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Background To address the issue whether three-dimensional (3D) offers real operative time advantages to the laparoscopic surgical procedure, we have designed a single-surgeon prospective randomized comparison of 3D versus two-dimensional (2D) imaging during two different bariatric procedures. Methods Forty morbidly obese patients were randomized on the day of surgery by a random computer-generated allocation list to receive either a 3D high-definition (HD) display or 2D HD imaging system laparoscopic bariatric procedure by a single experienced surgeon. Forty operations were performed with either a 3D HD display or 2D HD imaging system. After the insertion of the access ports, both surgical procedures were divided in component tasks, and the execution times were compared. Results The execution times for the entire procedure and the single tasks were not significantly different between the 2D and 3D groups during sleeve gastrectomy. The execution times for the entire procedure and the single tasks, except for the first one, were significantly different between the 2D and 3D groups during mini-gastric bypass ( p  < 0.05). The surgeon experienced better depth perception with the 3D system and subjectively reported less strain using 3D vision system rather than the 2D system particularly during longer procedure. Conclusions 3D imaging seems to decrease the performance time of more difficult bariatric procedures, which involve surgical tasks as suturing and intestinal measurement. Further comparative studies are necessary to address the issue if novice surgeons could benefit from reduced learning curve requested with 3D vision and to verify with greater numbers if 3D imaging can reduce complications.

BackgroundThe value of the routine histopathologic examination of resected gastric remnants following laparoscopic sleeve gastrectomy (LSG) remains to be controversial. This study aimed to determine whether the routine histopathologic examination of gastric specimens is necessary for all patients undergoing LSG if upper gastrointestinal endoscopy (UGIE) plus multiple biopsies are performed routinely during the preoperative work-up.Materials and MethodsClinicopathologic data of 474 patients who underwent LSG were analysed. Types of histopathologic findings in LSG specimens and the prevalence of these and Helicobacter pylori (HP) infection were estimated. Comparisons were conducted to assess the association of risk factors with the most frequent abnormal and premalignant histopathologic findings.ResultsChronic gastritis was the most common gastric pathology (63.5%) and premalignant lesions were present in 7.8% of the specimens. The prevalence of HP infection was 36.9%. A statistically significant association was observed between HP infection and chronic gastritis (P = .000), and premalignant lesions (P = .000). Similarly, a statistically significant association was noted between age and premalignant gastric lesions (P = .000).ConclusionHistopathologic examination of LSG specimens may not be routinely needed and can be performed on selected patients. While we recommend routine preoperative UGIE in all LSG-treated patients, we suggest that histopathologic assessment of the LSG specimens should be mandatory when UGIE biopsies demonstrate HP infection and/or premalignant lesions, in all patients older than 42 years, and in cases of intraoperative detection of incidental tumours or suspicious lesions.

Background Efficacy and safety of OAGB/MGB (one anastomosis/mini gastric bypass) have been well documented both as primary and as revisional procedures. However, even after OAGB/MGB, revisional surgery is unavoidable in patients with surgical complications or insufficient weight loss. Methods A questionnaire asking for the total number and demographics of primary and revisional OAGB/MGBs performed between January 2006 and July 2020 was e-mailed to all S.I.C. OB centres of excellence (annual caseload > 100; 5-year follow-up > 50%). Each bariatric centre was asked to provide gender, age, preoperative body mass index (BMI) and obesity-related comorbidities, previous history of abdominal or bariatric surgery, indication for surgical revision of OAGB/MGB, type of revisional procedure, pre- and post-revisional BMI, peri- and post-operative complications, last follow-up (FU). Results Twenty-three bariatric centres (54.8%) responded to our survey reporting a total number of 8676 primary OAGB/MGBS and a follow-up of 62.42 ± 52.22 months. A total of 181 (2.08%) patients underwent revisional surgery: 82 (0.94%) were suffering from intractable DGER (duodeno-gastric-esophageal reflux), 42 (0.48%) were reoperated for weight regain, 16 (0.18%) had excessive weight loss and malnutrition, 12 (0.13%) had a marginal ulcer perforation, 10 (0.11%) had a gastro-gastric fistula, 20 (0.23%) had other causes of revision. Roux-en-Y gastric bypass (RYGB) was the most performed revisional procedure (109; 54%), followed by bilio-pancreatic limb elongation (19; 9.4%) and normal anatomy restoration (19; 9.4%). Conclusions Our findings demonstrate that there is acceptable revisional rate after OAGB/MGB and conversion to RYGB represents the most frequent choice. Graphical abstract

Background Since its first documentation, a novel coronavirus (SARS-CoV-2) infection has emerged worldwide, with the consequent declaration of a pandemic disease (COVID-19). Severe forms of acute respiratory failure can develop. In addition, SARS-CoV-2 may affect organs other than the lung, such as the liver, with frequent onset of late cholestasis. We here report the histological findings of a COVID-19 patient, affected by a tardive complication of acute ischemic and gangrenous cholecystitis with a perforated and relaxed gallbladder needing urgent surgery. Case presentation A 59-year-old Caucasian male, affected by acute respiratory failure secondary to SARS-CoV-2 infection was admitted to our intensive care unit (ICU). Due to the severity of the disease, invasive mechanical ventilation was instituted and SARS-CoV-2 treatment (azithromycin 250 mg once-daily and hydroxychloroquine 200 mg trice-daily) started. Enoxaparin 8000 IU twice-daily was also administered subcutaneously. At day 8 of ICU admission, the clinical condition improved and patient was extubated. At day 32, patient revealed abdominal pain without signs of peritonism at examination, with increased inflammatory and cholestasis indexes at blood tests. At a first abdominal CT scan, perihepatic effusion and a relaxed gallbladder with dense content were detected. The surgeon decided to wait and see the evolution of clinical conditions. The day after, conditions further worsened and a laparotomic cholecystectomy was performed. A relaxed and perforated ischemic gangrenous gallbladder, with a local tissue inflammation and perihepatic fluid, was intraoperatively met. The gallbladder and a sample of omentum, adherent to the gallbladder, were also sent for histological examination. Hematoxylin-eosin-stained slides display inflammatory infiltration and endoluminal obliteration of vessels, with wall breakthrough, hemorrhagic infarction, and nerve hypertrophy of the gallbladder. The mucosa of the gallbladder appears also atrophic. Omentum vessels also appear largely thrombosed. Immunohistochemistry demonstrates an endothelial overexpression of medium-size vessels (anti-CD31), while not in micro-vessels, with a remarkable activity of macrophages (anti-CD68) and T helper lymphocytes (anti-CD4) against gallbladder vessels. All these findings define a histological diagnosis of vasculitis of the gallbladder. Conclusions Ischemic gangrenous cholecystitis can be a tardive complication of COVID-19, and it is characterized by a dysregulated host inflammatory response and thrombosis of medium-size vessels.

Objectives: The Kono-S anastomosis is a bowel-sparing surgical technique developed to reduce postoperative recurrence in Crohn’s disease (CD). While its efficacy has been established in adults, data in pediatric populations remain scarce. This study aims to evaluate the safety, feasibility, and early outcomes of the Kono-S technique in children and adolescents with CD at a single tertiary referral center. Methods: A retrospective review was conducted of pediatric CD patients who underwent bowel resection with Kono-S anastomosis between January 2022 and March 2025. Data collected included patient demographics, surgical indications, intraoperative findings, postoperative complications, and follow-up, including endoscopic surveillance. Results: Eleven patients (median age 14.7 years; 63.6% female) underwent laparoscopic Kono-S anastomosis, primarily ileocolic. Indications included stricturing disease (n = 6), intra-abdominal abscesses (n = 3), or both (n = 2). No postoperative complications occurred. Median follow-up was 21 months. Follow-up endoscopy was performed in nine patients: eight had a Rutgeerts score of 0, and one had a score of 1. All patients began anti-TNF-alpha therapy within a median of 10.4 weeks post-surgery. Conclusions: This first Italian pediatric case series suggests that Kono-S anastomosis may be safe and feasible in CD, with low early endoscopic recurrence. Larger, multicenter studies with long-term follow-up are needed to validate these findings.

Background Increased expertise with minimally invasive liver surgery (MILS) could cause an unjustified extension of indications to resect liver benign disease (BD). The aim of this study was to evaluate the operative risk of MILS for BD and if implementation and diffusion of MILS have widened indications for BD resection. Methods A prospective study including centers with > 6 MILS for BD, enrolled in the I Go MILS registry from January 2015 to October 2016. Cysts fenestrations were excluded. Results Eight hundred eighteen MILS were performed in 15 centers. One hundred seventy-three of these (21.1%) were for BD: conversion rate was 6.9%, postoperative mortality and morbidity rates were 0 and 13.9%. During the same period, 3713 liver resections (open + MILS) were performed and 407 (11.0%) were for BD. A time-trend analysis showed that the total number of MILS and the number of MILS for malignant disease significantly increased, but this increasing trend was not documented for the number of MILS for BD, which remained stable during the study period of time. This trend was confirmed for the overall rate of resected BD (open + MILS) that remained stable. Discussion BD represents a valid indication for MILS. For BD, 21.1% of MILS was performed, rate significantly lower than that previously reported in Italy. Although an evident growth of the use of MILS was observed during the time period analysis in Italy, this trend did not correspond to an increased number of MILS for BD, and the overall rate of resected BD was comparable to that reported in previous large open series.

Purpose Body image is a multidimensional construct that encompasses perceptions about body size, emotions, and cognition about physical appearance. Obese identity is related to body image in the lifetime, and according to scientific literature body image dissatisfaction among obese patient persist after bariatric surgery. The objective of this review is to examine the body image changes in patients with obesity pre-and post-bariatric surgery. Methods We have carried out a systematic review of literature on PubMed. Initially, 169 publications have been identified, but in total, in compliance with inclusion and exclusion criteria, 15 studies have been analyzed. Results According to the examined literature, body image does not change after bariatric surgery. These patients will be difficult to adapt for a new body, because there is a persistent obese view of self. Furthermore, ex-obese patients are dissatisfied with the excessive skin after bariatric surgery. Excessive body weight, and negative self-image are replaced with dissatisfaction with excessive skin, and the factors associated with body image stability are still unknown. Conclusion Literature examination raises the issue of body image dissatisfaction, but does not explain why it varies so widely across bariatric patients. Obese identity is related to body image across the lifetime and is an important factor of post-surgical outcomes. Longitudinal studies based on ideal body image pre- and post- bariatric surgery and evidence-based controlled studies on psychotherapeutic treatment for body image dissatisfaction are strongly recommended. Psychotherapy could improve body image quality and wellbeing. Level I Evidence obtained from: systematic reviews of experimental studies.

Background: Obesity remains a major global health challenge, and a significant proportion of bariatric surgery patients continue to experience dysfunctional emotional eating and body image concerns after surgery. Neurofeedback training (NFT) has been investigated as a potential intervention for maladaptive eating behaviours, but evidence in post-bariatric populations is still limited. Methods: Thirty-six patients who underwent sleeve gastrectomy were included, divided into an NFT group (N = 18) and a control group (N = 18). Assessments were performed at baseline and after 10 NFT sessions, using the Eating Disorder Inventory (EDI) and the Body Uneasiness Test (BUT). The intervention aimed to enhance alpha and theta waves with real-time feedback. Results: Compared with the control group, the NFT group showed significant improvements; specifically, reductions were observed in EDI subscales such as Drive for Thinness (p = 0.023, d = 0.51), Bulimia (p = 0.008, d = 0.92), Body Dissatisfaction (p = 0.015, d = 0.52), Ineffectiveness (p = 0.002, d = 0.89), Perfectionism (p = 0.006, d = 0.70), Interpersonal Distrust (p = 0.008, d = 0.82), and Interoceptive Awareness (p = 0.001, d = 0.91). Significant reductions were also found in BUT subscales including Weight Phobia (p = 0.041, d = 0.84), Body Image Concern (p = 0.039, d = 0.90), Avoidance (p = 0.027, d = 0.83), Compulsive Self-Monitoring (p = 0.013, d = 0.83), and Depersonalisation (p = 0.033, d = 0.85). Conclusions: The data indicate that NFT may help reduce emotional eating and related psychological factors in post-bariatric patients in the short term. However, studies with larger samples and longer follow-ups are needed to confirm its effectiveness and assess its clinical applicability.

Hepatitis B virus (HBV) may integrate into the genome of infected cells and contribute to hepatocarcinogenesis. However, the role of HBV integration in hepatocellular carcinoma (HCC) development remains unclear. In this study, we apply a high-throughput HBV integration sequencing approach that allows sensitive identification of HBV integration sites and enumeration of integration clones. We identify 3339 HBV integration sites in paired tumour and non-tumour tissue samples from 7 patients with HCC. We detect 2107 clonally expanded integrations (1817 in tumour and 290 in non-tumour tissues), and a significant enrichment of clonal HBV integrations in mitochondrial DNA (mtDNA) preferentially occurring in the oxidative phosphorylation genes (OXPHOS) and D-loop region. We also find that HBV RNA sequences are imported into the mitochondria of hepatoma cells with the involvement of polynucleotide phosphorylase (PNPASE), and that HBV RNA might have a role in the process of HBV integration into mtDNA. Our results suggest a potential mechanism by which HBV integration may contribute to HCC development. Hepatitis B virus (HBV) integration events are profiled in liver tissues from hepatocellular carcinoma patients using a high-throughput HBV integration sequencing method and bioinformatics. HBV is often found to integrate in mitochondrial DNA.

Background: Obesity is associated with a reduced life expectancy of 5 to 20 years, depending on the severity of the condition and the presence of comorbidities. Beyond first- and second-line interventions such as lifestyle changes, pharmacotherapy, which includes appetite suppressants, drugs that reduce fat absorption or regulate neurohormonal pathways, and endoscopic procedures, bariatric surgery is currently considered one of the most effective long-term interventions for severe obesity. This exploratory study investigates the psychological functioning of bariatric surgery candidates in the preoperative phase, aiming to identify risk factors and potential predictors of response to surgery in an Italian sample. Methods: This is a retrospective, observational study with follow-up. Participants, evaluated between September 2021 and September 2022 at Messina University Hospital, were recontacted approximately one year after surgery for re-evaluation. Of the 97 initial patients, 33 agreed to complete online questionnaires for follow-up. Results: The baseline data showed no significant differences between men and women in psychological assessments. In the subgroup that completed the follow-up, significant changes were observed, including a reduction in BMI and an increase in the discomfort index (Body Uneasiness Test) post-surgery, with large effect sizes in both cases. However, despite these changes, the regression analysis revealed that preoperative BMI values were not directly related to postoperative body image difficulties. These findings suggest a limited psychological impact of bariatric surgery, emphasizing the need for tailored psychological interventions to address these issues. Conclusions: While the intervention confirmed its effectiveness in reducing BMI, improvements in psychological well-being were less pronounced. In particular, a significant increase in body image concerns (PSDI) emerged after surgery, suggesting the need to address body-related distress in post-surgical care. These findings may suggest multidisciplinary approaches that integrate physical and psychological interventions may be needed to maximise long-term benefits. Further research should explore strategies to enhance patient awareness of treatment options, body image issues, and potential complications. These results should be interpreted with caution considering the limitations associated with this study such as a small sample size, lack of a control group, and the use of self-report and online methods to gather data, among others.