Timely recognition of intraoperative bleeding can support visualization and hemostatic response. This narrative review organizes representative systems by temporal purpose - anticipation, detection, and post-hoc assessment - while treating input sources separately. Video classifiers, object detectors, segmentation-assisted models, and synchronized device - video pipelines demonstrate distinct capabilities, but their reported metrics are not interchangeable. One device-associated detector achieved 81.0% sensitivity with 4.6% precision, corresponding to roughly eight false alerts per operation, whereas other studies evaluated event counts, duration, or warning lead time. We distinguish offline testing, streaming feasibility, and prospective intraoperative evaluation, and relate these evidence levels to event-level accuracy, alert burden, and response time. Current evidence remains limited by small datasets, uncertain transfer across procedures and institutions, workflow integration, and surgeon interaction. Future studies should test transferable contextual cues and determine prospectively whether alerts improve recognition or hemostatic response without excessive interruption.

Introduction: Anatomical gastrointestinal reconstruction following metabolic bariatric surgery (MBS) is a revisional procedure used for refractory complications, including malnutrition, intractable reflux, recurrent marginal ulcer disease, and post-bariatric hyperinsulinemic hypoglycemia (PBHH). Objective: This study aims to describe the indications, perioperative outcomes, and short-term results of laparoscopic anatomical reconstruction in a single-center series, focusing on patients with PBHH. Methods: We retrospectively reviewed 11 consecutive patients who underwent reconstruction following MBS at a single tertiary center. Perioperative outcomes, weight changes, and biochemical responses to standardized dual-modality (oral and intravenous) glucose suppression testing were analyzed. Results: Between 2018 and 2025, 11 patients completed laparoscopic anatomical reconstruction. The anatomy immediately preceding reconstruction was OAGB in nine patients (81.8%) and RYGB in two (18.2%). The indications overlapped; the most common were severe malnutrition (n = 9), marginal ulcer disease (n = 6), and PBHH (n = 4; three biochemically confirmed, one clinically diagnosed). Ten of eleven procedures (90.9%) were completed laparoscopically, with no 30-day Clavien–Dindo grade III–IV complications. Among the four PBHH patients, symptomatic resolution was achieved in all four, with residual asymptomatic biochemical hypoglycemia in one. Weight gain occurred in 10 of the 11 patients (mean 8.1 ± 4.9 kg) at a median follow-up of 7 months (IQR 3–12). Conclusions: In this preliminary series, laparoscopic anatomical reconstruction was feasible, though the small sample precludes conclusions regarding safety. Incretin hormones were not measured; the mechanistic contribution of restored foregut anatomy is inferred from prior literature rather than demonstrated here. Standardized dual-modality glucose suppression testing was central to patient selection and to documenting the biochemical response.