Thiyagarajan, Sibi Krishna

Abstract Purpose This study aims to evaluate whether diode laser-assisted deroofing, integrated into Minimally Invasive Techniques for Hidradenitis Suppurativa (MITHS), can accelerate wound healing, reduce recurrence, and improve symptom resolution compared to conventional surgical approaches. Does diode laser therapy as part of MITHS enhance clinical outcomes in HS patients versus traditional surgical methods? Methods We conducted a retrospective single center, single surgeon study between January 2022 and January 2024 involving 55 HS patients (Hurley stages 2–3) who underwent MITHS with a 1470 nm diode laser ablation after excisional tunneling debridement with an ultrasonic instrument. Hidradenitis tracts were ablated intraoperatively using the lasers. Outcomes were assessed based on symptom resolution: full, partial, or unresolved which was self reported. Patient demographics, prior treatment history, lesion location, and adverse effects were also recorded. Results Among 55 patients, 62 MITHS procedures were performed. Initially, 60% (n = 27) achieved complete resolution and 40% (n = 18) partial resolution. After subsequent treatments, 58% (n = 36) were complete and 29% (n = 18) partial; 13% (n = 8) were lost to follow-up. No symptom worsening occurred. Adverse effects were minimal and transient, including two reversible upper extremity nerve palsies. All procedures were well-tolerated under local anesthesia. Conclusion Diode laser therapy as an adjunct to MITHS shows high efficacy, minimal morbidity, and rapid recovery, offering a less invasive alternative for HS management. It may achieve remission or cure in moderate-to-severe cases and addresses unmet therapeutic needs. Further prospective studies are needed to validate and optimize its role in multidisciplinary care.

Background: Surgical resection (SR) and liver transplantation (LT) are the main curative options for non-hepatocellular carcinoma (non-HCC) liver malignancies, including colorectal liver metastases (CRLMs), intrahepatic cholangiocarcinoma (iCCA), hilar cholangiocarcinoma (hCCA), and neuroendocrine tumor liver metastases (NETLMs). Resection aims for negative margins and adequate hepatic reserve, while LT offers treatment for unresectable disease but is limited by donor scarcity, immunosuppression, and ethical constraints. Methods: A targeted literature search (2005–2025) was conducted using PubMed and Google Scholar with predefined MeSH terms combining “liver resection,” “hepatectomy,” and “liver transplantation” across non-HCC malignancies. Relevant studies, reviews, and guidelines were included. Results: For CRLMs, SR remains standard with 5-year overall survival (OS) up to 58%, while LT offers 60–83% in highly selected unresectable cases. In iCCA, resection achieves median survival around 40 months, and LT yields OS up to 69% in very early or neoadjuvant-controlled disease. For hCCA, the Mayo protocol combining neoadjuvant therapy with LT provides 5-year OS of 65–80%. In NETLMs, LT achieves 63–97% OS under strict criteria. Conclusions: SR remains first-line for resectable non-HCC malignancies, while LT provides superior outcomes in unresectable yet biologically favorable disease, emphasizing careful selection and organ allocation.

Introduction Due to rising incidence of Hepato-Pancreato-Biliary (HPB) malignancies and more effective therapies, there are increased survivors after curative surgery but little emphasis is placed on survivorship. This study aims to evaluate the value and yield of postoperative surveillance of surgically treated HPB cancer patients within a single surgeon’s practice. Methods A retrospective 1-year (2024) review identified 128 unique patients with prior surgical resection of a HPB malignancy undergoing active cancer surveillance by the surgical team. We excluded patients with benign indications for surgery or active cancer surveillance outside of the surgical team. Results Of these, 112 (87.5%) and 16 (12.5%) underwent pancreatic and hepatobiliary resection, respectively. Median follow up was 1.5 years from the index operation (IQR: 0.7-2.8 years). Pancreatic pathology was pancreatic adenocarcinoma (PDAC), neuroendocrine, or miscellaneous in 70, 25, and 9 patients, respectively. Hepatobiliary pathology was cholangiocarcinoma (CCA), metastatic colorectal cancer, or hepatocellular carcinoma in 16, 6, and 2 patients, respectively. We identified 12 (9.3%) patients who had findings during the study time period resulting in a repeat HPB surgery. In addition, we identified 12 (9.3%) patients who required referral to another department for additional medical, surgical, or interventional treatments. The remaining 104 (81.2%) patients had findings of either no disease recurrence or stable disease with continued surveillance as a recommendation. Conclusion This study underscores the value of cancer surveillance for HPB cancer patients, demonstrating a yield of nearly 20% of patients with findings requiring repeat surgical intervention or referral to other departments.

Abstract Objective To evaluate 2-year cost to insured patients treated with Roux-en-Y gastric bypass (RYGB) or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for type 2 diabetes (T2D) and obesity. Methods Using the 2017 to 2023 Merative™ claims database, we identified adult patients with severe obesity and T2D who were treated with a RYGB or GLP-1 RAs. Patients with RYGB had no treatment with GLP-1 RAs, and those who received GLP-1 RA therapy with tirzepatide or semaglutide for ≥ 2 years had no metabolic and bariatric surgery (MBS) procedures. The study cohorts were matched on demographics including obesity, associated medical problems, and baseline direct or out-of-pocket (OOP) costs to patients in the year prior to treatment initiation. Direct costs included those from outpatient services, inpatient admissions, and outpatient prescription filled that were paid directly by patients. We compared this cost up to two years after treatment initiation using paired t-tests. Results 1012 matched RYGB and GLP-1 RA patients were analyzed, including 35% male. At 1-year after treatment initiation, healthcare costs paid directly by patients were similar for the RYGB ($2,301) and GLP-1 RA ($2,179) (delta = $122, p = 0.15) cohorts. From one to two years after index treatment date, OOP costs were significantly lower in the RYGB treatment group ($1,277 vs. $2,104, p < 0.01). Two years after treatment initiation, RYGB patients spent $704 less in OOP costs than similar patients treated with GLP-1 RA medications (p < 0.01). Conclusions Direct OOP healthcare costs were lower for RYGB compared to GLP-1 RA use patients 2-years after treatment initiation.

Introduction: An 83-year-old female was discovered to have an incidental circumferential duodenal adenoma by upper endoscopy after being evaluated for irritable bowel syndrome. Imaging revealed a dilated common bile duct and main pancreatic duct but no evidence of malignancy. Therefore, she was considered a candidate for surgical removal. Methods and Materials: Using robotic-assisted surgery, a 4 trocar approach was employed involving three 8-mm and one 12-mm robotic trocar apart. 1 A standard cholecystectomy followed by careful dissection of the duodenum from the pancreas head was performed. The ampulla was identified, and the duodenum was laterally retracted with transection of the identified ampulla with exposure of the pancreaticobiliary orifice. A two-layered duct to mucosa pancreaticobiliary anastomosis was established between the common bile, pancreatic duct, and the jejunum. A side-to-side stapled gastrojejunostomy was constructed and the operation concluded. 2 , 3 Results: Pathological analysis revealed a noninvasive polypoid lesion within the duodenum measuring 7.5 × 5.0 × 0.6 cm. The surgery was completed in 350 minutes with blood loss of 100 mL. There were no postop complications, and the patient was discharged on the fifth day. The patient had some gastric symptoms post discharge which subsided with time. Conclusions: This case highlights the feasibility and safety of robotic resection for an obstructing duodenal polyp in complex anatomical regions, demonstrating its clinical utility and relevance for the management of benign ampullary duodenal lesions. Patient Consent Statement: The patient who was operated upon issued consent for operative data to be used for publication, under Mayo Clinic, Jacksonville, signed consent forms. The author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Conflict of Interests: This article is not under consideration by any other journal, and all authors have approved the article. None of the authors have any competing financial interests. Runtime of video: 9 minutes and 33 seconds.

Background Whistal (Whipple + Distal) is a rare parenchyma-preserving technique for select patients with disease in both the pancreatic head and tail, sparing a disease-free middle segment. It may also be used after prior partial pancreatectomy. Surgical resection remains the cornerstone of treatment for pancreatic diseases such as PDAC, RCC metastasis, and multifocal IPMN. Whistal may balance oncologic control with pancreatic function preservation. Though infrequent, it is practiced and reported in literature. Methods With IRB approval, a retrospective review of a prospective database (Aug 1999-Mar 2024) identified Whistal cases, categorized as staged Whistal (SW) or concomitant whistal (CW). Perioperative outcomes were assessed via Clavien-Dindo and ISGPS. A PubMed search identified reported middle segment pancreatectomy (Whistal) cases. Results Of 2008 resections (Aug 1999-Mar 2024), 5 were Whistals (3 CW, 2 SW) for PDAC (n = 3), RCC (n = 1), IPMN (n = 1), and bile duct stricture (n = 1). Rates for major morbidity, POPF, and DGE were each 40%. Literature review found 26 papers reporting 52 additional Whistal cases. Conclusion Whistal is safe for select patients, but wider adoption and long-term data are needed to confirm its efficacy.

Background: Despite advances in surgical techniques and perioperative care, pancreatic resections such as pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) remain high-risk procedures. Postoperative complications significantly impact morbidity, mortality, and patient quality of life. Methods: This narrative review summarizes recent literature on major complications following pancreatic surgery, including postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), and post-pancreatectomy hemorrhage (PPH), with an emphasis on incidence, risk factors, outcomes, and current preventive strategies. Results: POPF is a leading complication, occurring in 5–22% of cases and often linked with sepsis and hemorrhage. Key risk factors include high BMI, soft pancreatic texture, and small duct size. Preventive measures like Pasireotide, modified anastomosis techniques, and neoadjuvant therapy show variable success. DGE affects up to 57% of PD patients and is associated with prolonged recovery; antecolic reconstruction and erythromycin may reduce incidence. PPH, though less frequent (3–13%), can be life-threatening, particularly when secondary to POPF. Endovascular approaches are now favored for late arterial bleeding. Other complications include wound infections, abscesses, bile leaks, and pulmonary issues, all contributing to extended hospital stays and diminished quality of life. Conclusions: Pancreatic surgery continues to carry significant risks, with POPF, DGE, and PPH being the most impactful complications. While multiple interventions have shown promise, standardized protocols and predictive tools are still needed. Surgery should be performed in high-volume centers with experienced multidisciplinary teams to optimize outcomes.