Beckermann, Jason

Background: Whether robot-assisted cholecystectomy reduces bile duct injury compared with laparoscopic cholecystectomy remains uncertain because prior studies have inadequately accounted for disease severity and have rarely classified injury severity using standardized criteria. This study compared perioperative outcomes after robot-assisted and laparoscopic cholecystectomy across a large healthcare system while adjusting for operative complexity. Study Design: Adults undergoing robot-assisted or laparoscopic cholecystectomy within the Mayo Clinic Enterprise (2014–2025) were retrospectively evaluated. Propensity score weighting adjusted for demographics, surgeon case volume, learning curve, and disease severity using the Tokyo Guidelines and Parkland grading system in patients with acute cholecystitis. The primary outcome was bile duct injury; secondary outcomes included general and procedure-specific complications. Results: Among 23,513 patients (19,998 laparoscopic; 3,515 robotic), robot-assisted cholecystectomy was used more frequently for Parkland grade ≥3 disease. Overall, 227 bile duct injuries occurred (204 laparoscopic; 23 robotic), corresponding to absolute risks of 1.02% and 0.65%, respectively (absolute risk difference −0.37%, 95% CI −0.72% to −0.02%; number needed to treat, 273). Robot-assisted cholecystectomy was associated with lower odds of conversion to open surgery, 30-day readmission, and mortality, shorter hospital stay (β −0.56, 95% CI −0.66 to −0.45; P<0.001), and a 5-minute longer median operative time. In acute cholecystitis, robot-assisted cholecystectomy was associated with lower adjusted odds of bile duct injury (aOR 0.29, 95% CI 0.07–0.78; P=0.011). Conclusions: After adjustment for disease severity and surgeon-related factors, robot-assisted cholecystectomy was associated with lower odds of bile duct injury in acute cholecystitis and improved perioperative outcomes, including shorter hospitalization and lower conversion rates, despite greater use in more complex cases.

Background This study aimed to evaluate outcomes of different antibiotic durations in patients with severe diverticulitis. Methods Initial electronic medical record review identified 2437 adult patients who underwent sigmoid colectomy. Manual chart review identified 133 patients who underwent sigmoid resection and proximal diversion for Hinchey stage 3 or 4 diverticulitis. Patients who received a short antibiotic course (SAC, ≤5 days) were compared with those who received a long antibiotic course (LAC, >5 days). The primary composite outcome included superficial, incisional, organ-space infections or death within 30 days post procedure. Results A total of 53 SAC patients and 55 LAC patients were identified. The composite outcome occurred more frequently in LAC patients than in SAC patients (40% vs 15%; P = .005). Organ-space infection occurred more frequently in LAC patients than in SAC patients (31% vs 13%; P = .04). Conclusions Extended duration of antibiotics after adequate source control does not improve outcomes even in the setting of extensive intra-abdominal contamination.

Abstract Foramen of Winslow hernia is a rare subtype of internal hernias, accounting for ⁓8% of all internal hernia cases. Its nonspecific clinical presentation often delays diagnosis, with ˂10% identified preoperatively. With advances in minimally invasive techniques, robotic-assisted surgery has emerged as a safe and precise method for managing complex intra-abdominal pathology. A 70-year-old male presented with an acute abdomen. He was hemodynamically stable, and computed tomography imaging suggested an internal hernia. Robotic-assisted abdominal exploration revealed a segment of colon herniated through the foramen of Winslow. The colon was carefully reduced without complications. A piece of omentum was placed into the defect, and the retracted gall bladder naturally positioned itself within the foramen, potentially minimizing the risk of recurrence. The patient recovered uneventfully and discharged on postoperative day one. To our knowledge, this is the first documented case of foramen of Winslow hernia repair using a robotic-assisted approach.

Abstract Rectus sheath hematoma is a rare condition caused by bleeding from the epigastric arteries, with an incidence of 1.2–1.5 cases per year. We present a 49-year-old male with a smoking history and recent corona virus disease 2019 (COVID-19) infection who presented with symptoms of an upper respiratory infection and suspected venous thromboembolism. Imaging revealed bilateral pulmonary emboli and a left rectus sheath hematoma, which was initially managed conservatively. However, the patient’s condition worsened with a significant drop in hemoglobin and development of encephalopathy. Imaging showed an enlarging hematoma, leading to transfusion and selective embolization. On day 8, the patient developed generalized abdominal pain, and imaging confirmed a hollow viscus perforation. An exploratory laparotomy revealed cecal perforation due to mass effect from the hematoma. An ileocecectomy was performed.

Abstract Bilateral ureteroinguinal hernia is a rare presentation with only five cases previously presented in the literature. We describe a 60-year-old male who was diagnosed with large bilateral hernias extending into the scrotum containing redundant ureters. Both hernias were repaired in staged fashion with retrograde temporary ureteral stent placement and modified Lichtenstein technique. Follow-up computerized tomography imaging with &gt;5 years follow-up revealed intact repairs with no evidence of urinary obstruction.