Objectives: The aim of the study is to compare the safety and efficacy of unilateral anterograde cerebral perfusion (UACP) and bilateral anterograde cerebral perfusion (BACP) for acute type A aortic dissection (ATAAD). Methods: A systematic review of the MEDLINE (PubMed), Scopus, and Cochrane Library databases (last search: August 7th, 2021) was performed according to the PRISMA statement. Studies directly comparing UACP versus BACP for ATAAD were included. Random-effects meta-analyses were performed. Results: Eight retrospective cohort studies were identified, incorporating 2416 patients (UACP: 843, BACP: 1573). No statistically significant difference was observed regarding in-hospital mortality (odds ratio [OR]:1.05 [95% Confidence Interval (95% CI):0.70–1.57]), permanent neurological deficit (PND) (OR: 0.94 [95% CI: 0.52–1.70]), transient neurological deficit (TND) (OR: 1.37 [95% CI: 0.98–1.92]), renal failure (OR: 0.96 [95% CI: 0.70–1.32]), and re-exploration for bleeding (OR: 0.77 [95% CI: 0.48–1.22]). Meta-regression analysis revealed that PND and TND were not influenced by differences in rates of total arch repair, Bentall procedure, and concomitant CABG in UACP and BACP groups. Cardiopulmonary bypass time (Standard Mean Difference [SMD]: −0.11 [95% CI: −0.22, 0.44]), Cross clamp time (SMD: −0.04 [95% CI: −0.38, 0.29]), and hypothermic circulatory arrest time (SMD: −0.12 [95% CI: −0.55, 0.30]) were comparable between UACP and BACP. Intensive care unit stay was shorter in BACP arm (SMD:0.16 [95% CI: 0.01, 0.31]); however, length of hospital stay was shorter in UACP arm (SMD: −0.25 [95% CI: −0.45, −0.06]). Conclusions: UACP and BACP had similar results in terms of in-hospital mortality, PND, TND, renal failure, and re-exploration for bleeding rate in patients with ATAAD. ICU stay was shorter in the BACP arm while LOS was shorter in the UACP arm.

Advances in multimodal management of locally advanced rectal cancer (LARC), consisting of preoperative chemotherapy and/or radiotherapy followed by surgery with or without adjuvant chemotherapy, have improved local disease control and patient survival but are associated with significant risk for acute and long-term morbidity. Recently published trials, evaluating treatment dose intensification via the addition of preoperative induction or consolidation chemotherapy (total neoadjuvant therapy [TNT]), have demonstrated improved tumor response rates while maintaining acceptable toxicity. In addition, TNT has led to an increased number of patients achieving a clinical complete response and thus eligible to pursue a nonoperative, organ-preserving, watch and wait approach, thereby avoiding toxicities associated with surgery, such as bowel dysfunction and stoma-related complications. Ongoing trials using immune checkpoint inhibitors in patients with mismatch repair-deficient tumors suggest that this subgroup of patients with LARC could potentially be treated with immunotherapy alone, sparing them the toxicity associated with preoperative treatment and surgery. However, the majority of rectal cancers are mismatch repair-proficient and less responsive to immune checkpoint inhibitors and require multimodal management. The synergy noted in preclinical studies between immunotherapy and radiotherapy on immunogenic tumor cell death has led to the design of ongoing clinical trials that explore the benefit of combining radiotherapy, chemotherapy, and immunotherapy (mainly of immune checkpoint inhibitors) and aim to increase the number of patients eligible for organ preservation.

Background: Laparoscopic sleeve gastrectomy (LSG) is the most common primary bariatric operation performed in the United States. Its relative technical ease, combined with a decreased risk for anatomic and malabsorptive complications make LSG an attractive option compared to laparoscopic gastric bypass (LGB) for many patients and surgeons. However, emerging evidence for progressive gastroesophageal reflux disease (GERD) after LSG, and the inferior weight loss in many studies, suggests that the enthusiasm for LSG requires reassessment. We hypothesized that patient satisfaction and quality of life (QoL) may be lower after LSG compared to LGB because of these differences. Methods: We distributed a survey querying weight-loss outcomes, complications, foregut symptoms, QoL, and overall satisfaction to patients who underwent bariatric operations at our institution between 2000 and 2020 and who had electronic mail contact information available. Mean follow-up was 2.75 ± 2.41 years for LGB patients and 3.37 ± 2.18 ( P = .021) years for LSG patients. We compared these groups for weight-loss outcomes, changes in foregut symptoms, gastrointestinal QoL, postbariatric QoL, and overall satisfaction using appropriate statistical tests. Results: Among 323 respondents, 126 underwent LGB and 197 underwent LSG. LGB patients had larger body mass index (BMI) reduction than LSG patients (−17.16 ± 9.07 kg/m ² versus −14.87 ± 7.4 kg/m ² , P = .023). LGB patients reported less reflux ( P = .003), with decreased heartburn ( P < .0001) and regurgitation ( P = .0027). However, a greater proportion of LGB patients reported at least one complication ( P = .025). Despite this, more LGB patients reported satisfaction (92.86%) than LSG patients (73.6%). Conclusion: LGB patients are significantly more likely to be satisfied than LSG patients. Factors contributing to the higher level of satisfaction include less GERD and better BMI decrease.

Gastric emptying delay may be caused with both functional and anatomic derangements. Gastroparesis is suspected in patients presenting with certain foregut symptoms without anatomic obstruction. Data are still emerging regarding the best treatment of this condition. In cases where large paraesophageal hernias alter the upper gastrointestinal anatomy, it is difficult to know if gastroparesis also exists. Management of hiatal hernias is also still evolving, with various strategies to reduce recurrence being actively investigated. In this article, we present a systematic review of the existing literature around the management of gastroparesis and the management of paraesophageal hernias when they occur separately. In addition, since there are limited data to guide diagnosis and management of these conditions when they are suspected to coexist, we provide a rational strategy based on our own experience in patients with paraesophageal hernias who have symptoms or studies that raise suspicion for a coexisting functional disorder.

Background/Objectives: The global adoption of minimally invasive surgery has generated extensive video repositories, creating new opportunities for data-driven surgical education and quality assessment. Automated surgical phase recognition enables objective trainee evaluation, standardized competency assessment, and systematic procedural documentation. However, class imbalance in surgical workflows, where certain phases comprise 30–35% of frames while others represent only 5–10%, remains a significant challenge. This imbalance causes models to underperform on underrepresented yet clinically important phases. Methods: A retrospective analysis of laparoscopic cholecystectomy videos is performed with the implementation of a frame—based deep learning framework to develop and validate a surgical phase recognition pipeline based on ResNet-50 architecture with transfer learning. The model was designed to extract features from surgical video frames and classify them into seven distinct phases, without incorporating temporal context. We used the Cholec80 dataset and applied class balancing techniques to address inherent class imbalance. Results: The model achieved a mean balanced accuracy of 91.80% across five folds with consistent performance across all surgical phases. Per-phase F1-scores ranged from 0.89 to 0.95, demonstrating balanced classification without significant performance degradation on underrepresented phases. The confusion matrix revealed prediction errors primarily among adjacent or visually similar phases, reflecting the inherent ambiguity of surgical phase transitions. In practical terms, the model correctly identified the surgical phase in more than 9 out of 10 frames, enabling reliable automated segmentation of the operative workflow. Conclusions: This study demonstrates that artificial intelligence can reliably analyze surgical video data, achieving consistent and accurate phase recognition in laparoscopic cholecystectomy.