscopic distal pancreatectomy, with the intention of preserving the spleen, for benign tumors of the body and tail of the pancreas between August 2012 and December 2022. Follow-up for patients' survival was completed in January 2023. In all, 106 patients were in total included in this study. Median age was 58 (41 to 67) years. The study population included 29 males (27.4%) and 77 females (72.6%). RESULTS:Spleen preservation was possible in 67 (63.2%) patients. The tumor size was larger in the splenectomy group (respectively, 30 (16.5 to 49) vs. 15 (11 to 25); P <0.001). Overall, serious postoperative morbidity was 13.4% in the LSPDP group and 20.5% in the second group ( P =0.494). There were no perioperative deaths. The postoperative pancreatic fistula rate was 18% in the splenectomy group and 14.9% in the LSPDP group, while B and C fistulas were diagnosed in 15.4% and 10.5% of patients, respectively. In the multivariate logistic regression model, tumor size >3 cm was found to independently increase odds for unplanned splenectomy (OR 8.41, 95%CI 2.89-24.46; standardized for BMI). CONCLUSION:Unplanned splenectomy during the attempt of LSPDP does not increase the risk for postoperative morbidity and postoperative pancreatic fistula. The independent risk factor for unplanned splenectomy during LSPDP is tumor size above 3 cm.

Purpose The aim of this study was to establish whether laparoscopic RAMPS (L-RAMPS) is a safe procedure with better oncological outcomes compared to laparoscopic distal pancreatectomy (LDP) with splenectomy among patients with distal pancreatic ductal adenocarcinoma (PDAC). Methods This is a retrospective study performed on consecutive patients who underwent L-RAMPS and LDP with splenectomy for resectable or borderline resectable PDAC of the body and tail. In this paper, we presented our technique of laparoscopic RAMPS and analyzed intraoperative and perioperative complications, oncological efficacy, and long-term survival. Results The study included 12 patients in the L-RAMPS group and 13 patients in the LDP with splenectomy. L-RAMPS was associated with significantly higher rates of R0 resection (91.7% vs. 69.2%, p = 0.027). There were no differences between the L-RAMPS and LDP with splenectomy groups in intraoperative blood loss (400 mL vs 400 mL, p = 0.783) and median operative time (250 min vs 220 min, p = 0.785). No differences were found in terms of perioperative complications, including the incidence of pancreatic fistula. Conclusion Laparoscopic RAMPS is a feasible and safe procedure. It provides higher radicality as compared with LDP with splenectomy, without increasing the risk of complications. Further studies are necessary to evaluate long-term outcomes.

Introduction: The determinants influencing the risk for complications of laparoscopic distal pancreatectomies (LDP) are not yet fully defined, thus we aimed to determine risk factors for serious perioperative morbidity after LDP with spleen preservation, LDP and radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas (RAMPS). Material and methods: Retrospective cohort study of consecutive patients that underwent LDP between January 2019 and December 2022. The study group included cases of serious perioperative morbidity (III-V grades in Clavien-Dindo classification) during a 30-day period after operation. The control group consisted of patients without serious perioperative morbidity. As many as 142 patients were included in the study. Results: Serious perioperative morbidity was found in 33 (23.24%) operated patients, while mortality in 3 cases (2.11%). Serious perioperative morbidity after LDP with spleen preservation was found in 9/68 (13.2%) patients (27.3% of the perioperative morbidity group). Thirteen out of 51 patients, i.e. 25.5%, after LDP with splenectomy were included in the perioperative morbidity group (39.4%). Serious perioperative morbidity after RAMPS was found in 11/23 (47.8%) patients (33.3% of the perioperative morbidity group). In multivariate logistic regression, the need for splenectomy during pancreatectomy (OR 3.66, 95%CI 1.20-11.18) and tumor above 28 millimeters in size (OR 3.01, 95%CI 1.19-9.59) were independent risk factors for serious perioperative morbidity. Conclusions: The need for splenectomy during laparoscopic distal pancreatectomy and tumor size above 28 millimeters were independent risk factors for serious perioperative morbidity after laparoscopic distal pancreatectomies..

Introduction: Over the past three decades, almost every type of abdominal surgery has been performed and re-fined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. Aim: The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparos-copy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. Material and methods: The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations were for-mulated in a directive form and evaluated by a group of experts using the Delphi method. Results and conclusions: There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforat-ed ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications re-quiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The first part of the guidelines covers 5 sections and the following challenges for surgical practice: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia and acute cholecystitis. Contraindications for laparoscopy and the ERAS program are discussed.

Purpose: Laparoscopic liver resection is an established surgical approach, however more data is needed to assess its potential benefits and limits in major liver resections. Method: A retrospective study of laparoscopic major liver resections was performed based on data from the Polish National Registry of Minimally Invasive Liver Surgery. The registry includes all laparoscopic liver resections performed in Poland since its implementation in our country. Data were collected from 6 departments, where laparoscopic major liver resection is performed. Short-term results were compared with a group of patients who underwent open major liver resection in a tertiary referral center. Results: Up to 01/01/2023 there were 102 cases of laparoscopic major liver resection (≥3 segments) performed in Poland with a conversion rate of 15.7%. There were 71 (69.6%) right and 31 (30.4%) left laparoscopic hemihepatectomies. Control group consisted of 220 cases of open right (159; 72.3%) and left (61; 27.7%) hemihepatectomies. In both groups the most common indication for liver resection were colorectal liver metastases, in 59 (57.8%) and 98 (44.5%) cases, respectively. Postoperative complications and severe complications (≥3 in accordance to Clavien-Dindo classification) occurred similarly in 25.5% vs. 35.5% (p=0.095) and 14.7% vs. 8.6% (p=0.117), respectively. Postoperative stay was significantly shorter in laparoscopic group (p<0.001) with median duration of 7 and 8 days, respectively. Although R0 resection was observed more frequently in minimally invasive approach (87.0% vs. 79.5%), the difference was not significant (p=0.152). Conclusion: Laparoscopic approach for major liver resection provides short-term results at least non-inferior to open approach. Despite the nonsignificant difference in postoperative complication rate, duration of hospital stay is significantly decreased. Resection margin status is not compromised by minimally invasive approach.

Mental disorders are common in the group of candi-dates for bariatric surgery, and their complex and het-erogeneous nature justifies conducting a psychological consultation in the initial period of selection for surgi-cal treatment of obesity. Untreated mental disorders may be one of the important factors explaining weight regain in patients undergoing bariatric surgery. In or-der to optimize the surgical treatment of obesity, it seems important to implement an appropriate psycho-logical evaluation in diagnostic and therapeutic proce-dures. It is particularly important to identify such can-didates who require extended therapeutic procedures, including pharmacological and/or psychotherapeutic treatment before starting the procedure. The aim of the study was to discuss the case of a patient with an eating disorder and co-occurring personality disorder, who relapsed after surgical treatment of obesity.

Introduction:Laparoscopic sleeve gastrectomy (SG) is currently the most commonly performed bariatric operation, but re-do surgery may be necessary in up to half of the patients. Single anastomosis duodeno-ileal bypass (SADI-S) is quickly gaining recognition as a revisional procedure after failed SG. Aim:To discuss the surgical technique and analyze initial outcomes after introduction of SADI-S after SG with 1-year follow-up. Material and methods:This is a retrospective cohort study of consecutive patients who underwent re-do bariatric surgery - revisional SADI-S - in 2021 at a secondary referral public hospital. All patients' follow-up was completed 1 year after. Results:14 consecutive patients, 6 (43%) males and 8 females, were included. Median maximal body mass index (BMI) was 52.29 (47.96-77.16) kg/m2, BMI before SADI-S was 43.09 (41.64-48.99) kg/m2. No perioperative morbidity was recorded. Four (28%) patients reported recurrent abdominal crampy pain and diarrhea that required dietary advisement and pharmacological therapy in the postoperative period. No reoperations, mortality or readmissions were recorded during 1-year follow-up. SADI-S was associated with further weight loss, resulting in median BMI of 37.55 (36.29-39.43) kg/m2 1 year after SADI-S. Observed additional percentage total weight loss (%TWL) 1 year after SADI-S was 18.65% (17.25-21.89%), while additional percentage excess body mass index loss (%EBMIL) was 35.88% (29.18-41.92%). There was 1 case of diabetes mellitus type 2 remission and improvement in glycemic control in 1 patient. 4/6 patients (66.67%) had improvement in control of hypertension. Conclusions:SADI-S is promising re-do surgery after SG with low postoperative morbidity. Additional %TWL 1 year after SADI-S is ~19%, while additional %EBMIL is ~36%, with significant improvement of obesity-related comorbidities.