A prospective Vietnamese study evaluated the outcomes of 61 consecutive patients with gastroesophageal reflux disease (GERD) who failed to achieve adequate symptom control despite optimal medical therapy. All patients underwent laparoscopic Nissen fundoplication, with every procedure completed successfully using a minimally invasive approach.

The average operative time was approximately 102 minutes, and postoperative recovery was rapid. Only minor complications (Clavien–Dindo Grade I–II) were reported, with no mortality or major postoperative morbidity.

Key Findings

The study demonstrated significant and sustained improvement in reflux symptoms:

Mean GERD-Q score improved from 14.26 preoperatively to 7.00 at one month.
Scores further improved to 5.41 at final follow-up.
Approximately 84–90% of patients maintained good long-term symptom control.
Hospital stay was short with rapid return to normal activity.
Dysphagia was generally mild and transient.

Clinical Relevance

Despite the growing popularity of endoscopic reflux therapies, laparoscopic Nissen fundoplication remains the gold standard surgical treatment for carefully selected patients with medically refractory GERD. The study reinforces its excellent long-term efficacy, low complication rates, and durable symptom relief. These findings are valuable for patient counselling, quality assurance, and outcome auditing in minimally invasive foregut surgery.

Source: https://pubmed.ncbi.nlm.nih.gov/42494149/

POEM Review Highlights the Expanding Role of Endoscopic Myotomy in Esophageal Motility Disorders

A comprehensive review published in the Korean Journal of Gastroenterology summarizes the rapid evolution of Peroral Endoscopic Myotomy (POEM) from an innovative treatment for achalasia into a versatile third-space endoscopic platform capable of treating multiple esophageal motility disorders.

Current evidence demonstrates durable symptom relief comparable to laparoscopic Heller myotomy and pneumatic balloon dilatation for achalasia while allowing individualized extension of the myotomy based on disease phenotype.

Expanding Clinical Applications

The review discusses the growing role of POEM in treating:

Achalasia.
Esophagogastric junction outflow obstruction.
Distal esophageal spasm.
Hypercontractile (Jackhammer) esophagus.
Zenker's diverticulum (Z-POEM).
Diverticular POEM.

The authors also review evolving strategies to reduce postoperative gastroesophageal reflux following POEM, which remains one of the principal concerns after endoscopic myotomy.

Clinical Relevance

For laparoscopic foregut surgeons, POEM has become an important alternative within the therapeutic algorithm. Optimal patient care now requires multidisciplinary decision-making involving surgeons, gastroenterologists, endoscopists, and motility specialists. Individualized treatment should balance symptom relief, reflux risk, esophageal function, and long-term outcomes when choosing between POEM, laparoscopic Heller myotomy, and fundoplication.

Source: https://pubmed.ncbi.nlm.nih.gov/42494148/

EUS-Based Risk Stratification Recommended for Asymptomatic Upper GI Subepithelial Lesions

A review on upper gastrointestinal subepithelial lesions (SELs) emphasizes a structured diagnostic strategy centered on endoscopic ultrasound (EUS) rather than immediate surgical resection for incidentally detected asymptomatic lesions.

Most small SELs remain stable over time and do not require immediate intervention.

Diagnostic Approach

The review recommends:

Standard upper GI endoscopy as the initial evaluation.
EUS to determine:
- Size.
- Layer of origin.
- Echogenicity.
- Margins.
- High-risk imaging features.
Tissue diagnosis using:
- EUS-guided fine-needle biopsy.
- Mucosal incision-assisted biopsy when indicated.

Features suggesting the need for resection include:

Increase in lesion size.
Symptoms.
Ulceration or mucosal changes.
Suspicious EUS characteristics.
Larger tumour size.

The review also discusses advanced minimally invasive endoscopic techniques including:

Endoscopic Submucosal Dissection (ESD).
Submucosal Tunnelling Endoscopic Resection (STER).
Endoscopic Full-Thickness Resection (EFTR).

Clinical Relevance

For laparoscopic upper GI surgeons, careful risk stratification can prevent unnecessary surgery while identifying patients who may benefit from laparoscopic wedge resection, LECS (Laparoscopic Endoscopic Cooperative Surgery), or combined endoscopic-laparoscopic management of suspected gastrointestinal stromal tumours (GISTs).

Source: https://pubmed.ncbi.nlm.nih.gov/42494143/

Large-Diameter Plastic Biliary Stents May Be an Acceptable Option During Neoadjuvant Therapy for Pancreatic Cancer

A retrospective study compared plastic biliary stents with fully covered self-expandable metal stents (FCSEMS) in pancreatic cancer patients undergoing neoadjuvant chemotherapy before definitive surgical resection.

Major Findings

Among 47 patients:

Recurrent biliary obstruction occurred more frequently with plastic stents.
Metal stents demonstrated longer stent patency.
Non-obstructive adverse events, including pancreatitis-related complications, were somewhat more common with metal stents.
Overall complication rates were similar between both groups.
Plastic stents measuring 10 Fr or larger performed reasonably well in selected patients.

Clinical Relevance

Reliable biliary drainage is essential for patients receiving neoadjuvant therapy prior to pancreaticoduodenectomy. The study suggests that appropriately selected large-calibre plastic stents remain a practical option where metal stents are unavailable or cost considerations are important. Treatment decisions should be individualized through collaboration between HPB surgeons, endoscopists, oncologists, and interventional radiologists.

Source: https://pubmed.ncbi.nlm.nih.gov/42494150/

Imaging-Guided Minimally Invasive Surgery Demonstrates Excellent Outcomes in Angular Pregnancy

A retrospective Chinese study evaluated 22 cases of angular pregnancy managed using individualized minimally invasive strategies based on ultrasound findings and intraoperative assessment.

Surgical Strategy

Type I Angular Pregnancy

Hysteroscopic management under ultrasound guidance.
Median operative time: 26.5 minutes.
Median blood loss: 5 mL.

Type II Angular Pregnancy

Combined hysteroscopy and laparoscopy.
Laparoscopic monitoring.
Cornuostomy or wedge resection when required.
Median operative time: 64.5 minutes.
Median blood loss: 15 mL.

All procedures were successfully completed with:

No perioperative complications.
No retained gestational tissue.
Complete resolution confirmed at four and eight weeks.

Clinical Relevance

The study supports an individualized treatment pathway based on imaging findings rather than a single operative approach. Gynecologic laparoscopic surgeons should remain prepared to escalate from hysteroscopic monitoring to laparoscopic cornuostomy or wedge resection whenever intraoperative findings demand a more definitive intervention.

Source: https://pubmed.ncbi.nlm.nih.gov/42477916/

Rare Intrahepatic Duplicated Gallbladder Highlights Importance of Safe Conversion During Difficult Cholecystectomy

A case report describes a 70-year-old woman with an extremely rare congenital anomaly consisting of a normally positioned gallbladder together with a second intrahepatic duplicated gallbladder.

During surgery, the normally located gallbladder was removed laparoscopically. However, because the anatomy of the intrahepatic gallbladder could not be safely defined, the surgical team appropriately converted to open surgery.

Histopathology confirmed duplicated gallbladders with chronic cholecystitis, and the patient recovered without complications.

Surgical Lessons

The case highlights the importance of:

Careful preoperative imaging.
Awareness of congenital biliary anomalies.
Maintaining the Critical View of Safety.
Considering intraoperative cholangiography.
Accepting timely conversion when anatomy remains uncertain.

Clinical Relevance

Although extremely uncommon, duplicated or intrahepatic gallbladders significantly increase the risk of bile duct injury during laparoscopic cholecystectomy. The report reinforces that patient safety should always take priority over completing a difficult procedure laparoscopically, and timely conversion remains a hallmark of good surgical judgment.

Source: https://pubmed.ncbi.nlm.nih.gov/42494151/

Key Takeaway

Today's evidence highlights the continued advancement of minimally invasive foregut, hepatopancreatobiliary, and gynecologic surgery through better patient selection, individualized treatment strategies, multidisciplinary collaboration, and safe surgical decision-making. Whether choosing laparoscopic fundoplication, POEM, EUS-guided management, fluorescence-assisted diagnostics, or timely conversion during difficult procedures, optimal outcomes continue to depend on evidence-based practice, meticulous technique, and prioritizing patient safety.