Background: s/Aims: Postoperative pancreatic fistula (POPF) remains a significant complication following pancreatoduodenectomy (PD). It has been hypothesized that single loop (SL) reconstruction may increase the risk of POPF, leading to the proposal of double-loop (DL) reconstruction. In this approach, the pancreatic duct is connected to an isolated loop of bowel in a Roux-en-Y configuration. Methods: We conducted a retrospective multicenter study to compare various types of reconstruction after PD, analyzing data from 1,502 patients who underwent open, laparoscopic, or robotic PD across 28 centers worldwide. Propensity score matching (PSM) was applied to enhance comparability. Results: The overall rate of POPF was 34.89%, with a grade C POPF rate of 4.26%. The type of reconstruction (SL vs. DL) did not significantly impact the rates of POPF or grade C POPF, both before and after PSM. The rate of delayed gastric emptying (DGE) was 20.71%, and patients with DL reconstruction had a lower incidence of DGE both before and after PSM. Conclusions Our study found no significant differences in the risk of POPF between SL and DL reconstruction. However, DL reconstruction is associated with a reduced risk of DGE, suggesting it may be a preferable option following open PD.

The electrocardiogram (ECG) is a non-invasive and cost-effective screening tool that is widely available and has been incorporated into many pre-participation screening programs for athletes. Despite historical criticisms regarding its suboptimal specificity, which could impact cost-effectiveness, the ECG remains a fundamental diagnostic method. Over the last 2 decades, significant research has focused on distinguishing pathological from physiological ECG patterns, the latter associated with the "athlete’s heart". The most recent guidelines for ECG interpretation in athletes include the International Criteria, published in 2017, which categorize ECG findings into common (training related), uncommon (training unrelated), and a "borderline" sub-group, with findings that do not necessitate further investigation when isolated. Premature ventricular beats (PVBs), although often overlooked, are a frequent cause of secondary investigations in athletes, especially when detected during exercise testing. Recent advances over the past decade have refined diagnostic methodologies, placing greater emphasis on morphological features, exercise relationships, and reproducibility, rather than solely on the count of PVBs. This evolution aims to enhance stratification for further investigations, such as cardiac magnetic resonance, which is crucial within this updated diagnostic framework, as it identifies pathologies causing sudden cardiac death during exercise. This review aims to provide a modern revision of the interpretation of ECGs and PVBs, incorporating a historical excursus to trace the evolution of these criteria. It is designed to offer clinicians a practical key for enhanced diagnostic precision in athlete screenings, reflecting both past insights and current advances.

The electrocardiogram (ECG) is a non-invasive and cost-effective screening tool that is widely available and has been incorporated into many pre-participation screening programs for athletes. Despite historical criticisms regarding its suboptimal specificity, which could impact cost-effectiveness, the ECG remains a fundamental diagnostic method. Over the last 2 decades, significant research has focused on distinguishing pathological from physiological ECG patterns, the latter associated with the "athlete’s heart". The most recent guidelines for ECG interpretation in athletes include the International Criteria, published in 2017, which categorize ECG findings into common (training related), uncommon (training unrelated), and a "borderline" sub-group, with findings that do not necessitate further investigation when isolated. Premature ventricular beats (PVBs), although often overlooked, are a frequent cause of secondary investigations in athletes, especially when detected during exercise testing. Recent advances over the past decade have refined diagnostic methodologies, placing greater emphasis on morphological features, exercise relationships, and reproducibility, rather than solely on the count of PVBs. This evolution aims to enhance stratification for further investigations, such as cardiac magnetic resonance, which is crucial within this updated diagnostic framework, as it identifies pathologies causing sudden cardiac death during exercise. This review aims to provide a modern revision of the interpretation of ECGs and PVBs, incorporating a historical excursus to trace the evolution of these criteria. It is designed to offer clinicians a practical key for enhanced diagnostic precision in athlete screenings, reflecting both past insights and current advances.