Objective: This systematic review and meta-analysis aimed to determine the degree to which pancreaticobiliary maljunction (PBM) increases the risk of different types of biliary cancer (BC). Methods: A systematic review and meta-analysis were carried out using the following databases: PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Science Direct. We systematically searched from inception to April 2024. The search terms included were derived from the keywords “Pancreaticobiliary Maljunction” OR “Anomalous Pancreaticobiliary Junction” AND “Cancer” OR “Malignancy”. Studies that provided data comparing BC rates in relation to PBM presence or vice versa were included. The Newcastle–Ottawa Scale (NOS) was used for quality assessment. The random-effects model was used. Results: Fifteen studies were included with a total sample of 8604 patients, of whom 5015 (58.29%) were female with a mean age of 54.58 years. Patients with PBM had 8.42 (95% CI = 3.57–19.87) more risk of developing any type of BC, with a higher risk of GBC than BDC (OR = 16.91 vs. OR = 3.36, p-value = 0.003). There was a higher risk of having PBM in patients with GBC than BDC only when considering the Asian population (OR = 3.12, 95% CI = 1.09–8.94). Meta-regression analysis revealed that neither mean age (p = 0.087) nor percentage of female patients in the study population (p = 0.197) were statistically associated with the variations in OR for the risk of BC based on the presence of PBM. Conclusions: There is a significant association between PBM and the risk of having BC, mainly GBC when compared to BDC. Most of the studies published reported data from Japanese patients, which limits the generalization of the results. The age of patients and sex were not significantly associated with the relation between PBM and BC. Further prospective studies in broader populations will provide additional details to take measures for screening and early management of PBM and BC.

Aim: This study aimed to assess and compare outcomes of robotic inguinal hernia repair (RIHR) in patients under and over 70 years old, performed by a fellowship-trained robotic surgeon at a single institution. Methods: A retrospective analysis of patients undergoing robotic primary transabdominal preperitoneal inguinal hernia repair between 2020 and 2022 was conducted. Patients were categorized into two age groups: those under 70 years and 70 years and older. Data were collected through chart reviews with a mean follow-up of 30 days. Concurrently, a systematic review (SR) of relevant high-level literature was carried out. Results: Among the 37 patients studied, 75.7% (n = 28) were male, with a mean age of 64.8 years. Demographic features did not significantly differ based on age groups. Patients > 70 years had a higher incidence of reported complications (52.3% vs. 87.5%, p < 0.461). There were no differences in operative time or length of stay between the groups. In the SR, only 23.7% (n = 9) of studies provided age-related conclusions. Three studies identified age over 70 as a risk factor for postoperative complications, while two studies suggested that RIHR is feasible and safe in patients aged 80 years and older. Conclusion: Patients over 70 years old demonstrated a higher incidence of complications compared to younger patients. However, current literature indicates that the robotic approach may offer a safe and minimally invasive option for inguinal hernia repair in both younger and older adults.

Background: Single-Anastomosis Duodenoileostomy with Sleeve Gastrectomy (SADI-S) has been reported as both a safe and effective surgical procedure. However, these findings have not been directly compared to those of more established and less complex procedures, such as Sleeve Gastrectomy (SG), which remains the most commonly performed technique in Metabolic and Bariatric Surgery (MBS). Objective: This study aimed to assess and contrast the intraoperative and postoperative outcomes between patients who underwent SADI-S and those who underwent SG. Methods: A systematic review and meta-analysis were performed and registered under PROSPERO with the ID CRD42024532504. A comprehensive search strategy was executed on 15 April 2024, covering PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Science Direct from the first reports to March 2024. The search strategy incorporated relevant keywords, including: “SADI-S” OR “Single Anastomosis Duodenal-Ileal bypass” and “Sleeve Gastrectomy”. We included studies comparing adult patients (≥18 years old) undergoing SADI-S and SG, reporting at least one clinical outcome of interest. Results: Five studies published between 2019 and 2023, comprising 3593 patients, were included. Of these, 461 patients (12.8%) underwent SADI-S, while 3132 (87.2%) underwent SG. The mean patient age was 42.96 years, with 89.6% female participants. Patients undergoing SADI-S had a significantly higher Body Mass Index (BMI) than those undergoing SG (Mean: 49.73 ± 8.10 vs. 45.64 ± 7.84; Mean Difference [MD]: 3.83, 95% CI: 0.52–7.14; p = 0.02) and an increased risk of hypertension (OR: 1.38, 95% CI: 1.04–1.84; p = 0.03). SADI-S also resulted in longer operative times (125.63 ± 51.91 min vs. 49.67 ± 26.07 min; MD: 65.97 min, 95% CI: 61.71–70.25; p < 0.001) and length of hospital stay (2.30 ± 2.76 days vs. 1.21 ± 0.81 days; MD: 1.03 days, 95% CI: 0.70–1.37; p < 0.001). Moreover, patients who underwent SADI-S demonstrated a significantly higher risk of postoperative complications, such as readmissions and reinterventions (OR: 3.17, 95% CI: 2.15–4.67; p < 0.001), and experienced greater excess weight loss (MD: 12.42%, 95% CI: 0.92–23.92; p = 0.03). No significant differences were observed between the groups regarding age, sex, or the prevalence of obstructive sleep apnea (OSA). Conclusions: SADI-S appears to be a promising surgical technique for facilitating substantial weight loss in individuals with severe obesity. Given the higher risk of postoperative complications associated with SADI-S, careful evaluation and personalized decision-making for patient selection and education are essential to optimize clinical and safety outcomes.

Introduction: The Competency-Based Assessment of Robotic Surgery Skills (CARS) scale was developed as a novel approach to assess robotic surgery (RS) skills through 10 relevant RS competencies. CARS 2.0 aimed to expand on the findings of CARS by conducting a global survey study in which participants graded a blinded, edited surgical video with the CARS scale for 7 competencies measurable via video. Methods: CARS 2.0 is being conducted globally, including participants across medical specialties and training stages, from medical students to attending/consultant surgeons. Participants evaluated a blinded, edited surgical video using the CARS scale via an anonymous Google form, focusing on 7 video-measurable competencies. Results: A total of 320 responses were collected over 3 months, including 125 (39.06%) attending/consultant surgeons, 98 (30.6%) surgical specialty postgraduate trainees, 96 (30%) medical students, and 1 pre-medical student. ANOVA (analysis of variance) analysis showed that the operator scores increased with the evaluators’ level of experience, reaching statistical significance across all 7 competency categories. Spearman’s correlation indicated moderate associations between participants’ surgical experience and proficiency (ρ = 0.314, P < 0.001), as well as between their comfort with the CARS scale and proficiency (ρ = 0.337, P < 0.001). Regression analysis demonstrated that robotic stapler use and camera handling were predictors of higher CARS scores based on participants’ experience. Conclusion: CARS represents a first step toward establishing competency-based assessment of RS performance independent of specific surgical procedures. Its integration into surgical training programs can facilitate trainees’ attainment of RS competency. Longitudinal studies could further validate its effectiveness at improving surgical training with its implementation into training curricula.