Beat Peter Müller-Stich

Background: Social media is an important source of health information for patients considering metabolic and bariatric surgery (MBS), but the quality of this information remains unclear. We assessed the quality of MBS-related videos on TikTok, Instagram, and Facebook. Methods: This cross-sectional study evaluated English-language videos identified between October and December 2025 using four MBS-related hashtags. Two MBS-experienced reviewers independently assessed video quality using the validated DISCERN and Principles for Health-related Information on Social Media (PRHISM) instruments. Video characteristics, creator type, and engagement metrics were recorded and compared across platforms and creator groups. Results: Of 116 included videos, 55 were from TikTok, 28 from Instagram and 33 from Facebook. Overall information quality was low to moderate. Instagram had the highest DISCERN and PRHISM scores, followed by Facebook, while TikTok had the lowest. In unadjusted analyses, DISCERN scores were significantly lower on TikTok than Instagram, while PRHISM scores were significantly lower on TikTok than both Instagram and Facebook. Healthcare professionals produced videos with significantly higher DISCERN scores than non-medical creators (34.05 ± 6.63 vs 25.66 ± 5.77; p < 0.001) and higher PRHISM scores (49.14 ± 9.16 vs 31.53 ± 7.83; p < 0.001). However, non-medical creators received significantly more likes and shares. Greater engagement was associated with lower information quality in unadjusted analyses, but these associations were attenuated after adjustment for platform and creator type. Conclusion: The quality of MBS-related information in the sampled social-media videos was low to moderate. Although TikTok showed lower information-quality scores than Instagram and Facebook in unadjusted analyses, the platform difference in DISCERN scores was attenuated after adjustment for creator type. Healthcare professionals provided higher-quality content but received less engagement, highlighting the need for accurate, accessible, and engaging evidence-based MBS information on social media.

Robotic surgery is increasingly integrated into surgical practice, yet structured, benchmark-driven simulation training remains limited for general surgery trainees. Proficiency-based progression (PBP) offers a practical, specialty-tested approach for structuring robotic surgical training around demonstrated performance rather than case numbers, but standardized PBP curricula for general surgery robotic training remain underdeveloped. This study aimed to test the feasibility of a structured, simulation-based robotic training and, building on this, to develop a preliminary proficiency-based approach whose benchmarks can be formally evaluated in future studies. We conducted a prospective, single-center pilot feasibility study of a structured robotic simulation curriculum over two weeks, combining virtual reality simulation and dry-lab training on the da Vinci Xi system (Intuitive Surgical, Sunnyvale, CA, USA). Advanced and novice robotic surgeons completed stepwise training sessions targeting core robotic skills and procedural tasks. Feasibility was defined by successful implementation within the timeframe, completion of sessions, and participant acceptance, assessed informally; the curriculum was subsequently structured into skill modules with proposed proficiency benchmarks. The curriculum was successfully implemented within the planned two-week timeframe, with six advanced and fifteen novice robotic surgeons participating. The curriculum was structured into six sequential modules, representing key technical and non-technical skills in robotic surgical practice, each with proposed proficiency benchmarks. This pilot study demonstrates the feasibility of a structured robotic simulation curriculum in general surgery. The proposed benchmark-driven structure may inform the development of standardized robotic simulation curricula for general surgery training programs, pending further validation against clinical performance.

Background The impact of stapling technique on early postoperative outcomes after minimally invasive Roux-en-Y gastric bypass (RYGB) remains incompletely understood. This study compared short-term postoperative outcomes following linear versus circular gastrojejunostomy. Methods This nationwide administrative database study included RYGB cases in Switzerland between 2015 and 2022. The primary endpoint was major in-hospital postoperative complication (composite of diagnoses and reoperation). Secondary endpoints included individual complications, length of hospital stay (LOS), and temporal trends in stapling technique. Associations were assessed using generalised additive regression models and propensity score matching (PSM). Results Among 21,320 RYGB cases, 18,161 (85.2%) underwent linear and 3,159 (14.8%) circular gastrojejunostomy. Circular stapling was not associated with major complication in multivariable analysis (OR = 1.221, 95% CI 0.824–1.809), whereas higher odds were observed after PSM (OR = 2.464, 95% CI 1.225–4.956). Circular stapling was associated with both surgical site infection (SSI) and LOS exceeding the 50th percentile in both multivariable (SSI: OR = 2.251, 95% CI 1.331–3.809; LOS: RR = 1.136, 95% CI 1.047–1.232) and PSM analyses (SSI: OR = 7.647, 95% CI 2.885–20.271; LOS: RR = 1.318, 95% CI 1.218–1.426). For LOS exceeding the 90th percentile, an association was observed in multivariable analysis (RR = 1.209, 95% CI 1.014–1.441), but not after PSM (RR = 1.018, 95% CI 0.604–1.715). Circular stapling decreased overall during the study period (Τ=−0.714, p = 0.013), despite year-to-year variation. Conclusion The association between circular stapling and major in-hospital postoperative complication differed across analytical approaches. Associations with SSI and prolonged LOS were more consistent. Linear stapling increasingly predominated over time. Registry: ClinicalTrials.gov, TRN: NCT07483957, Registration date: 17 March 2026.

Conventional laparoscopic inguinal hernia repair (LIHR) is common and robotic-assisted techniques (RIHR) are increasingly being implemented. Current literature is indecisive on whether RIHR offers clinical and ergonomical benefits. This systematic review compares LIHR and RIHR specifically focusing on surgeon workload and ergonomics. A literature search was performed in four databases to find randomized controlled trials comparing RIHR and LIHR. A risk of bias assessment was conducted using the Cochrane Tool and results were synthesized as pooled estimate, odds ratio or narrative review. Four trials were identified, encompassing 482 patients. The groups showed similar baseline characteristics across studies. A broad range of surgeon experience could be observed between trials. All studies showed a significant difference in operative time, but while three studies found RIHR to take longer, one study reported shorter operative time with RIHR, altogether leading to a non-significant pooled estimate (MD 17.14; 95% CI −3.22 to 37.49). While one study showed significantly better ergonomics with RIHR, the other study reporting on that topic found ergonomics between the two approaches to be comparable. Surgeon task load varied substantially between the trials. The pooled estimate slightly favored RIHR but did not reach statistical significance (MD –4.50; 95% CI –16.78 to 7.78). Postoperative complication rate was not significantly different overall (OR 0.89, 95% CI 0.42 to 1.90), although one study reported significantly less complications after RIHR. RIHR shows comparable patient-centered outcomes to LIHR. At the moment, there is no evidence for significant benefits regarding task load and ergonomics.

Mesh-enforced open ventral hernia repair (OVHR) is associated with increased surgical site occurrences and prolonged hospital stay. Robotic-assisted ventral hernia repair (RVHR) may offer benefits compared to OVHR, but comparative literature is scarce. This multicenter prospective cohort study used data from the international CROSSFIRE (MultiCentre InteRnational PrOSpective DatabaSe For Ventral HernIa REpair) register. Patients undergoing OVHR or RVHR for ventral hernias with 3–15 cm transverse diameter between December 2023 and March 2026 were analyzed. The primary outcome was surgical revision after 30 days. Secondary outcomes included postoperative pain after 2 days and 6 weeks, operative time, length of stay (LOS), readmissions and follow-up at 1 year. Two hundred thirty patients were included and analyzed, of which 77 (41% female, BMI 28.4 kg/m2, 90.7% incisional hernias, median hernia diameter 4 cm) underwent OVHR, and 153 (33.7% female, BMI 29.4 kg/m2, 91.7% incisional hernias, median hernia diameter 5 cm) underwent RVHR. Surgical revisions were more frequent after OVHR compared to RVHR (13.7% vs. 4.8%; p = 0.027). Median LOS was longer after OVHR (4 days vs. 3days; p < 0.001). Median operation time was shorter in OVHR (100 min vs. 210 min; p < 0.001). The pain after two days was lower after OVHR (VAS 2 vs. 3; p = 0.002); however, it was higher after 6 weeks (2 vs. 1 VAS; p = 0.008). After one year, the clinical recurrence rate was higher after OVHR 7.1% vs. 0.0%; p = 0.010). RVHR was associated with fewer surgical revisions after 30 days, a shorter LOS, less pain after 6 weeks and improved outcomes after one year. Randomized controlled trials are needed to confirm these findings.

Introduction and importance: Abdominal cerebrospinal fluid pseudocysts (APCs) are a rare complication of ventriculoperitoneal (VP) shunts, occurring in 1–4.5% of cases and potentially causing abdominal symptoms, bowel obstruction, or shunt malfunction. We present a case of a VP shunt–associated pseudocyst leading to mechanical small bowel obstruction. Presentation of case: A 40-year-old woman with a long-standing VP shunt presented with abdominal pain, vomiting, and obstipation. CT imaging showed a large pseudocyst encasing the shunt tip and causing mechanical ileus. Emergency surgery revealed adhesion-related small-bowel obstruction, requiring partial cystectomy and ileal resection. cerebrospinal fluid (CSF) cultures grew Cutibacterium acnes , prompting complete shunt removal, external ventricular drainage, and later placement of a ventriculoatrial shunt. She recovered with conservative management of minor postoperative complications. Clinical discussion: APCs may form due to impaired CSF absorption, inflammation, or low-grade infection. In this patient, a chronic shunt infection likely contributed to cyst development and bowel obstruction. Management typically requires cyst drainage or resection, and revision of the distal catheter, with complete shunt removal necessary when infection is present. Early diagnosis and multidisciplinary management are essential to prevent morbidity. Conclusion: VP shunt–associated pseudocysts, though rare, can cause acute abdominal emergencies. Prompt imaging, surgical intervention, and appropriate treatment of shunt infection are critical for optimal outcomes.

Introduction The influence of metabolic bariatric surgery (MBS) on renal damage remains poorly understood. Data on the impact of different types of MBS on renal markers is limited. This study analyzes the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on traditional (urinary albumin-creatinine ratio (uACR), estimated glomerular filtration rate (eGFR)) and new markers (serum uromodulin (sUMOD), serum kidney injury molecule-1 (sKIM-1)) of kidney function in a retrospective cohort of patients with nephropathy. Methods 50 patients (RYGB n = 25; SG n = 25) with renal involvement, defined as microalbuminuria (uACR > 3 mg/mmol) and/or reduced eGFR (< 60 ml/min) were included. Patients were matched for sex, age, body mass index (BMI) and glycemic control. Kidney function was assessed using creatinine, cystatin C, eGFR, uACR, sUMOD and sKIM-1. Results After a mean follow-up of 28.8 ± 6.1 months, renal involvement completely resolved in 48% after SG (p<.001) compared to 68% after RYGB (p<.001). UACR decreased after both procedures (SG -9.9 ± 23.2 mg/mmol, p=.002; RYGB − 14.4 ± 28.9 mg/mmol, p<.001) without a difference between procedures (p=.923). SUMOD and sKIM-1 improved significantly after SG (p=.025, p=.028). Conclusions In this study, MBS was associated with improved nephropathy outcomes, independent of the type of procedure performed. SUMOD emerges as a promising biomarker to predict renal recovery.

Background: Obesity, a chronic disease with serious associated medical problems, remains a global health challenge. While metabolic bariatric surgery (MBS) is the most effective treatment for weight loss, GLP-1 receptor agonists (RAs) are emerging as promising alternatives or adjuncts. This study evaluates the impact of preoperative GLP-1 therapy on weight loss and obesity-related complications over three years and explores reasons for transitioning to surgery. Methods: Patients who underwent RYGB or SG from 2015–2021 were retrospectively analyzed, excluding those with revision and conversion surgeries, postoperative GLP-1 use, or pregnancy during follow-up. Propensity score matching (1:1) was used to adjust for confounders. The primary outcome was a combined endpoint of the SF-Bari Score, incorporating weight loss, improvement of obesity-related conditions, and surgical complications until 36 months post-surgery. Results: A total of 215 patients were analyzed, including 54 who received GLP-1 RAs prior to surgery, with a preoperative total body weight loss (%TWL) of 3.7 ± 4.3%. %TWL did not differ significantly between groups: at 12 months, 29.8 ± 7.7% (non-GLP-1) vs. 28.1 ± 7.6% (GLP-1); at 24 months, 28.9 ± 8.2% vs. 27.2 ± 8.4%; and at 36 months, 26.9 ± 9.1% vs. 25.4 ± 9.1%. SF-Bari Scores were similar between groups at all timepoints: 96.0 ± 24.2 vs. 93.5 ± 26.3 at 12 months, 93.8 ± 24.4 vs. 91.0 ± 25.6 at 24 months, and 89.1 ± 24.7 vs. 85.5 ± 25.8 at 36 months (non-GLP-1 vs. GLP-1). Propensity score matching confirmed comparable outcomes between groups. Patients transitioned to surgery for definitive treatment, side effects, or medication unavailability. Conclusion: Among patients who proceeded to surgery after GLP-1 therapy, prior GLP-1 use was not associated with different surgical outcomes.

Objective: To investigate the impact of cumulative liver age on graft survival in liver transplant recipients. Summary of Background Data: Organ shortage has led to increased use of elderly donor livers for an ageing group of recipients, particularly in Europe. We hypothesized that hypothermic oxygenated perfusion (HOPE) enhances graft resilience against aging in livers from elderly donors. Methods: This post-hoc analysis of the multicenter European HOPE-REAL study (NCT05520320) examined liver age in adult recipients of HOPE-treated brain-dead donor (DBD) livers. Cumulative liver age was defined as the sum of donor age and post-transplant graft survival. HOPE-treated DBD liver transplants were compared with a single-center control cohort of non-perfused DBD livers using propensity score matching to adjust for confounders. Results: The median cumulative liver age was significantly higher in the HOPE-treated (n=768) cohort than in the non-perfused (n=863) group (69 vs. 61 years, PPPP<0.001). Conclusions: HOPE treatment appears to mitigate the risks associated with transplanting elderly DBD livers, leading to excellent long-term survival in an ageing recipient population. These findings support broader adoption of HOPE to improve utilization of older donor livers and expand the donor pool.