We performed a systematic review of epidemiological, diagnostic, and therapeutic outcomes of esophageal perforations. A systematic review was performed in PubMed database using the key-phrase ‘esophageal perforation’. All studies regarding acute esophageal perforations were reviewed and parameters of epidemiology, diagnosis, and management published in the literature from 2005 up to 2015 were included in the study. Studies of postoperative esophageal leaks were excluded. Two researchers performed individually the research, while quality assessment was performed according to GRADE classification. Main outcomes and exposure were overall mortality, perforation-to-admission interval, anatomical position, cause, prevalent symptom at admission, diagnostic tests used, type of initial management (conservative or surgery), healing rate, and fistula complication. There were 1319 articles retrieved, of which 52 studies including 2,830 cases finally met inclusion criteria. Mean duration of study period was 15.2 years. Mean patient age was 58.4 years. Out of 52 studies included, there were 43 studies of very low or low quality included. The overall mortality rate according to extracted data was 13.3% (n = 214, 1,644 patients, 39 studies). Admission before 24 hours was reported in 58.1% of patients (n = 514). Position was thoracic in 72.6% of patients (n = 813, 1,120 patients, 20 studies). Mean cause of perforation was iatrogenic in 46.5% of patients (n = 899, 1,933 patients, 40 studies). Initial management was conservative in 51.3% of cases (n = 904, 1,762 patients, 41 studies) CT confirmed diagnosis in 38.7% of overall cases in which it was used as imaging diagnostic procedure (n = 266), X-ray in 36.6% (n = 231), and endoscopy in 37.4% (n = 343). Sepsis on admission was observed in 23.3% of cases (209 out of 898 patients, 16 studies). The present systematic review highlighted the significant proportion of cases diagnosed with delay over 24 hours, mortality rates ranging over 10% and no consensus regarding optimal therapeutic approach and optimal diagnostic management. As esophageal perforation represents a high-risk clinical condition without consensus regarding optimal management, there should be large multicenter prospective studies or Randomized Controlled Trial (RCT)s performed in order to advance diagnostic and therapeutic approach of such challenging pathology.

Obesity poses a significant challenge to societies and healthcare systems worldwide. Metabolic bariatric surgery (MBS) has emerged as a proven primary intervention for severe obesity. This cross-sectional study investigated the interplay between sociodemographic and psychological factors and their influence on attitudes toward eating and body mass index (BMI) among candidates undergoing MBS. Recruitment took place over a period of more than five years. Sociodemographic and BMI data were collected, and psychological evaluations were conducted using standardized self-report questionnaires and clinical interviews. Data were analysed using Pearson and Spearman correlations, multiple linear regression, and bootstrapped mediation analysis. After exclusion of those who did not meet surgical suitability criteria, declined participation, or had incomplete data, the study included 515 participants. Significant associations were found between lower educational attainment, unmarried status, and higher BMI. High neuroticism was linked to increased BMI, depression, and anxiety. Resilience was moderately negatively correlated with anxiety and depressive symptoms and showed a small but statistically significant indirect (partial mediating) effect on the relationship between neuroticism and anxiety or depressive symptoms, although its small magnitude and the cross-sectional design preclude causal interpretation. The findings demonstrate that several variables play substantial roles in eating attitudes and influence BMI in this population. Notably, resilience emerges as a significant psychological factor. However, further research is warranted to fully elucidate its role and impact. These insights provide valuable guidance for refining preoperative assessments.

Background: This study examined demographic, anthropometric, and psychological factors associated with health-related quality of life (HRQoL) among Greek candidates for bariatric surgery. Methods: A total of 524 candidates for bariatric surgery (mean age = 41.49 years, SD = 11.18) were recruited from the Interbalkan Medical Centre of Thessaloniki between May 2019 and November 2024. Participants completed standardized measures assessing depressive symptoms, anxiety, disordered eating attitudes, psychological resilience, personality traits, and HRQoL. Eight theory-informed multiple linear regression models were fitted to examine cross-sectional associations with the SF-36 domains, adjusting simultaneously for 12 demographic, anthropometric, and psychological covariates. Heteroscedasticity-consistent (HC3) standard errors and false discovery rate (FDR) correction were applied. Results: Depressive symptoms were negatively associated with all eight SF-36 domains after multivariable adjustment and FDR correction. Higher BMI was associated with poorer scores across all four physical HRQoL domains, as well as Social Functioning and Vitality, while older age was negatively associated with all four physical domains. Anxiety symptoms were independently associated only with Mental Health. Psychological resilience was positively associated with General Health Perceptions and Vitality, whereas higher Neuroticism and Extraversion were associated with poorer and better mental and psychosocial HRQoL, respectively. Adjusted R² values ranged from 0.245 to 0.548 across the eight SF-36 domains. Discussion: Depressive symptoms emerged as the most consistent correlate of HRQoL among Greek candidates for bariatric surgery, whereas BMI, age, resilience, anxiety, and personality traits demonstrated more domain-specific associations. These findings highlight the relevance of comprehensive preoperative assessment addressing both physical and psychological functioning. Conclusions: Longitudinal studies are needed to clarify temporal relationships and determine whether these characteristics are associated with postoperative HRQoL outcomes.