Current non-invasive diagnostic modalities of iatrogenic bile leak (BL) are not particularly sensitive and often fail to localise the BL origin. Percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) are considered the gold standard, yet are invasive studies with potential complications. Ce-MRCP has been not comprehensively studied in this setting but may prove particularly helpful given its non-invasive nature and the anatomical dynamic detail. This paper reports a monocentric retrospective study of BL patients referred between January 2018 and November 2022 submitted to Ce-MRCP followed by PTC. The primary outcome was the accuracy of Ce-MRCP in detecting and localising BL compared to PTC and ERCP. Blood tests, coexisting cholangitis features and time for leak resolution were also investigated. Thirty-nine patients were included. Liver-specific contrast-enhanced MRCP detected BL in 69% of cases. The BL localisation was 100% accurate. Total bilirubin above 4 mg/dL was significantly associated with false negative results of Ce-MRCP. Ce-MRCP is highly accurate in detecting and localising BL, but sensitivity is significantly reduced by a high bilirubin level. Ce-MRCP may be very useful in early BL diagnosis and in accurate pre-treatment planning, but can only be reliably used in selected patients with TB < 4 mg/dL. Non-surgical techniques, both radiological and endoscopic, are proven to be effective in terms of leak resolution.

Background: The role of tailored immunosuppression (IS) in the development of the humoral response (HR) to SARS-CoV-2 mRNA-based vaccination in liver transplant (LT) recipients is unknown. Methods: This is a single-centre prospective study of patients who underwent LT between January 2015 and December 2021 and who have received three doses of mRNA-based SARS-CoV-2 vaccination. Patients undergoing Tacrolimus-based immunosuppression (TAC-IS) were compared with those undergoing Everolimus-based immunosuppression (EVR-IS). Patients receiving the TAC-EVR combination were divided into two groups based on trough TAC concentrations, i.e., above or below 5 ng/mL. HR (analysed with ECLIA) was assessed at 30 to 135 days after vaccination. The primary outcome was the presence of a positive antibody titre ($\ge$0.8 U/mL). Secondary outcomes were the presence of a highly protective antibody titre ($\ge$142 U/mL), median antibody titre, and incidence of COVID-19. Results: Sixty-one participants were included. Twenty-four (40%) were receiving TAC-IS and thirty-seven (60%) were receiving EVR-IS. At the median follow-up of 116 (range: 89–154) days, there were no significant differences in positive antibody titre (95.8% vs. 94.6%; p = 0.8269), highly-protective antibody titre (83.3% vs. 81.1%; p = 0.8231), median antibody titre (2410 [IQ range 350–2500] vs. 1670 [IQ range 380–2500]; p = 0.9450), and COVID-19 incidence (0% vs. 5.4%; p = 0.5148). High serum creatinine and low estimated glomerular filtration rate were risk factors for a weak or absent HR. Conclusions: Three doses of mRNA-based SARS-CoV-2 vaccination yielded a highly protective HR in LT recipients. The use of TAC or EVR-based IS does not appear to influence HR or antibody titre, while renal disease is a risk factor for a weak or null HR.

One anastomosis gastric bypass (OAGB) is gaining popularity among bariatric procedures. However, data on the number and outcomes of revisional surgeries is scarce. This study included patients undergoing OAGB revision in a high-volume centre between January 2020 and October 2024. The study evaluates the indication for revision, the type of procedure performed, and the success of revisional surgery, assessed by symptom resolution or percent excess weight loss (%EWL) > 40% at 2 years. OAGB was performed on 3280 patients, of which 52 (1.6%) necessitated surgical revision for late complications as well as 18 patients who had their primary OAGB elsewhere. A total of 68 patients (47 females, 21 males) underwent OAGB revision. The mean time to revision after primary OAGB was 28 months. Indications for revision in the 68 patients were recurrent weight gain (51.5%, 0.73% of the total), severe bile reflux (29.4%, 0.52% of the total), marginal ulcers (7.4%, 0.12% of the total), excessive malabsorption (5.9%, 0.06% of the total), and stenosis (5.9%, 0.12% of the total). Revisional procedures in the 68 patients included biliary-pancreatic limb lengthening (47%), conversion to RYGB (29.4%), redo gastro-jejunal anastomosis (13.3%), biliary-pancreatic limb shortening (5.9%), and pouch resizing (4.4%). There were no major postoperative complications and 5.8% minor complications, all managed conservatively. At 20 months, 98.5% of revisional surgeries were successful, with complete symptom resolution for reflux, anastomotic ulcers and stenosis. The mean of %EWL in the recurrent weight gain group was 33.7%, 57.4% and 84% at 3 months, 1 year and 2 years. OAGB appears to be a safe procedure with a low revision rate. When necessary, surgical revision procedures can be tailored and have a high success rates and low morbidity. A management algorithm has been developed and proposed.

Background: The increasing emphasis on sustainability and digitalization has brought telemedicine to the forefront, particularly in bariatric surgery. This study evaluates the safety, clinical effectiveness and environmental impact of telemedicine for patients with obesity eligible for bariatric surgery.Materials and methods: A total of 338 patients underwent remote consultations via Zoom in 2023. Median age was 38 years (±4); 70% of patients were female. Mean BMI before surgery was 43 kg/m² (±5). Surgical procedures included One Anastomosis Gastric Bypass (50%), Sleeve Gastrectomy (20%), Roux-en-Y Gastric Bypass (20%), revisional surgery (8%), and other procedures (2%). CO₂ emissions were estimated based on the avoided travel, considering patient-reported transportation methods and distances. All patients were later evaluated in person before hospital admission. The primary outcome was environmental impact; the secondary outcome was whether remote evaluations influenced surgical indication or perioperative management.Results: Remote consultations reduced total travel emissions from 50,766.01 kg to 17.73 kg CO₂, a 99.97% reduction (from 150.20 kg to 0.05 kg per patient). No patients required additional telemedicine or outpatient visits. Surgical indications and preoperative plans remained unchanged after in-person consultations. Postoperative complications occurred in 7.4% of patients, all minor and managed conservatively. There was no mortality. Median length of stay was 2.6 ± 3 days. At one-year follow-up, the mean BMI decreased to 29 kg/m² (±3). In the revisional surgery group, percent excess weight loss reached 75.4% at one year.Conclusion: Telemedicine in bariatric surgery is safe, effective, and significantly reduces environmental impact. Remote consultations did not alter clinical decisions or outcomes. Wider adoption could benefit from dedicated digital tools to enhance patient care and sustainability.