Arquivos Brasileiros De Cirurgia Digestiva[JOURNAL]
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200 papers
First robotic telesurgery applied to bariatric surgery in Latin America: technical fundamentals, operational challenges and perspectives in clinical practice.
Nassif PAN, Malafaia O, Ramalho GL … +5 more , Almeida Junior A, Silva RMID, Palermo M, Cavazzola LT, Loureiro MP
Arq Bras Cir Dig · 2026 · PMID 42339901 · Full text
BACKGROUND: The use of robotic systems in bariatric surgery has reached a stage of maturity that supports its application with consistent results in the management of severe obesity. At the same time, the improvement of...
BACKGROUND: The use of robotic systems in bariatric surgery has reached a stage of maturity that supports its application with consistent results in the management of severe obesity. At the same time, the improvement of communication networks and digital support bases has renewed the debate on telesurgery as an alternative to extend the reach of specialized surgical care, particularly in contexts marked by the unequal concentration of highly complex services. AIMS: To present the first teleassisted bariatric robotic operation in Latin America between two states of Brazil separated by 3,200 km, in order to demonstrate its operational capacity in real time. METHODS: Vertical gastrectomy was performed with two separate teams: one performing the procedure in the metropolitan area of Curitiba (PR), and the other in the city of João Pessoa (PB), both in Brazil. RESULTS: The procedure was performed without significant operative differences when compared to the face-to-face system and in the same way that it could have been done without the use of telesurgery. CONCLUSIONS: Within this transition process, robotic assisted bariatric surgery stands out as a strategic environment for experimentation, systematic evaluation and consolidation, giving access to new approaches, such as telesurgery, contributing to the construction of a more integrated and innovative surgical model.
Delta Madureira Filho. Former President of the Brazilian College of Digestive Surgery (2019-2020).
Manso JEF
Arq Bras Cir Dig · 2026 · PMID 42339900 · Full text
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Probe-based confocal laser endomicroscopy for prediction of uterine rejection in a patient submitted to live-donor uterus transplantation.
Safatle-Ribeiro AV, Ejzenberg D, Franco FC … +4 more , Soares Junior JM, Baracat EC, Monteleone PA, Andraus W
Arq Bras Cir Dig · 2026 · PMID 42339899 · Full text
Uterus transplantation is a relatively new procedure, with successful births performed using living donors in Sweden since 2014 and a deceased donor, for the first time in Brazil, in 2016. Probe-based confocal endomicros...
Uterus transplantation is a relatively new procedure, with successful births performed using living donors in Sweden since 2014 and a deceased donor, for the first time in Brazil, in 2016. Probe-based confocal endomicroscopy is considered an optical biopsy method (with 1000 times magnification), allowing detailed visualization of tissue cytoarchitecture and microvascular patterns at a penetration depth of approximately 50 to 60 μm. The application of confocal endomicroscopy to the uterine cervix emerges as a promising alternative to weekly cervical examinations in the follow-up of patients who have undergone uterus transplantation. The authors report the case of a 34-year-old woman with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, diagnosed at 15 years of age, who in August 2026 underwent the first successful live-donor uterus transplantation performed in Latin America. The surgical procedure was uneventful. The confocal endomicroscopy of the uterine cervix was employed to evaluate its potential utility in identifying inflammatory changes that might precede graft rejection. No irregular or distorted epithelium or severe inflammation was observed, and this finding was confirmed by biopsies and histological analysis. They concluded that the probe-based confocal endomicroscopy may support more effective and individualized post-transplant management, representing a meaningful advancement in the fields of regenerative medicine and transplantation. Uterus transplantation is a relatively new procedure, with successful births performed using living donors. More than 100 transplants have already been performed in recent years in various countries around the world, achieving excellent results. Probe-based confocal endomicroscopy (pCLE) is considered an optical biopsy method (with 1000 times magnification), allowing detailed visualization of tissue cytoarchitecture and microvascular patterns at a penetration depth of approximately 50 to 60 μm. The application of confocal endomicroscopy to the uterine cervix has previously been reported as an adjunctive tool for guiding targeted biopsies during colposcopy evaluation. The use of pCLE in the follow-up of patients undergoing uterus transplantation enables early detection of graft rejection while avoiding the risks associated with biopsy.
Three-dimensional computed tomography reconstruction of the gastroesophageal junction following hiatal hernia repair with Collis gastroplasty and fundoplication: a novel method to demonstrate postoperative morphology and better understand hiatal hernia recurrence.
Luna RA, Sardenberg VM, Oliveira RV … +5 more , Ribeiro GDS, Lima MEA, Werner Junior H, Decker D, Hunter JG
Arq Bras Cir Dig · 2026 · PMID 42339898 · Full text
BACKGROUND: Collis gastroplasty for esophageal lengthening is a complex adjunct to hiatal hernia repair in patients with esophageal foreshortening. AIMS: To study the final morphology of the repair using state-of-the-art...
BACKGROUND: Collis gastroplasty for esophageal lengthening is a complex adjunct to hiatal hernia repair in patients with esophageal foreshortening. AIMS: To study the final morphology of the repair using state-of-the-art imaging: computed tomography with three-dimensional reconstruction. METHODS: Nine patients with prior Collis gastroplasty and hiatal hernia repair were studied with three-dimensional computed tomography reconstruction to evaluate the anatomy of the repair and screen for hiatal hernia recurrence. Secondary outcomes were quality of life and surgical morbidity. RESULTS: After a medium follow-up of 34 months, objective recurrence of the hiatal hernia was observed in three patients (1.5, 2.2, and 3 cm), and two patients were symptomatic. The gastroesophageal junction tube (neo-esophagus) created by the gastroplasty was similar in shape and volume to the native esophagus in all patients. The fundoplication previously performed covered the neo-esophagus in only two of the nine patients. No fistulas or mortality were observed. CONCLUSIONS: Three-dimensional computed tomography reconstruction of the gastroesophageal junction following hiatal hernia repair with Collis gastroplasty and fundoplication reliably demonstrates postoperative anatomy and helps better understand hiatal hernia recurrence.
Reduced handgrip strength and body mass index, gender, and diagnosis are associated with length of stay in hospitalized patients.
Mazzini LR, Leandro-Merhi VA
Arq Bras Cir Dig · 2026 · PMID 42339897 · Full text
BACKGROUND: Handgrip strength assessment may be a useful indicator for nutritional diagnosis and association with outcomes. AIMS: To investigate the relationship between handgrip strength and clinical outcomes in hospita...
BACKGROUND: Handgrip strength assessment may be a useful indicator for nutritional diagnosis and association with outcomes. AIMS: To investigate the relationship between handgrip strength and clinical outcomes in hospitalized patients. METHODS: A cross-sectional study with 100 patients, investigating clinical outcome variables and explanatory variables (disease, surgery, comorbidities, gender, age, handgrip strength, body mass index, and subjective global assessment). The χ2 test, Fisher's exact test, Mann-Whitney test, Spearman correlation coefficient, simple and multiple Cox regression analysis, and the Poisson regression model were used for data analysis. RESULTS: The variables that, together, best explained the length of hospital stay were handgrip strength (p<0.0001; estimated parameter=-0.020432; standard error=0.003443), body mass index (p<0.0001; estimated parameter=-0.029020; standard error=0.004952), gender (p<0.0001; estimated parameter=0.302456; standard error=0.069615), and diagnosis. Body mass index and handgrip strength were inversely associated with the length of hospital stay. Male gender and vascular or orthopedic disease, compared to other diseases, were also associated with a higher length of hospital stay. No variable was considered an associated factor for complications. CONCLUSIONS: Handgrip strength and body mass index were inversely associated with the length of hospital stay. Male gender and vascular or orthopedic disease, compared to other diseases, were associated with a higher length of hospital stay.
Central pancreatectomy: a Latin American experience of parenchyma-sparing surgery for benign and low-grade pancreatic neoplasms.
Conde-Monroy D, Namur GN, Tustumi F … +6 more , Stolzemburg LCP, Jureidini R, Jukemura J, Ribeiro Junior U, Herman P, Ribeiro TC
Arq Bras Cir Dig · 2026 · PMID 42339896 · Full text
BACKGROUND: Central pancreatectomy (CP) is a parenchyma-sparing alternative to standard resections for benign or low-grade lesions of the pancreatic neck. While it aims to preserve endocrine and exocrine function, it is...
BACKGROUND: Central pancreatectomy (CP) is a parenchyma-sparing alternative to standard resections for benign or low-grade lesions of the pancreatic neck. While it aims to preserve endocrine and exocrine function, it is associated with significant technical complexity and high rates of postoperative pancreatic fistula (POPF). AIMS: To analyze the CP at a single high-volume Brazilian center. METHODS: A retrospective analysis of a prospectively maintained database was conducted. All patients undergoing CP at a single high-volume Brazilian center between January 2009 and December 2024 were included. Data on demographics, operative details, pathology, complications (International Study Group of Pancreatic Surgery - ISGPS/Clavien-Dindo criteria), and long-term pancreatic function were collected. RESULTS: Twenty-two patients underwent CP (mean age 54 years, 72% female). The majority of lesions were cystic (50%) or neuroendocrine tumors (36.4%). The POPF rate was 86.4%, all Grade B, most managed conservatively via prolonged drainage. No Grade C fistulas, postoperative hemorrhages, or mortality occurred. Delayed gastric emptying occurred in 22.7%. After a median follow-up of 5.59 years, endocrine insufficiency developed in 9% of patients without prior diabetes (none insulin-dependent), and exocrine insufficiency in 13.6%. Only one locoregional recurrence was observed (isolated metastasis). CONCLUSIONS: This first Latin American series demonstrates that central pancreatectomy is a feasible and effective parenchyma-sparing procedure. It provides excellent long-term preservation of pancreatic function with low severe morbidity, despite high rates of manageable POPF. These outcomes support its role as a valuable surgical option for selected patients in experienced centers.
Robotic surgery for median arcuate ligament syndrome: technical aspects and imaging correlation.
Siqueira MAF, Daim RH, Knaesel MEH … +1 more , Cotta-Pereira RL
Arq Bras Cir Dig · 2026 · PMID 42307400 · Full text
BACKGROUND: Median arcuate ligament syndrome (MALS) is an uncommon condition characterized by chronic and intermittent abdominal pain, typically postprandial, and weight loss, caused by extrinsic compression of the celia...
BACKGROUND: Median arcuate ligament syndrome (MALS) is an uncommon condition characterized by chronic and intermittent abdominal pain, typically postprandial, and weight loss, caused by extrinsic compression of the celiac trunk by the median arcuate ligament. The pathophysiology of the disease is not fully understood. Diagnosis is challenging due to nonspecific symptoms, and requires a careful correlation between clinical findings and imaging studies. AIMS: To demonstrate the feasibility, safety, and technical aspects of robotic median arcuate ligament release using a case-based approach with detailed imaging correlation. METHODS: The authors report the technical aspects in an elderly male patient with typical symptoms of MALS, who underwent robotic-assisted median arcuate ligament release using the da Vinci X platform. Preoperative evaluation included CT angiography and color Doppler ultrasound, demonstrating focal proximal celiac trunk stenosis. RESULTS: The robotic approach allowed precise dissection and complete decompression of the celiac trunk without intraoperative complications. Postoperative imaging demonstrated resolution of the stenosis and normalization of Doppler flow parameters. The patient experienced complete symptom resolution, and remained asymptomatic after one year of follow-up. CONCLUSIONS: Robotic median arcuate ligament release is a safe and effective minimally invasive option, providing excellent visualization and precise dissection in a challenging anatomical region. This technique should be considered a valuable approach for selected patients with MALS. CENTRAL MESSAGE: Robotic surgery, due to the surgeon's ergonomics and the stability of the arms and instruments, wrist movement, and magnified threedimensional vision, allows for facilitated and safe access to the origin of the celiac artery as well as the dissection of fibrous tissues, innervation, and lymphatic vessels surrounding it. Given this, robotic surgery becomes feasible, effective, and safe for treating this syndrome, and it should be considered a preferred option in selected patients. PERSPECTIVES: The median arcuate ligament syndrome should be considered in cases of abdominal pain with no defined causes. A high index of suspicion can diagnose and treat more cases. Moreover, it is expected that robotic surgery will become increasingly accessible, allowing for an expansion of its indications.
Anal fistulas: do classification systems predict surgical outcomes?
Hora JAB, Sobrado LF, Sobrado CW … +4 more , Horvat N, Marques CFS, Ribeiro Junior U, Nahas SC
Arq Bras Cir Dig · 2026 · PMID 42307399 · Full text
BACKGROUND: Anal fistulas remain challenging in colorectal surgery, with recurrence and postoperative incontinence common despite advances in treatment. Multiple classification systems exist, but their predictive value f...
BACKGROUND: Anal fistulas remain challenging in colorectal surgery, with recurrence and postoperative incontinence common despite advances in treatment. Multiple classification systems exist, but their predictive value for surgical and functional outcomes is unclear. AIMS: The aim of this study was to compare Parks, American Society of Colon and Rectal Surgeons (ASCRS), and St. James's University Hospital (SJUH) MRI-based classifications in predicting surgical outcomes, including continence preservation. METHODS: Retrospective analysis of 89 patients undergoing definitive surgical treatment for anorectal fistulas at a single referral center (2012-2019). Exclusions included rectovaginal fistulas, Crohn's disease, or prior pelvic radiotherapy. Fistulas were classified using Parks, ASCRS, and, when available, SJUH (n=49). Outcomes included the number of procedures, type of initial procedure, fistula closure, and closure without continence deterioration. Continence was assessed using the Cleveland Clinic Jorge-Wexner score. RESULTS: Most fistulas were transsphincteric (Parks Type 2, 62%) and complex (ASCRS, 65%). Overall, 86.5% achieved fistula closure, and 73% achieved closure without continence deterioration. Parks and ASCRS were significantly associated with fistula closure with continence preservation (p=0.008 and 0.007, respectively) and type of initial procedure. Parks remained significant when considering closure alone (p=0.005), while ASCRS showed a borderline association (p=0.051). SJUH classification was associated only with procedure selection. CONCLUSIONS: Parks and ASCRS classifications were associated with fistula closure with continence preservation and type of initial procedure. Considering closure alone, only Parks remained significant. SJUH was limited to procedure selection. Overall, Parks and ASCRS guide surgical planning and prediction of functional outcomes, with Parks slightly more sensitive. CENTRAL MESSAGE: Parks and ASCRS classifications are strongly associated with initial procedure choice and functional outcomes, including fistula closure with continence preservation. SJUH classification predicts only procedure selection. Parks appears slightly more sensitive, highlighting its value for surgical planning and anticipating postoperative function. PERSPECTIVES: Accurate classification of anal fistula is essential for guiding surgical strategies and counseling patient effectively. The Parks and ASCRS classification systems help predict which fistulas are likely to close successfully while preserving continence. Understanding the strengths and limitations of each system allows clinicians to select appropriate procedures, set realistic expectations, and facilitate shared decisionmaking. This approach ultimately improves outcomes in the management of complex anal fistulas.
ERRATUM: Optimal upfront surgery for gastric adenocarcinoma. Real life situation in Brazil. Results comparable to neoadjuvant treatment.
Arq Bras Cir Dig · 2026 May · PMID 42207077 · Full text
[This corrects the article doi: 10.1590/0102-67202025000055e1924].
[This corrects the article doi: 10.1590/0102-67202025000055e1924].
"K" EY rules to improve learning skills in forth arm robotic platform.
Bigolin AV, Cavazzola LT, Kalil AN
Arq Bras Cir Dig · 2026 · PMID 42154895 · Full text
BACKGROUND: The number of robotic surgeries in the world grows every year. There is pressure to train surgeons, who face the challenge of transforming their surgical technique and adapting to new technology. However, the...
BACKGROUND: The number of robotic surgeries in the world grows every year. There is pressure to train surgeons, who face the challenge of transforming their surgical technique and adapting to new technology. However, there is a gap in training standardization that allows improvements to be assessed. One of the main technical challenges of the robotic platform with four working arms is their simultaneous cooperation through the movement itself. The technique presented in this article was developed based on the training of more than 400 robotic surgeons. AIMS: To describe the steps to be carried out when performing the training: activation of the arm during "swap" maneuvers (changing active instrument) during one surgical procedure, to understand the movement of the 4th robotic arm, using the letter "K" as a reference. TECHNIQUE: The screen will be divided into right and left and, then, the side of the screen that houses two working arms will be divided into three quadrants - top, bottom and middle. There are four basic rules that will mitigate the learning curve, avoiding the main mistakes that lead to considerations of instruments and difficulty in intracavitary mobility. CONCLUSIONS: The K technique is a relevant resource in teaching robotic surgery, offering a simple and reproducible methodology for developing important skills to reduce the learning curve for new robotic surgeries.
The use of mesenchymal stem cells adhered to the suture filament in the closure of rat aponeurosis.
Kalil J, Bustorff-Silva JM, Calderoni DR … +4 more , Leme KC, Camargo GCA, Fávaro WJ, Luzo ÂCM
Arq Bras Cir Dig · 2026 · PMID 42018912 · Full text
BACKGROUND: Abdominal wall hernia is a common disease, with an incidence of around 20%. Recent studies have shown the benefits of using stem cells, especially mesenchymal ones, to improve tissue healing. AIMS: Evaluate t...
BACKGROUND: Abdominal wall hernia is a common disease, with an incidence of around 20%. Recent studies have shown the benefits of using stem cells, especially mesenchymal ones, to improve tissue healing. AIMS: Evaluate the use of mesenchymal stem cells derived from adipocytes adhered to a suture filament to enhance tensile strength and collagen formation in aponeurosis. METHODS: Human stem cells derived from adipocytes were adhered to a suture filament. Thirty-seven rats of the species Sprague Dawley were divided into three groups: Group 1 was the control group, Group 2 used only a regular suture filament to close abdominal aponeurosis, and Group 3 used a suture filament with stem cells. These animals were evaluated seven, 14, and 56 days after the intervention. RESULTS: Rupture occurred at the semilunar line and the midline. All animals from Groups 2 and 3, submitted to incision and closure, evaluated at D7 and D14, showed a rupture in the midline. However, all animals evaluated at D56 (all groups) ruptured at the semilunar line. Furthermore, tensile strength was significantly lower at D7 in Groups 2 and 3 compared to Group 1 (p<0,001). On D14, Groups 2 and 3 showed a similar increase in tensile strength, but still inferior to the one observed in Group 1 (p<0,05). On D56, all groups reached similar values (p=0,074, p>0.05). Collagen histologic analysis showed that animals from Group 3 had the highest values in all time points, and Group 2 had higher values than Group 1 in all time points (p>0,05). In graphical analysis, Groups 2 and 3, on D7, had an increase in collagen, but on D14 showed a decrease, with a similar level on D56 (p>0,05). CONCLUSIONS: This study do not support the use of mesenchymal stem cells to improve the healing of a midline abdominal incision in healthy subjects. However, an option for future studies is to employ this filament, combined with matrices for reconstructive purposes, in areas requiring extensive repair, such as large hernias where the aponeurosis is insufficient for defect correction.
Pouch cancer in familial adenomatous polyposis. Incidence, risk factors and literature review: a propos of three rare cases.
Campos FG, Martinez CAR, Moura RN … +4 more , Safatle-Ribeiro AV, Marques CFS, Ribeiro Junior U, Herman P
Arq Bras Cir Dig · 2026 · PMID 41983869 · Full text
BACKGROUND: Development of pouch cancer is a great challenge to both surgeons and patients with familial adenomatous polyposis (FAP) after restorative proctocolectomy (RPC). AIMS: We aimed to present our experience with...
BACKGROUND: Development of pouch cancer is a great challenge to both surgeons and patients with familial adenomatous polyposis (FAP) after restorative proctocolectomy (RPC). AIMS: We aimed to present our experience with pouch cancer diagnosis and review literature data regarding incidence and associated risk factors. METHODS: This retrospective study enrolled FAP patients undergoing RPC between 1981 and 2023 in our academic institution. It included only J-pouch stapled patients with at least three years of follow-up. Patients' demographics and disease features were retrieved. RESULTS: After excluding seven patients, we selected 87 RPC, and three cases (3.4%) of pouch cancer were identified. They were diagnosed in three men aged 23-40 years at RPC and 41-62 years at cancer diagnosis. Interval from RPC to pouch cancer diagnosis varied from 11.6 to 20 years (average 14.6 years). All patients had colorectal cancers (CRC) detected in the specimen from the index surgery, two of them with multicenter lesions. A brief review of the literature series showed that pouch cancer has been detected in incidences ranging from 0.8 to 3.4%. Male sex, CRC in the RPC specimen, pouch phenotype during follow-up and an association with duodenal adenomas are considered risk factors. CONCLUSIONS: Pouch cancer is a rare event associated with specific risk factors. After RPC, all patients should undergo endoscopic surveillance, with special attention to those who develop an aggressive phenotype during the first decade of follow-up. CENTRAL MESSAGE: Familial adenomatous polyposis (FAP) is an autosomal dominant disease associated with mutations in the APC gene. As a dominantly inherited cancer-predisposing syndrome, the main challenge of FAP management is the significant risk of CRC that requires prophylactic colectomy in a timely manner aiming to reduce colorectal cancer (CRC) risk while maintaining quality of life. Cancer prevention is most usually accomplished through restorative procedures such as total colectomy with ileorectal anastomosis (IRA) or a restorative proctocolectomy with ileoanal anastomosis (RPC). The development of ileoanal pouch cancer is not so common in patients with FAP, even in specialized centers. PERSPECTIVES: Pouch cancer is a rare disease diagnosed in incidences varying from 0.8 to 3.4% in worldwide FAP series. Male patients, presence of CRC in the RPC specimen, colorectal phenotype, and association with duodenal adenomas are considered the main risk factors. Pouch adenomas develop after both hand-sewn or stapled anastomosis. Pouch polypectomy might prevent the development of adenocarcinomas, as patients under surveillance are diagnosed with more localized diseases.
Gastric neuroendocrine tumors: a comprehensive analysis of clinicopathological characteristics and survival outcomes from a reference center.
Ribeiro MB, Pereira MA, Mucerino DR … +5 more , Yagi OK, Dias AR, Nigro BC, Ribeiro Junior U, Ramos MFKP
Arq Bras Cir Dig · 2026 · PMID 41983868 · Full text
BACKGROUND: Gastric neuroendocrine tumors (gNETs) are uncommon neoplasms arising from enterochromaffin-like cells, representing a distinct subset of gastric malignancies, with challenging clinical management. AIMS: To an...
BACKGROUND: Gastric neuroendocrine tumors (gNETs) are uncommon neoplasms arising from enterochromaffin-like cells, representing a distinct subset of gastric malignancies, with challenging clinical management. AIMS: To analyse the classification, treatment indication, and survival of patients diagnosed with gNETs. METHODS: We retrospectively analyzed patients diagnosed with gNETs between 2009 and 2025 at a high-volume tertiary center in Brazil. Clinical, pathological, and treatment data were reviewed, and tumors were classified according to World Health Organization and clinicopathological criteria into Types I, II, and III. RESULTS: Of the 75 patients included, 53 (70.7%) were classified as Type I, 5 (6.7%) as Type II, and 17 (22.6%) as Type III. Treatment included surgery in 25 patients (33.3%) and endoscopic resection in 50 (66.7%). Type I tumors predominated in females (p<0.001), were frequently multifocal (p<0.001), associated with higher body mass index (p=0.002), and were mainly managed endoscopically (p=0.008). Type II tumors were rare and associated with multiple endocrine neoplasia Type 1, while Type III tumors were predominantly male, larger, high-grade (G3), and frequently metastatic, requiring surgical resection and palliative therapy. Among the 25 surgically treated patients, most were men (52%) and included 12 patients (48.0%) with Type I, 3 (12.0%) with Type II, and 10 (40.0%) with Type III tumors. Survival analysis showed significantly worse outcomes for Type III and G3 tumors. Multivariable analysis identified advanced age (hazards ratio 4.11; 95% confidence interval (95%CI): 1.14-14.80; p=0.030) and tumor, lymph node, metastasis (TNM) stage III/IV (HR 5.42; 95%CI: 1.26-23.26; p=0.023) as independent predictors of poorer survival. CONCLUSIONS: gNETs exhibit heterogeneous clinical behavior, with Type I tumors predominating in the Brazilian population. Tumor type, grade, and TNM stage are critical determinants of prognosis and should guide individualized treatment strategies. CENTRAL MESSAGE: The stomach is the most frequent site of gastrointestinal neuroendocrine neoplasms (NENs), with an annual incidence of approximately 0.4 per 1,00,000 individuals. According to the most recent World Health Organization Classification of Tumors of the Digestive System, NENs are divided into three major categories: gastric neuroendocrine tumors, which are the most common, well-differentiated, and have any grade; neuroendocrine carcinomas, which are poorly differentiated and high-grade; and mixed neuroendocrine-non-neuroendocrine neoplasms, which are aggressive and harbor multiple molecular alterations. These neoplasms originate from enterochromaffin-like cells of the gastric mucosa. PERSPECTIVES: Gastric neuroendocrine tumors (gNETs) are uncommon and heterogeneous, and require individualized management. In this largest Brazilian cohort, Type I gNET predominated, showing indolent behavior and favorable outcomes with endoscopic treatment. Type II tumors were rare and invariably linked to multiple endocrine neoplasia type 1, while Type III tumors presented aggressive features, advanced stage, and poor survival. Prognosis was strongly determined by tumor, lymph node, metastasis stage, highlighting the importance of accurate staging and histopathological evaluation.
Finsterer- Bancroft-Plenk operation and Bouveret's syndrome: a rare association.
Tafner PFDA, Brito GT, Vaz JGO … +7 more , Albuquerque BMV, Arantes AC, Macedo AAC, Tercioti Junior V, Coelho Neto JS, Andreollo NA, Lopes LR
Arq Bras Cir Dig · 2026 · PMID 41983867 · Full text
Peptic ulcer disease (PUD) presents different spectrums of evolution and severity. Epigastric pain is the patient's most important complaint and may be associated with other complications, such as bleeding, perforations...
Peptic ulcer disease (PUD) presents different spectrums of evolution and severity. Epigastric pain is the patient's most important complaint and may be associated with other complications, such as bleeding, perforations and stenosis, associated with comorbidities. Bouveret syndrome is a rare syndrome with nonspecific symptoms and prolonged evolution, characterizing duodenal obstruction by a large gallstone migrated through a cholecystoduodenal fistula. It is currently known as the Finsterer-Bancroft-Plenk technique, the preservation of the antrum and removal of the antral mucosa associated by partial gastrectomy. The Finsterer-Bancroft-Plenk technique is still a surgical option in the face of complex duodenal stenoses secondary to PUD.
Reviews, expert opinions, consensus statements, position papers, protocols, and evidence-based guidelines: what are their roles in clinical practice?
Tustumi F, Calthorpe L, Coimbra FJF … +1 more , Alseidi A
Arq Bras Cir Dig · 2026 · PMID 41810652 · Full text
CENTRAL MESSAGE: Clinical practice guidance documents are not all the same. In digestive surgery, evidence-based guidelines, consensus statements, position papers, and protocols each serve different purposes, and the dis...
CENTRAL MESSAGE: Clinical practice guidance documents are not all the same. In digestive surgery, evidence-based guidelines, consensus statements, position papers, and protocols each serve different purposes, and the distinctions between them should be clear. Recognizing the strengths and limitations of each format is essential to improving decision-making, guiding research, and ultimately benefiting our patients. PERSPECTIVES: Digestive surgery evolves rapidly, and traditional publication models may not keep pace with emerging technologies and clinical demands. Future guidance documents are expected to incorporate artificial intelligence for evidence screening, living systematic reviews for continuous updates, and transparent digital repositories for open access to consensus voting and dissent. National registries and real-world data will complement trials where randomized evidence is scarce.
Impacts of pringle maneuver on hepatectomies: analysis of survival and clinical effects.
Cansi ARZ, Vitor JS, Lopes JFDS … +1 more , Glória RD
Arq Bras Cir Dig · 2026 · PMID 41739719 · Full text
BACKGROUND: The Pringle maneuver remains a widely used technique in hepatic surgery with varying opinions on its effects on postoperative outcomes and survival, requiring evidence-based evaluation of its impact on liver...
BACKGROUND: The Pringle maneuver remains a widely used technique in hepatic surgery with varying opinions on its effects on postoperative outcomes and survival, requiring evidence-based evaluation of its impact on liver function and long-term results. AIMS: The aim of this study was to evaluate the impact of the intermittent Pringle maneuver on postoperative liver function and survival in hepatectomy patients, focusing on early dysfunction markers as prognostic factors. RESULTS: In this retrospective cohort of 198 patients (106 women and 92 men; mean age, 59 years), the Pringle group showed longer surgical times (226.87±82.18 vs. 184.00±80.90 min, p<0.001) and extended intensive care unit stays (4.02±2.1 vs 3.11±1.9 days, p=0.026), but lower bilirubin levels (2.18±0.33 vs. 3.13±0.39 mg/dL, p=0.049). Multivariate analysis revealed that the Pringle maneuver reduced mortality risk (hazard ratio [HR]=0.540, 95% confidence interval [95%CI]: 0.333-0.876, p=0.013). Early liver dysfunction markers strongly predicted worse outcomes: elevated bilirubin nearly doubled mortality risk (HR 1.975, 95%CI 1.100-3.545, p=0.023), and decreased prothrombin activity tripled it (HR 3.055, 95%CI 1.839-5.075, p<0.001). CONCLUSIONS: While the Pringle maneuver extends operative time and intensive care unit stay, it demonstrates a protective effect on survival. Early postoperative liver dysfunction strongly predicts poor outcomes, emphasizing the importance of careful postoperative monitoring regardless of vascular control strategy. These findings suggest that a controlled intermittent Pringle maneuver offers survival benefits when properly timed.
Optimal upfront surgery for gastric adenocarcinoma. Real life situation in Brazil. Results comparable to neoadjuvant treatment.
Gonçalves AC, Racy RS, Mitidieri ACH … +5 more , Castro BGD, Zanon CC, Freitas Junior WR, Castro OAP, Kassab P
Arq Bras Cir Dig · 2026 · PMID 41711850 · Full text
BACKGROUND: Complete neoadjuvant treatment for gastric cancer is not always tolerated due to nutritional and clinical reasons, such as gastric outlet obstruction. In this context, upfront surgery becomes an alternative....
BACKGROUND: Complete neoadjuvant treatment for gastric cancer is not always tolerated due to nutritional and clinical reasons, such as gastric outlet obstruction. In this context, upfront surgery becomes an alternative. AIMS: The aim of the study was to compare upfront resection with neoadjuvant systemic therapy followed by surgery and identify factors influencing their outcomes. METHODS: Retrospective study of 410 patients with locally advanced gastric adenocarcinoma followed between 2012 and 2020, comparing upfront surgery and perioperative treatment. Patients with early tumor (cT1N0), metastasis, and stump cancer were excluded. The comparison was stratified by stage without the influence of systemic treatment (primary stage). Resections with D2 dissection, no residual tumor (no R2), and no complications were considered optimal surgery. RESULTS: Upfront resection was performed in 216 patients (85% of upfront surgeries). Gastrectomy after neoadjuvant treatment was performed in 47 cases (76% of indications), and another four were resected among 39 previous unsuccessful surgeries (10%). In total, there were 51 resections after chemotherapy. Independent factors associated with overall survival at 60 months were: preoperative chemotherapy (57.3% vs. 40.7%, p=0.029); complication rate; D2 lymphadenectomy; and primary stage. Initial cases showed a better outcome in the neoadjuvant group without statistical significance (p=0.447), but it was present in more advanced tumors (p=0.027). Optimal surgery was achieved in 68.6% of the neoadjuvant group and 51.9% of the upfront group (p=0.030) and resulted in similar overall survival (56.6% vs. 52.4%, p=0.904). CONCLUSIONS: Optimal upfront surgery followed by adjuvant therapy, particularly with D2 dissection, is effective and was not statistically inferior to neoadjuvant treatment.
Uterus transplantation - indications, technique, and results.
Andraus W, Ejsenberg D, Waisberg DR … +12 more , Santana AC, Ducatti L, Arantes RM, Martino RB, Santos VR, Pinheiro RS, Leis L, Silva MS, Haddad LB, Soares Junior JM, Monteleone PAA, Baracat EC
Arq Bras Cir Dig · 2026 · PMID 41711849 · Full text
CENTRAL MESSAGE: Uterus transplantation was a transformative innovation in reproductive medicine and organ transplantation in general, and an alternative for the treatment of infertility. The problem of infertility affec...
CENTRAL MESSAGE: Uterus transplantation was a transformative innovation in reproductive medicine and organ transplantation in general, and an alternative for the treatment of infertility. The problem of infertility affects 8-12% of the population of reproductive age, causing an enormous social impact. Uterus transplantation, a relatively new treatment, has emerged as an excellent option for couples with absolute uterine infertility. The first uterus transplant performed was in 2000, in Saudi Arabia. At this same time, a Swedish researcher began several experimental works with uterine transplantation in different animal models. Only more than a decade after the first attempt in humans was a second case performed, in Turkey, in 2011. The first transplant in the Americas was performed in the United States of America, in 2016, with a deceased donor. In the same year, in Brazil, the group from Hospital das Clínicas, Faculty of Medicine, University of São Paulo, performed the first uterus transplant in Latin America, also with a deceased donor. This Brazilian case resulted in the world's first birth from a deceased donor uterus transplant in December 2017, making Brazil and Hospital das Clínicas in a vanguard position in the world transplant scenario. Even so, we have today more than 100 transplants performed on the planet, with the birth of more than 70 children. Uterus transplantation was a transformative innovation in reproductive medicine and organ transplantation. It is an alternative for the treatment of absolute uterine factor infertility. Mayer-Rokitansky-Küster-Hauser syndrome is the main cause of uterine agenesis. This Brazilian case resulted in the world's first birth from a deceased donor uterus transplant in December 2017. Today, more than 100 transplants are performed on the planet, with the birth of more than 70 children. Uterus transplantation has undoubtedly been a transformative innovation in reproductive medicine and organ transplantation. It comes as an alternative for treating infertility of an absolute uterine cause. Among these causes, we have women who were born without this organ, or there was a need to perform a hysterectomy, or they have a non-functioning uterus, such as severe malformations (severe bicornuate uterus, Asherman syndrome). Modern society has increasingly respected each individual's decision, provided they are informed of all alternatives and risks involved. In this way, uterine transplantation has become an important alternative for patients with infertility due to uterine causes. PERSPECTIVES: Uterus transplantation is a new modality among organ transplants. It has undoubtedly brought great innovation and excellent results to the therapeutic armamentarium for infertility of uterine cause. Uterus transplantation is a great example where multidisciplinarity, in which each one contributes with their expertise, enables the realization of a greater feat. The gain of experience, technology, and minimally invasive surgeries will certainly bring even better results.
ALDH1 and ALCAM as emerging biomarkers in personalized rectal cancer therapy.
Ribas-Filho JM, N Doelken E, Tripathi S … +7 more , Polat B, Lissner R, Böeldicke T, Ribas CAPM, Malafaia O, Gasser M, Waaga-Gasser AM
Arq Bras Cir Dig · 2026 · PMID 41711765 · Full text
BACKGROUND: The preoperative evaluation of serum tumor markers provides valuable prognostic and therapeutic insights in solid malignancies. Although not diagnostic by themselves, increased preoperative concentrations oft...
BACKGROUND: The preoperative evaluation of serum tumor markers provides valuable prognostic and therapeutic insights in solid malignancies. Although not diagnostic by themselves, increased preoperative concentrations often reflect greater tumor burden, advanced disease stage, and unfavorable clinical outcomes. AIMS: The aim of this study was to investigate the expression and diagnostic-prognostic potential of the tumor markers aldehyde dehydrogenase 1 (ALDH1) and activated leukocyte cell adhesion molecule (ALCAM) in the blood of rectal cancer patients under the influence of short- or long-term radio-/chemoradiotherapy (RTx/RCTx). METHODS: Serum samples taken from patients with rectal carcinoma (n=164) at different time points during and after RTx/RCTx were retrospectively examined to determine whether these markers could predict disease progression and long-term survival. RESULTS: Kaplan-Meier analysis confirmed the prognostic relevance of the Union for International Cancer Control (UICC) staging, while no significant associations were observed between serum levels of the investigated biomarkers and individual patient or tumor characteristics such as age, sex, or tumor stage. Overall, ALCAM and ALDH1 in this limited patient cohort exhibited elevated serum levels compared with healthy controls, and tumor tissues demonstrated stage-dependent increases in marker expression (UICC III/IV versus I/II). CONCLUSIONS: Serum concentrations of ALCAM and ALDH1 were significantly elevated in our patient cohort with rectal cancer but showed no significant correlation with tumor stage or survival, whenever serum samples were obtained either during or after neoadjuvant and adjuvant therapy, which may be particularly due to the limited number of studied subjects. Although their prognostic utility remains limited, their consistent elevation in cancer patients underscores their potential value in early detection or as components of a broader biomarker panel.
APACHE II, SOFA, and SAPS III after transhiatal and thoracoscopic in prone position esophagectomy for esophageal cancer: a single-center retrospective cohort analysis.
Ferrer JAP, Tercioti Junior V, Falcão ALE … +4 more , Coelho Neto JS, Macedo AAC, Andreollo NA, Lopes LR
Arq Bras Cir Dig · 2025 · PMID 41660937 · Full text
BACKGROUND: Esophagectomy is a major, invasive, and long-lasting surgery performed in patients with comorbidities and compromised nutritional conditions. The historical challenges of surgical treatment of esophageal canc...
BACKGROUND: Esophagectomy is a major, invasive, and long-lasting surgery performed in patients with comorbidities and compromised nutritional conditions. The historical challenges of surgical treatment of esophageal cancer are to overcome mortality, improve survival, and decrease morbidity. AIMS: The aim of the study is to compare the intraoperative morbidity of two distinct surgical techniques of esophagectomy in esophageal cancer, transhiatal esophagectomy and video-assisted thoracoscopy in the prone position, analyzing intraoperative physiological parameters, scores on admission to the intensive care unit (ICU) (APACHE II, SOFA, and SAPS III), and postoperative evolution. METHODS: Retrospective, cross-sectional study evaluating patients admitted to the ICU in the immediate postoperative period of elective esophagectomy for esophageal neoplasia (squamous cell carcinoma and adenocarcinoma). Data were obtained from a computerized registry database of the ICU and from patient records. RESULTS: Sixty-three patients over 18 years of age were evaluated and divided into two groups: 31 (49.21%) underwent transhiatal esophagectomy, and 32 (50.79%) underwent videoassisted thoracoscopic esophagectomy. No statistically significant difference was observed for length of ICU stay (p=0.5309), length of postoperative hospital stay (p=0.3066), or death in the perioperative period (30 days, p=0.6562). Regarding intraoperative parameters, no statistically significant difference was observed for patients who received blood transfusion (p=0.2097); amount in milliliters (p=0.2893); patients who used vasoactive drugs (VADs) (p=0.9243); time VAD use (p=0.9327); volume of fluids infused in milliliters (p=0.7825); or diuresis in milliliters (p=0.7286). A statistically significant difference was observed for surgical time (310 min in transhiatal esophagectomy vs. 373 min in video-assisted thoracoscopy, p=0.0012) and anesthetic time (385 minutes in transhiatal vs. 467 min in video-assisted thoracoscopy, p<0.0001). A statistically significant difference was observed in the number of patients extubated at the end of the procedure (48.38% in transhiatal vs. 9.37% in video-assisted thoracoscopy, p=0.0022). Regarding gasometric parameters at the end of the surgical procedure, only pO2 showed a statistically significant difference (p=0.0010). Regarding ICU admission scores, there were no differences regarding APACHE II (p=0.6542), SOFA (p=0.8949), and SAPS III (p=0.7656). CONCLUSIONS: This study showed no differences between the transhiatal and thoracoscopic esophagectomy in the prone position, in prognostic score performance, studied operative parameters, ICU stay and hospital stay times, and perioperative mortality, in agreement with literature findings. The advent of minimally invasive techniques in video-assisted esophagectomies brought the same benefits as thoracotomy, offering greater safety in mediastinal dissection under direct vision, in addition to mitigating the physiological repercussions of thoracotomies.
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