Rectus abdominis diastasis is defined as a widening of the linea alba exceeding 2 cm. The European Hernia Society (EHS) provides a classification to guide its management. This article details the abdominal wall surgeon's perspective, particularly for symptomatic patients without major skin excess. Following a well-conducted physiotherapy, the rise of minimally invasive extraperitoneal techniques, particularly robotic approaches, offers an alternative to abdominoplasty in selected cases. By avoiding large subcutaneous dissections, these posterior approaches drastically reduce morbidity. The goal of the repair goes beyond cosmetics: it aims for a complete biomechanical and functional restoration.

Robotic ventral hernia repair is increasing worldwide. No guidelines currently exist regarding indications for this approach, or agreed operative steps. We aimed to develop expert consensus regarding indications for robotic approaches in patients with a primary ventral hernia, and define agreed procedural steps for each robotic technique. A systematic review was undertaken and used to generate statements relating to indications, peri-operative steps and dissection techniques in robotic ventral hernia surgery. Through a nominal group technique statements were revised and piloted. A panel of international robotic hernia surgeons was established. The experts performed three rounds of a Delphi survey responding to statements in each domain. Consensus was considered achieved for any statement reaching > 80

In 2023, robotic surgery has witnessed an expansion in the number of surgical procedures and in the number of platforms on the market. We illustrate the phenomenon, by exploring parietal, œso-gastric and liver robotic surgery. Surgical innovation aligns with advancements in oncology. Immunotherapy now enables "watch and wait" strategies for patients with colorectal cancer, and decreases recurrence rate and improves survival after liver surgery for hepatocellular carcinoma and œso-gastric surgery. The multidisciplinary field of obesity management has seen the development of new medications, diversifying the treatment options, while surgery continues to deliver the best weight-loss outcomes.

In 2023, robotic surgery has witnessed an expansion in the number of surgical procedures and in the number of platforms on the market. We illustrate the phenomenon, by exploring parietal, œso-gastric and liver robotic surgery. Surgical innovation aligns with advancements in oncology. Immunotherapy now enables "watch and wait" strategies for patients with colorectal cancer, and decreases recurrence rate and improves survival after liver surgery for hepatocellular carcinoma and œso-gastric surgery. The multidisciplinary field of obesity management has seen the development of new medications, diversifying the treatment options, while surgery continues to deliver the best weight-loss outcomes.

The advantages of prehabilitation in surgical oncology are unclear. This systematic review aims to (1) evaluate the latest evidence of preoperative prehabilitation interventions on postoperative outcomes after gastrointestinal (GI) cancer surgery and (2) discuss new potential therapeutic targets as part of prehabilitation. Randomized controlled trials published between January 2017 and August 2022 were identified through Medline. The population of interest was oncological patients undergoing GI surgery. Trials were considered if they evaluated prehabilitation interventions (nutrition, physical activity, probiotics and symbiotics, fecal microbiota transplantation, and ghrelin receptor agonists), alone or combined, on postoperative outcomes. Out of 1180 records initially identified, 15 studies were retained. Evidence for the benefits of unimodal interventions was limited. Preoperative multimodal programs, including nutrition and physical activity with or without psychological support, showed improvement in postoperative physical performance, muscle strength, and quality of life in patients with esophagogastric and colorectal cancers. However, there was no benefit for postoperative complications, hospital length of stay, hospital readmissions, and mortality. No trial evaluated the impact of fecal microbiota transplantation or oral ghrelin receptor agonists. Further studies are needed to confirm our findings, identify patients who are more likely to benefit from surgical prehabilitation, and harmonize interventions.

AimThis paper describes a robotic approach to combined gastrointestinal continuity restoration and complex abdominal wall reconstruction after Hartmann's procedure complicated by large midline and parastomal hernias. MethodsA robotic Hartmann reversal is performed, followed by robotic retromuscular abdominal wall reconstruction of all ventral defects with bilateral posterior component separation using the double-docking approach. Surgical steps are thoroughly described, and the accompanying video highlights critical steps of the procedure, anatomical landmarks and technical details relevant to successful completion. ResultsComplete restoration of the anatomy was achieved with an operative time of 6.5 h. Mobilization occured on day 1, and bowels were opened on day 3. Surgical discharge was possible on day 5. No intra-operative surgical complication occurred and follow-up at 6 months showed no recurrence or mid-term complication. ConclusionCombined minimally invasive reconstruction of the gastrointestinal tract and abdominal wall was feasible using a robotic system. In addition, potential advantages of postoperative rehabilitation and reduced surgical site complications are suggested. Prospective evaluation of the technique is ongoing.

Abstract Background Robotic incisional hernia repair (RIHR) with sublay mesh is gaining traction as a minimally-invasive alternative to open retro-rectus reconstruction (OIHR). Obesity is a known risk factor for complications following hernia repair. Aims The objective of this study is to compare the clinical outcomes and costs of RIHR versus OIHR with sublay mesh in overweight patients. Methods Patients with a body mass index (BMI) of 25-35 kg/m2 who underwent OIHR or RIHR with sublay mesh over a 2 years’ period were included. Recurrent hernias after mesh repair were excluded. The main outcome was length of hospital stay (LOS). Secondary outcomes included surgical site complications (SSC), visual analog pain score (VAS), analgesic methods, and general complications. Results Ninety patients were included, 45 in each group. The mean length of stay (LOS) was significantly shorter in RIHR (6.8 days ± 4.6 vs. 2.3 days ± 2, p < 0.001), as were VAS at day 0 (3.0 ± 2.7 vs. 1.7 ± 1.8, p = 0.005) and day 1 (4.2 ± 2.2 vs. 2.4 ± 1.8, p < 0.001), with a significant reduction in morphine consumption and epidural analgesia. The mean operative time was 163 min. ± 65 in OIHR and 191 min. ± 94 in RIHR (p = 0.06), despite a higher proportion of component separation in the robotic group (18% vs 33.3%, p = 0.005). The open group had higher rates of SSC (20% vs 2.2%, p = 0.015) and general complications (40% vs 13.3%, p = 0.004). General costs per diagnosis showed a mean reduction of 4797 CHF in the robotic group, mostly due to reduced hospitalization costs (9364 CHF vs. 3472 CHF). Conclusions The robotic approach improved post-operative outcomes of incisional hernia repair with sublay mesh compared to the open approach in overweight patients, without significantly increasing operative time and costs.

Abstract Background Ventral midline incisional hernia (VMIH) is common and recurrence rates remain of concern after gold-standard open repairs. Personalized optimization and risk stratification are traditionally performed through preoperative considerations regarding patients’ general and medical status and occulting mechanical factors. Aims The aim of this retrospective observational cohort study is to identify mechanical parameters potentially influencing VMIH recurrence (VMIHR) after repair. Methods Data were derived from an institutional quality database. Patients who underwent VMIH open repair with retromuscular or preperitoneal non-absorbable mesh reinforcement, confirmed by an available preoperative CT scan for biomechanical measurements, between June 2012 – June 2020 in a single centre, were included. Exclusion criteria were non-open repairs, non-midline hernias, absence of preoperative scan, absence of mesh reinforcement, intraperitoneal/bridging mesh positions, biologic/biosynthetic mesh and use of component separation techniques. The main outcome was VMIHR, a symptomatic clinically confirmed recurrence re-operated in the same institution within 36 months maximum following primary open repair. Patients with/without recurrence were compared using standard analytic tools. Results Fourty-eight patients met the inclusion criteria of which 11 (23%) developed VMIHR. The following parameters were statistically significantly associated with VMIHR: smaller visceral fat surface (mean of 244.9 cm2 in the recurrence group vs 286.3 cm2 in non-recurrence group, p = 0.0295), smaller mesh length (17.2 cm vs 23 cm, p = 0.001), smaller total mesh surface (315.2 cm2 vs 550.1 cm2, p = 0.0095), coated meshes (p = 0.033), absorbable suture for mesh anchoring (p = 0.043) and a greater largest defect width/mesh width ratio (0.42 vs 0.29, p = 0.0146). Conclusions When focusing on mechanical parameters, non-modifiable and patient-related parameters seem to play a limited role. However, using uncoated meshes of larger dimensions (greater than/equal to 3.5x defect size) than suggested previously (defect size + 5cm) resulted in fewer recurrences. This may help to orientate further larger prospective trials.

This study aimed to determine which bariatric procedure allows patients to obtain the best weight‐loss outcomes and a remission of type 2 diabetes.

BACKGROUND:Gastrointestinal tumors are among the most common cancer types, and early detection is paramount to improve their management. Cell-free DNA (cfDNA) liquid biopsy raises significant hopes for non-invasive early detection.AIM:To describe current applications of this technology for gastrointestinal cancer detection and screening.METHODS:A systematic review of the literature was performed across the PubMed database. Articles reporting the use of cfDNA liquid biopsy in the screening or diagnosis of gastrointestinal cancers were included in the analysis.RESULTS:A total of 263 articles were screened for eligibility, of which 13 articles were included. Studies investigated colorectal cancer (5 studies), pancreatic cancer (2 studies), hepatocellular carcinoma (3 studies), and multi-cancer detection (3 studies), including gastric, oesophageal, or bile duct cancer, representing a total of 4824 patients. Test sensitivities ranged from 71% to 100%, and specificities ranged from 67.4% to 100%. Pre-cancerous lesions detection was less performant with a sensitivity of 16.9% and a 100% specificity in one study. Another study using a large biobank demonstrated a 94.9% sensitivity in detecting cancer up to 4 years before clinical symptoms, with a 61% accuracy in tissue-of-origin identification.CONCLUSION:cfDNA liquid biopsy seems capable of detecting gastrointestinal cancers at an early stage of development in a non-invasive and repeatable manner and screening simultaneously for multiple cancer types in a single blood sample. Further trials in clinically relevant settings are required to determine the exact place of this technology in gastrointestinal cancer screening and diagnosis strategies.

Registries are a valuable tool for data collection and observation of medical innovations in a real-world setting. Serenity LiquidTM and Serenity GenomeTM are newly launched diagnostic platforms analyzing large genetic datasets in combination with clinical data to deliver precision preventative medicine. To this point, no systematic data is available to observe the use and clinical implementations of these platforms. To create a data repository collecting data from Serenity LiquidTM, Serenity GenomeTM, and clinical parameters for analyses. Individuals receiving Serenity LiquidTM or Serenity GenomeTM are solicited to participate in this registry. In addition to the initial dataset, a clinical update is secured every six months. Data from the registry participants are pseudo-anonymized and archived in a HIPPA-compliant research database for regular analyses. Includes but is not limited to correlations between genetic and clinical data, the impact of genetic data on the clinical course of patients, comparisons between specific cohorts (within this database and against historical cohorts) on an ongoing basis. This is a prospective registry collecting genetic and clinical data to gather important information, provide novel insights by continuously analyzing the data in this registry.

Liquid biopsy is a relatively novel method using a range of technologies for the discovery of cancer-specific mutations in the blood. It is an accepted tool in the armamentarium of the refined oncologist and used to make non-operative, targeted treatment decisions for a range of cancers. 1 Zill O.A. Greene C. Sebisanovic D. et al. Cell-free DNA next-generation sequencing in pancreatobiliary carcinomas. Canc Discov. 2015; 5: 1040-1048 Crossref PubMed Scopus (173) Google Scholar Several products are available in the market and mostly used to screen for actionable mutations, as advocated as a standard of care by the National Comprehensive Cancer Network. 2 Ettinger D.S. Wood D.E. Aggarwal C. et al. NCCN guidelines insights: non-small cell lung cancer, version 1.2020. J Natl Compr Canc Netw. 2019; 17: 1464-1472 Crossref PubMed Scopus (380) Google Scholar In this setting, liquid biopsy offers advantages over tissue biopsy when tissue harvesting is logistically challenging, particularly after initial treatment, and DNA yield might be inadequate or incomplete with a traditional tissue biopsy. 3 Sholl L.M. Aisner D.L. Varella-Garcia M. et al. Multi-institutional oncogenic driver mutation analysis in lung adenocarcinoma: the lung cancer mutation consortium experience. J Thorac Oncol. 2015; 10: 768-777 Abstract Full Text Full Text PDF PubMed Scopus (256) Google Scholar The insights into the cancer mutations then inform if the cancer may be resistant or susceptible to specific treatments, and patients can receive precision medicine. Such personalized approaches have shown improved outcomes for some indications, for example the identification of resistant mutations in lung cancer. 4 Esposito A. Criscitiello C. Trapani D. Curigliano G. The emerging role of “liquid biopsies,” circulating tumor cells, and circulating cell-free tumor DNA in lung cancer diagnosis and identification of resistance mutations. Curr Oncol Rep. 2017; 19: 1https://doi.org/10.1007/s11912-017-0564-y Crossref PubMed Scopus (26) Google Scholar Esposito et al. found that liquid biopsies can detect de novo and resistant genetic alterations, as well as provide real-time monitoring of treatment responses. 4 Esposito A. Criscitiello C. Trapani D. Curigliano G. The emerging role of “liquid biopsies,” circulating tumor cells, and circulating cell-free tumor DNA in lung cancer diagnosis and identification of resistance mutations. Curr Oncol Rep. 2017; 19: 1https://doi.org/10.1007/s11912-017-0564-y Crossref PubMed Scopus (26) Google Scholar

Introduction Application of a prophylactic mesh during stoma closure was shown to reduce the incidence of incisional hernia at the site of stoma closure. Our objective is to provide high quality evidence to validate this finding. Methods and analysis The study will be a randomised controlled triple-blinded superiority parallel monocentric trial. Patients undergoing elective ileostomy or colostomy closure after surgery for digestive cancer will be eligible for inclusion. Patients allergic to the mesh, immunosuppressed or refusing to participate will be excluded. Randomisation will be performed based on a 1:1 allocation ratio between stoma closure with application of a non-absorbable mesh in the sublay position (intervention) and stoma closure without a mesh (control). The primary outcome will be the 1-year incidence of incisional hernia at the site of stoma closure, determined clinically and by CT. Secondary outcomes will be the 31-day incidence of surgical site infection and the modified Carolinas Comfort Scale. Patients, radiologists and investigators performing the assessment at 1 year will be blinded for the allocated study group. Analysis will be performed in intention-to-treat. The trial will include 68 patients (34 with mesh, 34 without mesh). Ethics and dissemination The present randomised controlled trial was registered into clinicaltrials.gov (NCT 04510558) and was accepted by the local ethic committee (Geneva, Switzerland: CCER 2021-00053). The results will be presented at national and international congresses in the fields of colorectal surgery and general surgery, and published in a peer-reviewed journal.

This is an early clinical analysis of the DEEPGENTM platform for cancer detection. Newly diagnosed cancer patients and individuals with no known malignancy were included in a prospective open-label case-controlled study (NCT03517332). Plasma cfDNA that was extracted from peripheral blood was sequenced and data were processed using machine-learning algorithms to derive cancer prediction scores. A total of 260 cancer patients and 415 controls were included in the study. Overall, sensitivity for all cancers was 57% (95% CI: 52, 64) at 95% specificity, and 43% (95% CI: 37, 49) at 99% specificity. With 51% sensitivity and 95% specificity for all stage 1 cancers, the stage-specific sensitivities trended to improve with higher stages. Early results from this preliminary clinical, prospective evaluation of the DEEPGENTM liquid biopsy platform suggests the platform offers a clinically relevant ability to differentiate individuals with and without known cancer, even at early stages of cancer.