Background and Objectives: Gallstone ileus (GI) is a rare mechanical intestinal obstruction resulting from gallstone impaction through a bilioenteric fistula, accounting for 1–4% of mechanical intestinal obstructions. This study aimed to evaluate the clinical approach, surgical management, and outcomes in a cohort of surgically treated GI patients. Materials and Methods: A retrospective cohort analysis of 12 patients diagnosed with GI and treated surgically between January 2018 and December 2024 was conducted. Data collected included demographics, clinical presentation, imaging findings, surgical approach, and postoperative outcomes. Descriptive statistics were used due to small sample size. Results: All patients presented with abdominal pain and vomiting, with delayed admission (mean 3.83 ± 2.08 days). Rigler’s triad was identified on CT in 91.7% of cases. The distal ileum (66.7%) was the most common site of obstruction, with a mean stone size of 3.19 ± 0.6 cm. Surgical management included enterolithotomy alone (66.7%, n = 8) and one-stage procedures (33.3%, n = 4). Laparoscopic approaches were employed successfully in 41.7% of cases (n = 5) without the need for conversion. Postoperative complications occurred in 41.7% of patients, with 8.3% mortality (n = 1). One recurrence was observed during a median (IQR) follow-up period of 33.00 (7.00–66.00) months. Conclusions: GI management should be individualized based on patient risk factors. In our cohort, enterolithotomy alone was the most common approach for high-risk elderly patients, while one-stage procedures were performed in stable patients with residual gallstones. Laparoscopic approaches were utilized in selected hemodynamically stable patients with appropriate surgical expertise. Our experience suggests that minimally invasive techniques can be successfully achieved in this traditionally challenging condition with careful patient selection.

Prognostic assessment of resected gastroesophageal junction (GEJ) adenocarcinoma relies primarily on American Joint Committee on Cancer (AJCC) tumor–

Background: Pilonidal sinus disease (PSD) is a chronic inflammatory condition predominantly affecting young adults. Minimally invasive techniques such as pit-picking have gained increasing popularity; however, recurrence rates remain a significant concern. Microwave ablation (MWA) has recently emerged as a novel adjunctive modality that may improve treatment durability through enhanced destruction of residual sinus epithelium. Materials and Methods: This retrospective multicenter comparative cohort study included 403 consecutive patients treated for PSD between January 2022 and January 2024. Among these, 200 patients underwent pit-picking combined with MWA (MWA group) and 203 underwent pit-picking alone (PP group). Recurrence was defined as any clinical reappearance of pit, abscess, or discharging sinus confirmed at follow-up. Primary outcome was disease recurrence; secondary outcomes included operative time, postoperative pain (VAS), complications, SSI, wound healing time, pain-free sitting, and return to work. Multivariable logistic regression and Kaplan–Meier analysis were performed. Results: MWA group demonstrated superior postoperative outcomes: shorter pain-free sitting (2 vs 4 days), healing time (11 vs 16 days), and return to work (3 vs 5 days). Overall complication rates were lower (4.5% vs 11.3%; OR 0.37, 95% CI 0.16–0.84; p=0.018). Recurrence rates were significantly reduced (5.5% vs 13.8%; OR 0.36, 95% CI 0.17–0.75; p=0.006). MWA treatment remained an independent predictor of reduced recurrence on multivariable analysis (adjusted OR 0.35, 95% CI 0.16–0.76; p=0.007). Conclusion: Pit-picking combined with microwave ablation is a safe and effective minimally invasive treatment strategy for PSD, significantly improving postoperative recovery, reducing morbidity, and lowering recurrence rates. Further prospective randomized studies with longer follow-up are warranted.

Background/Objectives: Although current guidelines (European Society of Gastrointestinal Endoscopy [ESGE] 2024, U.S. Multi-Society Task Force [USMSTF] 2020) recommend cold snare polypectomy (CSP) over cold forceps polypectomy (CFP) for small colorectal polyps, CFP remains widely used. Comparative economic data using real institutional pricing are scarce, limiting evidence for guideline-concordant resource allocation. We evaluated the healthcare economics and procedural outcomes of CSP versus CFP to assess their institutional resource implications. Methods: This prospective cohort study analyzed 153 consecutive patients (181 polyps ≤ 9 mm) at a single tertiary care center (June–October 2025). Technique allocation was based on endoscopist preference. The primary outcome was histopathologically confirmed complete resection; secondary outcomes were one-piece resection rate, procedure time, and cost outcomes based on institutional pricing. Firth penalized logistic regression, propensity score matching, and a neoplastic-restricted sensitivity analysis were performed. Results: Complete resection rates did not differ significantly (CSP 97.4% vs. CFP 94.2%, p = 0.29). CSP achieved higher one-piece resection rates (96.2% vs. 84.5%, p = 0.011) and shorter procedure time (median 3.2 vs. 5.1 min, p < 0.001). For 6–9 mm polyps, piecemeal resection was reduced with CSP (6.8% vs. 28.6%, p = 0.010). Despite higher device costs ($6 vs. $3), direct device-plus-labor cost was lower for CSP ($18.06 vs. $22.24, p < 0.001), with no statistically significant difference in complete resection. High-grade dysplasia was the only variable independently associated with incomplete resection. Findings were consistent in propensity score-matched (n = 61 pairs) and neoplastic-restricted (n = 134) analyses. Conclusions: By reducing direct device-plus-labor costs by 19% while improving one-piece resection, and remaining consistent across multivariable, propensity score-matched, and sensitivity analyses, these findings indicate that, within a cost-minimization framework, CSP is a cost-saving, guideline-concordant technique with no statistically significant difference in complete resection or observed adverse events.

Purpose: No consensus exists on the optimal method of appendiceal stump closure during laparoscopic appendectomy. This study aimed to compare the safety and clinical outcomes of three stump closure methods: loop, Hem-o-lok clip, andendostapler.Methods: Medical records of patients who underwent laparoscopic appendectomy for acute appendicitis between May 2023 and March 2025 at a single institution were retrospectively reviewed. Patients were grouped according to the stump closure method. Demographic data, operative parameters, histopathological findings, 30-day complications (Clavien-Dindo classification), and late complications were compared among the three groups.Results: A total of 368 patients were analyzed: loop (n=201), Hem-o-lok clip (n=100), and endostapler (n=67). The three groups were comparable in terms of demographics and comorbidities. The endostapler group had significantly larger appendix diameter on computed tomography and more intraoperative abscess findings (p

Background: Preoperative evaluation in bariatric surgery aims to minimize perioperative risks and identify comorbid abdominal pathologies that may influence surgical planning. The role of routine abdominal ultrasonography (USG) remains debatable. Methods: This retrospective study included 1119 consecutive candidates for bariatric surgery who underwent routine preoperative ultrasonography (USG) between January 2022 and October 2024. Patients were stratified by BMI and categorized according to USG findings as normal, incidental, requiring follow-up/concomitant procedures, or necessitating cancellation. Baseline characteristics, USG findings, surgical outcomes, and predictors of cancellation were analyzed using univariate, multivariate, and Firth’s penalized logistic regression analyses. Ultrasonographic findings were further stratified as clinically significant (requiring intervention) or non-clinically significant (not requiring intervention) to standardize interpretation. Results: Abnormal USG findings were present in 77.5% of patients, with hepatic steatosis (60.8% [n = 680]), hepatomegaly (21.5%), and gallstones (13.9%) being the most frequent. Higher BMI was significantly associated with hepatomegaly, steatosis, and gallstones (all p < 0.05), but not with surgical cancellation. Bariatric surgery was cancelled in 11 patients (1.0%) due to critical findings exclusively identified on USG, including large ovarian/uterine masses, choledochal cysts, and suspected malignancies. In multivariate and Firth-adjusted regression, large ovarian/uterine masses (adjusted OR 12.9, 95% CI 3.0–55.2, p = 0.001; Firth OR 11.4, 95% CI 2.5–51.4, p = 0.002) and choledochal cysts (Firth OR 29.7, 95% CI 1.8–489.5, p = 0.048) emerged as independent predictors of cancellation. Conclusions: Although the overall cancellation rate was low, the detection of critical USG findings in 1.0% of patients had major clinical implications, preventing inappropriate or unsafe surgery and enabling timely referral for specialist management. Routine preoperative ultrasonography thus offers a clinically meaningful safeguard in bariatric surgery, supporting its inclusion in preoperative assessment algorithms.