Evans, Lorna A

Background: Revisional bariatric surgery for recurrent weight gain is becoming more common, though it carries higher risks and may be less effective than primary bariatric surgery. This study compares clinical outcomes between primary and revisional duodenal switch (DS) in patients with a body mass index (BMI) > 55 kg/m2. Methods: A retrospective cohort study was conducted on 20 patients who underwent either primary or revisional duodenal switch (DS) surgeries, including biliopancreatic diversion with duodenal switch (BPDDS) and Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-s), between January 2015 and December 2023. Revisional DS was defined as the conversion from Sleeve Gastrectomy (SG) to either BPDDS (C-BPDDS) or SADI-S (C-SADI-S). Perioperative and postoperative variables were analyzed. A statistical analysis was performed using chi-square and McNemar tests for categorical variables and Student’s t-test for continuous variables. A p-value of <0.05 was considered significant. Results: Eleven primary DS patients (six BPDDS, five SADI-s) and nine revisional DS patients (five C-BPDDS, four C-SADI-s) were included. The revisional group had a slightly higher preoperative BMI (57.56 ± 5.92 kg/m2 vs. 55.93 kg/m2 ± 6.91 kg/m2). Although operative times were shorter in the revisional group (153.20 ± 53.26 vs. 193.27 ± 46.79 min), the length of stay was longer (2.70 ± 1.25 vs. 2.18 ± 1.16 days). Primary DS patients experienced three minor late complications (dehydration, nephrolithiasis), whereas the revisional group had one major complication (internal hernia requiring reoperation). At the 12-month follow-up, both groups demonstrated similar outcomes in terms of percentage of total weight loss (%TWL) (primary DS: 25.25% ± 12.38 vs. revisional DS: 30.31% ± 10.79) and percentage of excess weight loss (%EWL) (primary DS: 48.41% ± 22.93 vs. revisional DS: 53.24% ± 14.48). Conclusions: Revisional DS was associated with shorter operation times and similar weight loss to primary DS. Additionally, it was accomplished safely and led to adequate and sustained weight loss in patients with a BMI greater than 55 kg/m2.

Abstract Squamous cell carcinoma (SCC) is the second most prevalent type of skin cancer after basal cell carcinoma, with the highest incidence occurring in sun-exposed regions of the body, particularly the head and neck. Approximately 300,000 new cases are diagnosed each year, imposing significant financial burdens on healthcare systems due to treatment costs and on the economy due to productivity losses. Surgery remains the primary treatment option; however, patients, particularly those with advanced-stage disease, may decline surgery due to concerns about functional and cosmetic outcomes. Other effective treatments include cryosurgery, radiotherapy, topical therapies, photodynamic therapy, and Mohs micrographic surgery. Recently, electrochemotherapy (ECT) has emerged as a novel treatment option. ECT involves administering bleomycin followed by electric pulses targeted at the tumor and surrounding margins, inducing transient cell membrane permeabilization. This enhances drug uptake and amplifies cytotoxic effects by over 1,000-fold. Since 2006, ECT has been a standard therapy in Europe and was introduced in Argentina in 2020, offering a new approach for patients who are unsuitable for or decline other treatments. In this study, we present outcomes from six patients with head and neck SCC treated with ECT on an outpatient basis. Most patients required only a single 60-minute treatment session. Observed side effects included grade 1-2 edema, pain, and flu-like symptoms per CTCAE 4.0. Tumor response was assessed using RECIST criteria, with results showing 71.4% complete response (5 of 7 lesions), 14.3% partial response (1 lesion), and 14.3% progressive disease, yielding an objective response rate of 85.7%.In conclusion, electrochemotherapy proved to be a safe and effective treatment for select head and neck SCC patients who are not candidates for surgery, providing a promising alternative in the therapeutic landscape. Citation Format: Felipe H. Maglietti, Sebastian D. Michinski, Lorna A. Evans, Raquel Lertora. Electrochemotherapy for the treatment of head and neck squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4707.

Revisional metabolic and bariatric surgery (RMBS) presents unique challenges in addressing weight loss failure or complications arising from initial bariatric procedures. This review aims to explore the complexities and solutions associated with revisional bariatric procedures comprehensively, offering insights into the evolving terrain of metabolic and bariatric surgery. A literature review is conducted to identify pertinent studies and expert opinions regarding RMBS. Methodological approaches, patient selection criteria, surgical techniques, preoperative assessments, and postoperative management strategies are synthesized to provide a comprehensive overview of current practices and advancements in the field, including institutional protocols. This review synthesizes key findings regarding the challenges encountered in RMBS, including the underlying causes of primary procedure failure, anatomical complexities, technical considerations, and assessments of surgical outcomes. Additionally, patient outcomes, complication rates, and long-term success are presented, along with institutional approaches to patient assessment and procedure selection. This review provides valuable insights for clinicians grappling with the complexities of RMBS. A comprehensive understanding of patient selection, surgical techniques, preoperative management, and postoperative care is crucial for enhancing outcomes and ensuring patient satisfaction in the field of metabolic bariatric surgery.

Liver transplant surgery is a complex procedure that demands high knowledge of surgical anatomy and the precise recognition and preservation of structures. To address this, the use of fluorescence imaging has facilitated the identification of anatomical structures such as biliary ducts, arteries, and liver segmentation. Indocyanine green is among the most commonly utilized fluorescent agents, not just during surgery but also in the pre- and postoperative phases, where it is used to assess graft failure by measuring the plasma disappearance rate. New advancements such as artificial intelligence paired with fluorescence imaging have the potential to enhance patient outcomes. Additionally, technologies such as augmented reality and mixed reality could be integrated into surgical procedures, broadening the scope of possibilities for improving patient safety.