Metabolic-bariatric surgery(MBS)has become an important treatment for pathological obesity and metabolic diseases.However,common postoperative nutritional complications—such as protein-energy malnutrition,iron deficiency anemia,and vitamin B12 deficiency—significantly affect patients' long-term prognosis.Traditional nutritional management models rely on static monitoring and standardized supplementation,which are insufficient to address individual variability and dynamic postoperative changes.Artificial intelligence(AI),through integrating multimodal data(such as biochemical indicators,imaging information,and wearable device monitoring)and intelligent modeling,offers new approaches for dynamic monitoring,risk prediction,and personalized intervention.Based on literature from 2017 to 2025,this article systematically evaluates the application of AI in perioperative nutritional management for MBS,covering key technologies including machine learning,deep learning,and natural language processing.It also analyzes current challenges in clinical translation,such as data fragmentation,lack of model interpretability,and limited long-term validation.In the future,enhanced multi-center collaboration,the development of standardized databases,and explainable models will be essential to advancing nutritional management in MBS from empirical practice to precision medicine.

With the rising incidence of hiatal hernia and gastroesophageal reflux disease,surgical techniques urgently require refinement to improve patient outcomes.Guided by the concept of"anatomical priority",Professor Chen Shuang's team has established a standardized seven-step laparoscopic protocol,emphasizing three key components:precise dissection of the"sacred plane",three-dimensional crural reconstruction,and tension-controlled fundoplication.To address limitations such as restricted intraoperative visualization and poor reproducibility,the team further developed the innovative"necktie traction technique".This method employs a red pediatric catheter to create a dynamic traction system,enabling directional field exposure,axial esophageal repositioning,and quantitative control of fundoplication.Integrating biomechanical principles,the technique provides a visualized and standardized operative pathway,significantly enhancing surgical safety,efficacy,and reproducibility.As a novel approach combining anatomical restoration with functional anti-reflux reconstruction,the"necktie technique"offers robust technical support for the standardized promotion of laparoscopic anti-reflux surgery.

Retroperitoneal sarcoma is a rare but highly malignant type of soft tissue tumor,and its diagnosis and treatment have long been focal points in clinical research.In December 2021,the Japanese Society for Sarcoma Research,together with several other medical organizations,published the Clinical practice guidelines for the management of retroperitoneal sarcoma,which were revised in April 2023.The guidelines provide recommendations on three key aspects:the diagnosis of retroperitoneal tumors,treatment of primary retroperitoneal sarcomas,and management of recurrent or unresectable cases.They also address 11 clinical questions derived from these topics and,for the first time,present a systematic diagnostic and treatment algorithm for this disease—offering important reference value for standardizing the management of retroperitoneal sarcoma in China.The diagnostic process includes assessment of clinical features,imaging evaluation,pathological diagnosis,and biopsy.Despite the technical challenges,surgical resection remains the mainstay of treatment,with a particular emphasis on achieving R0 resection.In addition,chemotherapy,radiotherapy,particle therapy,and targeted therapy also play crucial roles.This article focuses on analyzing and discussing the guideline's recommendations on imaging,pathological diagnosis,and surgical resection,in comparison with other domestic and international guidelines.It further explores the effectiveness of current non-surgical treatment strategies based on recent advances in particle and immunotherapy,and looks ahead to the prospects of improving patient outcomes through personalized treatment,multimodal therapy,and multidisciplinary collaboration.

Background and Aims:Polycystic ovary syndrome(PCOS)is a common endocrine disorder among obese women,often accompanied by psychological issues such as anxiety and depression.Laparoscopic sleeve gastrectomy(LSG)is an effective treatment for obesity and its related metabolic conditions,and has shown clear benefits in improving weight and metabolic profiles in PCOS patients.However,the potential mechanisms by which psychological status may affect weight loss outcomes remain unclear.This study aimed to evaluate the psychological characteristics of obese patients with PCOS and explore their impact on postoperative weight loss outcomes,in order to provide evidence for individualized intervention strategies.Methods:Female obese patients scheduled for LSG between November 2020 and September 2022 were enrolled and divided into PCOS and non-PCOS groups.Standardized psychological scales were used to assess anxiety,depression,self-esteem,and eating behaviors.Weight loss outcomes were recorded at 6 and 12 months postoperatively.Propensity score matching was used to control for confounding factors such as age and body mass index(BMI),and correlation analysis was conducted to explore the relationship between psychological status and weight loss outcomes.Results:A total of 314 patients were included,with 130 cases(41.4％)in the PCOS group.Before matching,the PCOS group had significantly worse psychological indicators and lower weight loss outcomes compared to the non-PCOS group(all P＜0.05);after matching,these differences were no longer statistically significant(all P＞0.05).Emotional eating was positively correlated with 12-month weight loss outcomes in the PCOS group,while anxiety and internalized weight stigma were associated with weight loss outcomes in the non-PCOS group(P＜0.05).Additionally,among patients with moderate and extreme obesity,weight loss outcomes in the PCOS group were superior to those in the non-PCOS group(P＜0.05).BMI was negatively correlated with self-esteem,eating behaviors,and quality of life(all P＜0.05).Conclusion:Obese patients with PCOS exhibit notable psychological distress.However,after controlling for BMI and age,their psychological status and weight loss outcomes are comparable to those of non-PCOS patients.BMI may serve as an important confounding factor,and psychological factors may influence weight loss indirectly through eating behaviors.Preoperative psychological screening and intervention are recommended.

Mucinous gastric adenocarcinoma(MGC)is a distinct but under-researched subtype of gastric cancer,accounting for approximately 2.2％to 6.8％of all cases.It is characterized by the presence of ≥50％extracellular mucin within the tumor tissue.Although recognized as an independent subtype by international classification standards,significant controversies persist regarding the definition criteria,clinical prognosis,and treatment strategies of MGC.This article systematically reviews the epidemiological features,histological evolution,molecular mechanisms,and imaging characteristics of MGC,with a particular focus on the key issues related to definitional discrepancies,prognostic contradictions,and therapeutic challenges.Addressing these issues may provide references for optimizing clinical diagnosis and treatment,promote the development of individualized therapeutic strategies for MGC,and offer theoretical support for reducing global disparities in gastric cancer management.

The surgical approach for hiatal hernia repair with anti-reflux procedures has transitioned from traditional open thoracotomy to the era of minimally invasive techniques.In recent years,laparoscopic surgery has been widely applied in hiatal hernia repair.Robotic-assisted hiatal hernia repair represents an important trend in the development of minimally invasive surgery for this condition and has seen rapid progress in recent years.However,there is currently no definitive guideline for clinical practice.To further standardize the robotic surgical treatment of hiatal hernia,the Expert Working Group of Gastroesophageal Reflux Disease of Surgeons Society of Chinese Medical Doctor Association,building upon the 2023 consensus,took the lead in organizing domestic experts in related fields to review relevant literature from both China and abroad,discuss key issues and challenges,and formulate the 2024 edition of the expert consensus.This resulted in the publication of the"Chinese expert consensus on robotic-assisted hiatal hernia repair with anti-reflux surgery in adults(2024 Edition)",which aims to provide guidance and reference for the continued advancement of robotic hiatal hernia surgery in China.

Based on the"Laparoscopic standardized seven-step surgical procedure guidelines for hiatal hernia and gastroesophageal reflux disease(GERD)(2021 edition)",this guideline updates the evidence-based evidence from the past four years.It aims to provide standardized and homogenized guidance for the surgical treatment of GERD and hiatal hernia.The guideline elaborates on preoperative examination,surgical indications,contraindications,preoperative preparation,surgical steps,postoperative management,and follow-up.The surgical procedure follows a seven-step approach,which includes placement of trocars,abdominal cavity exploration,mobilization of the abdominal esophagus,closure of the hiatal defect,reinforcement of the diaphragmatic crura with mesh fixation,construction of the anti-reflux valve mechanism,irrigation of the operative field and closure of port sites.The guideline emphasizes the importance of preoperative multidisciplinary evaluation,individualized surgical planning,and management of postoperative complications,aiming to enhance the safety and effectiveness of surgery,reduce postoperative complications,and improve the patient's quality of life.

Obesity,as a major global public health issue,has seen effective improvements in body weight and metabolic disorders through bariatric-metabolic surgeries such as Roux-en-Y gastric bypass(RYGB)and sleeve gastrectomy(SG).However,the management of postoperative complications remains a significant clinical challenge.Gastrointestinal leakage/fistula is one of the more severe complications,and current endoscopic treatment options include stent placement,double-pigtail stent internal drainage,over-the-scope clips,endoscopic suturing,tissue adhesive sealing,negative pressure drainage systems,and gastric wall incision.The combination with laparoscopic techniques can further enhance treatment efficacy.For SG-related torsion or stenosis,endoscopic balloon dilation is the first-line approach.In refractory cases,additional therapies such as endoscopic radial incision or modified gastric peroral endoscopic myotomy(G-POEM)may be required.G-POEM offers particular advantages in treating non-spiral stenosis but remains limited in practice due to technical complexity.Postoperative gastrointestinal bleeding requires stratified management:thermal coagulation or hemostatic clips can be used in acute bleeding;marginal ulcer bleeding at the gastrojejunostomy site after RYGB responds well to endoscopic treatment,while bleeding at the jejunojejunostomy site often requires enteroscopy or reoperation.Anatomical changes after RYGB increase the complexity of managing common bile duct stones.Among improved endoscopic retrograde cholangiopancreatography(ERCP)techniques,endoscopic ultrasound-guided transgastric ERCP has emerged as a minimally invasive and efficient option,though its long-term safety remains to be fully validated.For patients experiencing weight regain,endoscopic interventions include endoscopic sleeve gastroplasty and transoral outlet reduction(TORe),with TORe offering the dual benefits of narrowing the anastomosis and relieving dumping syndrome.The risk of gastroesophageal reflux disease increases after SG;balloon dilation can relieve reflux caused by anatomical stenosis,while emerging techniques such as anti-reflux mucosal resection and anti-reflux mucosal ablation are still under exploration.In refractory GERD cases,conversion to RYGB remains the mainstream solution.Overall,endoscopic techniques have significantly reduced reoperation rates through diverse strategies,but a balance must be maintained between procedural complexity and long-term efficacy.Future efforts should focus on device innovation,standardization of procedures,and multidisciplinary collaboration to improve the comprehensive management of complications following bariatric-metabolic surgery.

Obesity has become a global public health crisis,attracting significant attention due to its association with metabolic syndrome,cardiovascular diseases,type 2 diabetes,and various cancers.Bariatric-metabolic surgery,as a long-term effective method for weight management,can significantly reduce visceral and subcutaneous fat,improving metabolic health.However,it is also crucial to recognize the postoperative decline in muscle mass and bone density,which can lead to a series of related issues,adversely affecting patients' physical health and quality of life.Given this complex clinical reality,research on postoperative body composition changes becomes particularly important.Here,the authors systematically summarize the characteristics of body composition changes at different stages after bariatric-metabolic surgery,delves into the clinical significance of body composition loss,and provides a forward-looking perspective on the future development of this field,aiming to develop more scientific and reasonable postoperative management strategies for clinical practice.

Background and Aims:Approximately 20％-25％of individuals experience insufficient weight loss(IWL)or weight regain(WR)after bariatric surgery.However,there is limited research on using semaglutide in this patient population,and its efficacy and safety remain to be confirmed.Therefore,this study was conducted to evaluate the effectiveness and safety of semaglutide in patients with IWL or WR after bariatric surgery through a systematic review to provide evidence to support clinical decision-making.Methods:A comprehensive search was conducted across multiple domestic and international databases for studies using semaglutide in patients with IWL or WR after bariatric surgery.The search period was from the database's inception to July 1,2024.Relevant studies were screened according to inclusion and exclusion criteria,and data were analyzed using Stata 14.0 software.Results:A total of 5 retrospective studies were included,encompassing 289 patients who received semaglutide treatment after bariatric surgery.The analysis showed that,compared to baseline,semaglutide use resulted in an average total weight reduction of 10.66％(MD=10.66％,95％CI=6.47％-14.89％);body mass index decreased by 3.57 kg/m2(MD=3.57 kg/m2,95％CI=2.46-4.67 kg/m2);the type of surgery did not significantly affect the degree of weight loss(P＞0.05).The proportion of patients who experienced＞5％weight loss was 80％(OR=0.80,95％CI=0.76-0.85);＞10％weight loss was observed in 45％of patients(OR=0.45,95％CI=0.41-0.50);and＞15％weight loss occurred in 18％of patients(OR=0.18,95％CI=0.08-0.27).Most patients had undergone sleeve gastrectomy(69.8％).There was no significant difference in HbA1c levels before and after treatment(P＞0.05).The incidence of adverse events was 14％(OR=0.14,95％CI=0.01-0.28),primarily gastrointestinal side effects.Conclusion:Semaglutide can significantly reduce body weight in patients with IWL or WR after bariatric surgery,with a relatively low incidence of adverse effects.It may be considered for patients who experience suboptimal weight loss following bariatric surgery.However,further prospective and large-scale clinical studies are needed to confirm these findings.