Background: Acute pain after video-assisted thoracoscopic surgery (VATS) promotes respiratory splinting, impaired cough, and pulmonary complications, and predicts persistent opioid use. Surgeon-administered intercostal nerve block (ICNB) is a simple regional technique, but its independent effect on early pain and opioid requirement in a contemporary uniportal VATS (UVATS) pathway is incompletely defined. Methods: We performed a retrospective cohort study of 456 consecutive patients undergoing UVATS at a single Israeli center between 2017 and 30 May 2025. Patients receiving an intercostal block were compared with those who did not. Baseline covariates were balanced by 1:1 nearest-neighbor propensity-score matching (caliper 0.2 SD of the logit propensity score). The primary endpoints were pain on postoperative day (POD) 1 (visual analog scale, VAS) and postoperative opioid use; secondary endpoints included later pain, analgesic regimen, postoperative pneumonia, and mortality. Results: Matching yielded 159 patients per group (n = 318) with all clinically relevant covariates balanced (standardized mean difference [SMD] < 0.13). Median POD1 VAS was lower with the block (4 [IQR 3–4] vs. 5 [5–7]; p < 0.001), and 76.1% of block patients were opioid-free versus 10.7% who were not (p < 0.001). The effect was concentrated early and attenuated by POD3. In multivariable analysis the block was independently associated with lower POD1 VAS (adjusted β = −1.64, 95% CI −2.00 to −1.29; p < 0.001). Postoperative pneumonia was less frequent in the block group (5.7% vs. 20.1%; p < 0.001). Thirty-day and one-year mortality did not differ significantly. Conclusions: In UVATS, a surgeon-placed intercostal nerve block was associated with lower early postoperative pain that persisted after adjustment for operating surgeon and surgical era, concordant with pooled meta-analytic estimates; associated reductions in opioid use and pneumonia were confounded with surgeon and secular trend and are hypothesis-generating. These single-center, retrospective findings require prospective, protocol-randomized confirmation.

Background: The right renal vein is about half the length of the right renal artery and is shortened further by endovascular stapling at laparoscopic donor nephrectomy. Right-sided living-donor grafts carry roughly twice the adjusted risk of delayed graft function and of early graft loss, a penalty absent from deceased donation, where the inferior vena cava accompanies the graft. The deficit is one of venous length, not of the organ; extension is the remedy, and no guideline specifies how the conduit should be obtained. Methods and cases: Three consecutive recipients of right living-donor kidneys had the renal vein extended with a deceased-donor iliac vein. Conduits were recovered at multiorgan retrieval from ABO-identical or ABO-compatible donors, immersed in University of Wisconsin solution at 4 °C, and used within seven days; elective right donor nephrectomy was booked to follow a suitable retrieval within that window. Extension was an end-to-end back-table anastomosis with continuous 5-0 or 6-0 polypropylene, converting a short-vein implantation into a routine end-to-side anastomosis to the external iliac vein. All three grafts functioned immediately, without venous thrombosis, technical graft loss, or delayed graft function; the last serum creatinine was 0.91, 1.22, and 1.42 mg/dL. Conclusions. A calibre- and ABO-matched deceased-donor iliac vein, held in University of Wisconsin solution at 4 °C and used within seven days, makes venous extension a scheduled step of an elective right living-donor operation and requires no cryopreservation infrastructure. Where a donor’s safety mandates right nephrectomy, a short right renal vein need not preclude donation. Three cases establish feasibility; the low thrombotic risk of venous extension rests on published series rather than on this report.

Background and Objectives: Anastomotic leak after left-sided colectomy has not declined despite refinements in technique and patient selection, prompting interest in whether local reinforcement might influence the clinical course of leaks that occur rather than their occurrence. We describe the feasibility and safety of Hemopatch serosal reinforcement of stapled colocolic anastomoses in elective left colectomy, and the distribution of leak grades observed under two reinforcement practices in routine use. Materials and Methods: A retrospective single-centre cohort of consecutive elective left colectomies was observed (January 2013–December 2024). Reinforcement technique followed the operating surgeon’s routine practice and was therefore completely confounded with surgeon and department; the study was not designed to isolate a device effect, and no causal or comparative-effectiveness inference is drawn. Leaks were graded by the ISREC classification. Balance was quantified with standardised mean differences (SMD) and proportions with exact 95% confidence intervals; a penalised (Firth) logistic model is reported as exploratory. Results: Ninety-four patients were analysed (28 Hemopatch, 66 s-line suture). Reinforcement was applied as intended in all 28 Hemopatch cases (100%, 95% CI 87.7–100). The Hemopatch group was older (median 76.5 vs. 68 years; SMD 0.89), with further imbalance in both directions. Anastomotic leak occurred in 14.3% (95% CI 4.0–32.7) versus 13.6% (6.4–24.3); the exploratory model was uninformative (OR 1.20, 95% CI 0.32–4.48). Leak grades were distributed differently, with no Hemopatch leak requiring reoperation (0%, 95% CI 0–12.3) versus four (6.1%, 1.7–14.8) and radiologically detected leaks more frequent with Hemopatch; all intervals overlapped substantially. Length of stay (median 9 vs. 6.5 days), readmission (35.7% vs. 11.3%) and two reoperative small-bowel obstructions occurred in the Hemopatch group. Conclusions: Hemopatch serosal reinforcement was technically feasible. Leak occurrence was similar between practices; leak grades differed in distribution, with reoperation for leak absent in the Hemopatch group. As reinforcement was confounded with surgeon and department, these differences describe two practices rather than a device effect. Longer stay and higher readmission require prospective safety capture; two adhesive obstructions occurred in the Hemopatch group, with operative findings in both remote from the reinforcement site. Prospective cluster-adjusted evaluation is required before any efficacy claim.

Background/Objectives: Pediatric spontaneous or non-traumatic extrahepatic bile duct perforation (SBDP) is a rare cause of bile ascites and biliary peritonitis. We aimed to characterize presentation, diagnosis, management, outcomes, and summarize practical management considerations. Methods: A systematic review was performed in accordance with PRISMA 2020, we searched PubMed/MEDLINE, EMBASE, and Google Scholar from inception to February 2026, and completed backward citation tracking in June 2026. We included pediatric SBDP cases and excluded traumatic, iatrogenic, isolated gallbladder, and perforated choledochal cyst cases. Case-level data were extracted when available, and exploratory subgroup analyses were performed by age and management approach. Results: A total of 139 studies reported 208 cases; with one institutional case, final cohort of 209 patients. Median age was 3.0 months (IQR, 1.15–15.0; n = 174), and 70.5% of patients were ≤1 year old (124/176). Bilious ascites or bile-stained fluid was confirmed in 95.2%. The cystic duct–CHD/CBD junction was the most frequently reported site (82/180, 45.5%), and biliary anomalies were reported in 39.7% (83/209). A step-up initial management was used in 60.3% and immediate surgery in 38.8%. Reported survival was 97.0% (197/203), although publication bias limits interpretation. Clinical complications and reinterventions were reported in 75/198 (37.9%) and 66/209 (31.6%), respectively. Conclusions: Pediatric SBDP is age-dependent and anatomy-driven; infants more often presented with cholestatic-ascitic features, whereas older children more often had acute-abdominal features. Bilious ascites is an important diagnostic clue. Management should prioritize stabilization and source control, followed by anatomical definition and selective reconstruction.

Background: Kartagener syndrome (KS) is a rare subset of primary ciliary dyskinesia characterized by the triad of situs viscerum inversus (SVI), chronic sinusitis, and bronchiectasis. Laparoscopic cholecystectomy (LC) in patients with SVI is technically demanding because of mirror-image anatomy, while evidence supporting the use of indocyanine green (ICG) fluorescence in this setting is scarce. Case Presentation: We report the case of a 25-year-old woman with KS and SVI totalis who underwent elective LC for symptomatic cholelithiasis. The procedure was performed using a mirror American approach with four trocars and near-infrared ICG fluorescence cholangiography. ICG enabled real-time visualization of biliary anatomy and facilitated intraoperative orientation. The procedure was completed laparoscopically without intraoperative or postoperative complications, and the postoperative course was uneventful. Methods: A non-systematic narrative review of the literature was conducted to identify reported cases of LC in patients with SVI, including cases associated with KS. Studies published between 1991 and 2025 were retrieved from PubMed, Web of Science, Scopus, and Embase. Data were descriptively summarized, focusing on surgical technique, trocar placement, and reported use of ICG fluorescence. Results: A total of 143 articles were included. Most cases involved isolated SVI, while KS was reported only in a minority of patients. The mirror American technique and four-trocar configuration were the most frequently adopted approaches. Only three cases, including the present report, described the use of ICG fluorescence during LC in patients with SVI or KS. Conclusions: LC in patients with SVI is feasible but technically demanding. ICG fluorescence may assist intraoperative biliary orientation in complex anatomical settings; however, current evidence is extremely limited and should be considered hypothesis-generating only.

Background/Objectives: Obesity can delay kidney-transplant listing, and metabolic and bariatric surgery (MBS) may help address this barrier, but its role, timing, and procedure choice are not established for every candidate. We evaluated transplant-access outcomes, failed pathways, bariatric safety, procedure-specific considerations, and evidence relevant to pretransplant referral. Methods: PubMed/MEDLINE, Embase, and Google Scholar were searched through 6 August 2026. The review and protocol were prospectively registered in PROSPERO. Reports were mapped to access/pathway, bariatric-safety, post-transplant, and procedure/timing/pharmacokinetic/enteric-oxalate domains. Cumulative transplantation proportions were synthesized as an exploratory outcome using a restricted maximum likelihood random-effects model with Hartung–Knapp confidence intervals. Results: Forty-seven reports from 30 source clusters were included. Across 10 independent bridge cohorts (180/531 transplants), the pooled proportion over heterogeneous study-specific follow-up was 39.6% (95% CI, 28.2–52.3%; I² = 77.4%), with a 95% prediction interval of 12.9–74.4%. This pooled estimate was descriptive and non-comparative. Adjusted observational estimates favored MBS for waitlisting, active listing, or kidney transplantation but were not pooled because their estimands and pathway structures differed. The two randomized trials had some concerns and high risk of bias, respectively, and all 23 nonrandomized comparative results were at serious or critical risk of bias. No validated treatment-effect modifier or referral prediction model was identified. Conclusions: MBS may facilitate transplant access when obesity is a principal reversible barrier. However, very-low-certainty evidence establishes neither a causal effect of MBS on transplant access nor referral criteria, an individual transplantation probability, optimal timing, or superiority of sleeve gastrectomy over gastric bypass. Referral and procedure choice should remain individualized and multidisciplinary.