Metabolic bariatric surgery（MBS） is the preferred and most effective treatment for severe obesity complicated by metabolic diseases. However, the postoperative incidence of "suboptimal weight loss （suboptimal clinical response） and weight recurrence" is 20%-35%, which has become a major challenge in metabolic bariatric surgery. At present, the two major international authoritative organizations—the International Federation for the Surgery and Other Therapies for Obesity（IFSO） and the American Society for Metabolic and Bariatric Surgery（ASMBS）—have significant differences in the terminology and quantitative definitions of these two outcomes.In addition, no unified standard has yet been established regarding the indications for endoscopic intervention, anti-obesity pharmacotherapy, and revisional surgery, as well as the selection of specific procedures. Based on the 2023-2026 IFSO Delphi consensus, the latest 2026 ASMBS statement, and evidence from international expert Delphi studies, this article systematically reviews the differences in the definitions of these two adverse outcomes, compares the efficacy and safety of various revisional procedures with a focus on sleeve gastrectomy and Roux-en-Y gastric bypass, discusses the role of endoscopic intervention in stepwise treatment, and summarizes the appropriate populations and efficacy evidence for weight-loss medications, thereby providing evidence-based guidance for clinical stratified management.

Obesity imposes a major global public health burden. As an effective treatment for obesity, metabolic bariatric surgery has seen a steady increase in procedure volume. In recent years, with continuous optimization of clinical practice models and advances in mechanistic research, metabolic bariatric surgery has become an increasingly indispensable component of obesity management. However, its development still faces several challenges, including supply-demand imbalance, misperceptions between patients and physicians, and delayed database development. By analyzing the current status of metabolic bariatric surgery and examining the impact of issues arising during its development, such as pharmacotherapy, endoscopic weight-loss techniques, and patient-physician cognitive bias, as well as summarizing shortcomings in management and database construction, this article provides a theoretical basis for the development of metabolic bariatric surgery in China and for overcoming current bottlenecks, thereby promoting its greater role in weight management.

The clinical benefits of metabolic bariatric surgery have expanded from weight control to the alleviation of metabolic comorbidities and protection of target organs. Patients with obesity often have metabolic dysfunction-associated steatotic liver disease （MASLD） and its progressive form, metabolic dysfunction-associated steatohepatitis（MASH）, while the degree of liver fibrosis reflects persistent metabolic inflammatory burden and long-term hepatic risk. A study by the authors' team based on a liver biopsy cohort of 417 patients undergoing sleeve gastrectomy showed that baseline MASH did not affect proportional weight loss at 12 months after surgery, whereas the stage of liver fibrosis was associated with achievement of individualized weight-loss goals.These findings suggest that short-term weight-loss efficacy and long-term hepatic risk should be evaluated separately.Drawing on domestic and international guidelines, representative clinical trials, and studies from the authors' team, this article reviews preoperative stratification of MASLD/MASH, procedure selection and perioperative management, postoperative follow-up, and the sequential relationship between medication and surgery.It also proposes clinical decision-making pathways for low-,intermediate-,and high hepatic risk patients, with the aim of providing a reference for comprehensive management throughout the course of metabolic bariatric surgery.

One-anastomosis gastric bypass（OAGB） is one of the internationally recommended bariatric and metabolic procedures and is associated with stable and durable weight-loss and glycemic control. However, its weight-loss efficacy comes at the inherent cost of an increased risk of malnutrition, requiring careful clinical balancing between these two outcomes.At present, postoperative malnutrition after OAGB remains a prominent issue, with a higher incidence than that observed after other mainstream bariatric procedures. This article systematically reviews the key contributing factors to malnutrition after OAGB,including biliopancreatic limb length, patient-related factors, and postoperative nutritional adherence, and summarizes recent advances in treatment, including nutritional supplementation, management of gastrointestinal symptoms, and revisional surgery.The aim is to provide a reference for clinicians to balance weight-loss benefits against nutritional risks and to standardize the prevention and treatment of postoperative malnutrition.

As an important intervention for obesity, metabolic bariatric surgery can significantly improve obesity-induced metabolic dysfunction-associated steatotic liver disease（MASLD）.Its core mechanisms include postoperative caloric restriction, changes in gastrointestinal hormones,and alterations in the gut-liver axis. Although various types of metabolic bariatric surgery can, to some extent, alleviate hepatic fat accumulation as well as the progression of inflammation and fibrosis,differences still exist among procedures in terms of weight-loss efficacy and the degree of MASLD improvement.In addition, postoperative weight regain in some patients may weaken the protective effect on MASLD.Therefore, individualized procedure selection and long-term postoperative weight maintenance remain key areas for future research.

Objective To analyze the learning curve of 200 consecutive cases of three-port laparoscopic sleeve gastrectomy（TPLSG） performed by a single surgeon using a risk-adjusted cumulative sum（RA-CUSUM） model. Methods The complete clinical data of 200 patients who underwent consecutive TPLSG performed by the same bariatric surgical team with extensive experience in laparoscopic sleeve gastrectomy at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, from January 2018 to December 2020 were retrospectively collected. Traditional cumulative sum （CUSUM） curves were constructed using operative time and intraoperative blood loss as core indicators. An RA-CUSUM risk-adjusted model was constructed using postoperative complications of Clavien-Dindo grade ≥Ⅱ as the adverse outcome, with the risk offset coefficient set as R_A=2, ARL₀=1 000, and ARL₁=30. Based on the inflection points of the bilateral CUSUM curves, the entire cohort was divided into an initial learning phase, a proficiency phase, and a mastery phase. Differences in baseline characteristics, surgery-related indicators, postoperative complications, and length of hospital stay among the three groups were compared. Results Among the 200 included patients, two key inflection points identified by the complication-based RA-CUSUM curve were case 61 and case 114. Operative time in the initial learning phase was significantly longer than that in the proficiency and mastery phases （ [136.5±22.8] min, [98.3±16.4] min, and [76.2±12.1] min, P<0.001）. Intraoperative blood loss in the initial learning phase was greater than that in the proficiency and mastery phases （ [68.4±19.7] mL, [37.6±11.3] mL, and [21.5±8.6] mL,P<0.001）.Patients with a high body mass index （≥40 kg/m²） and severe sleep apnea were concentrated in the early cases, and the incidence of Clavien-Dindo grade ≥Ⅱ complications was significantly higher during this phase. In the proficiency phase, the upper RA-CUSUM curve fell back within the control limit, the procedures of greater curvature mobilization and stapling/anastomosis were standardized, and the complication rate approached the expected model level. In the mastery phase, the lower RA-CUSUM curve broke through the lower control limit, the overall curve remained stable with only minor fluctuations, the adjusted complication rate was lower than expected, and the postoperative length of hospital stay was the shortest. Conclusion After RA-CUSUM risk adjustment, the surgeon entered the proficiency phase after completing 61 TPLSG procedures and the mastery phase after 114 procedures. RA-CUSUM can eliminate confounding by baseline risk in obese patients and thereby distinguish the learning phases of TPLSG.

Objective To evaluate the short-term efficacy and safety of gastric bypass stents in the treatment of obesity and metabolic diseases. Methods A total of 40 patients with obesity who underwent gastric bypass stent placement at Zhongnan Hospital of Wuhan University from September 2024 to March 2026 were retrospectively included. All patients were included in the safety analysis, and 35 patients completed the planned 3-month stent indwelling period and were included in the primary efficacy analysis. Body weight changes from preoperative baseline to 1-6 months after surgery were analyzed. Changes in anthropometric measures, glucose and lipid metabolism, liver function, hepatic steatosis （quantitatively assessed by controlled attenuation parameter [CAP]）, and nutrition-related indicators were compared between preoperative status and 3 months after surgery. A linear mixed-effects model was used to analyze repeated measures of body weight. Results Body weight at all postoperative time points was significantly lower than preoperative levels （P<0.001）. At 3 months after surgery, the percentage of total weight loss（%TWL） was （10.79±3.33）%, and the percentage of excess weight loss （%EWL） was （52.73±27.72）%; at 6 months after surgery, %TWL and %EWL reached （14.51±4.91）% and （73.29±36.19）%, respectively. At 3 months after surgery, body fat percentage, waist circumference, hip circumference, and systolic blood pressure were all significantly reduced （all P<0.05）, whereas skeletal muscle percentage was significantly increased（P<0.001）. Glycemic indicators, including glycated hemoglobin, fasting blood glucose, fasting insulin, C-peptide, and homeostasis model assessment of insulin resistance, all improved significantly （all P<0.01）. CAP and transaminases, including alanine aminotransferase, aspartate aminotransferase, and γ-glutamyl transferase, all decreased significantly （all P<0.001）, but there was no statistically significant change in liver stiffness measurement. Total cholesterol and low-density lipoprotein cholesterol decreased significantly （P<0.05）, whereas triglycerides and high-density lipoprotein cholesterol showed no significant changes. Serum iron, ferritin, and hemoglobin levels decreased significantly at 3 months after surgery （P<0.05）, while vitamin B₁₂, folate, and 25-hydroxyvitamin D showed no obvious changes. In terms of safety, 17 of the 40 patients（42.5%） reported adverse reactions, mainly mild nausea, vomiting, and abdominal pain. In 5 patients （12.5%）, the stent was removed early because of serious adverse reactions such as upper gastrointestinal bleeding, severe abdominal pain, or hypocalcemic seizures. No serious adverse events such as liver abscess or perforation occurred. Conclusion Within the 3-month indwelling period, gastric bypass stents can effectively reduce body weight in patients with obesity and improve glucose metabolism, hepatic steatosis, and some lipid parameters; however, overall safety warrants further attention. Monitoring of iron metabolism indicators should also be strengthened. Their long-term efficacy and safety still need to be validated in larger-scale studies with longer follow-up.

Objective To analyze the clinical efficacy of single-incision laparoscopic sleeve gastrectomy via the midline approach with in situ resection of the gastric fundus and body. Methods A retrospective analysis was conducted on clinical data from 50 patients who underwent laparoscopic sleeve gastrectomy treated at Beijing Luhe Hospital, Capital Medical University, from February 2024 to June 2025. According to patients' subjective preferences and the surgical procedure they received, patients were divided into two groups:the control group （40 patients） received conventional multiport lateral approach surgery, and the study group （10 patients） received single-incision laparoscopic surgery via the midline approach. Outcomes included sex, age, preoperative height, weight, and body mass index, operative duration, intraoperative blood loss, changes in body mass index and percentage of excess weight loss （%EWL） at 1, 3, 6, and 12 months postoperatively, and gastroesophageal reflux disease questionnaire （GERD-Q） scores. Results No serious complications such as gastric leakage or intra-abdominal bleeding occurred in either group. The operative time was longer in the study group than in the control group （median:179.5 min vs 120.0 min, Z=-3.983, P<0.001）. There were no statistically significant differences between the two groups in age, intraoperative blood loss, postoperative weight loss magnitude （body mass index, %EWL）, or gastroesophageal reflux （GERD-Q score） （all P>0.05）. Conclusion Single-incision laparoscopic sleeve gastrectomy via the midline approach, despite a slightly longer median operative time, demonstrates good safety and efficacy. However, this was a small-sample retrospective study, and the conclusions remain preliminary and require further validation in large-sample prospective studies.

Objective To investigate the association of the controlling nutritional status（CONUT） score with postoperative complications and prognosis in patients with obstructive left-sided colon cancer. Methods Clinical data from 113 patients with obstructive left-sided colon cancer, diagnosed by imaging and pathology and treated in the Department of General Surgery of Beijing Chao-yang Hospital,Capital Medical University,from January 2017 to January 2021,were collected. According to the CONUT score, patients were divided into a high-CONUT group （CONUT≥2,66 cases） and a low-CONUT group （CONUT<2,47 cases）.Clinicopathological characteristics,postoperative complications, and prognosis were compared between the two groups. Results The incidence of postoperative complications was higher in the high-CONUT group than in the low-CONUT group （39.4% [26/66] vs 21.3% [10/47], P <0.05）. Multivariate analysis showed that a high CONUT score（OR=3.667,95%CI：1.397-9.625,P=0.008） and emergency surgery（OR=2.653,95%CI：1.101-6.392, P=0.030） were independent risk factors for postoperative complications. In terms of survival outcomes, compared with the low-CONUT group,the high-CONUT group had lower overall survival（74.1% vs 90.6%） and progression-free survival（64.6% vs 83.0%）. Conclusion A high CONUT score is associated with postoperative complications and survival prognosis in obstructive left-sided colon cancer. Patients with a high CONUT score（>2） have a higher incidence of postoperative complications and poorer survival outcomes.

Objective To characterize clinical features of pediatric primary intussusception and identify factors associated with recurrence following ultrasound‑guided hydrostatic enema reduction. Methods This retrospective study enrolled 713 children with primary intussusception treated at the Department of Pediatric Surgery, Mianyang Maternal and Child Health Hospital, between January 2020 and January 2024. Clinical data were summarized. Patients who underwent ultrasound-guided hydrostatic reduction （n = 524） were categorized by outcome into a recurrence group （n= 62） and a non‑recurrence group （n = 462）. Univariate and multivariate logistic regression analyses were used to determine independent predictors of recurrence. Results Among 713 patients, the male‑to‑female ratio was approximately 1.35∶1;the majority of cases occurred between ages 1 and <3 years. The most frequent presenting symptoms were abdominal pain/paroxysmal crying （91.44%, 652/713） and vomiting （75.88%, 541/713）. Ultrasound‑guided hydrostatic enema reduction was the predominant treatment （73.49%, 524/713）. Ultrasound measurements, including transverse "target" （concentric ring） diameter and longitudinal "pseudokidney/sleeve" sign length, showed no significant correlation with time from symptom onset to admission, but both were negatively correlated with intussusception type （r =-0.467 and -0.483, respectively; both P< 0.001）. The ileocecal （ileocolic） type was the most common subtype（54.28%, 387/713）. Multivariate logistic regression identified four independent risk factors for recurrence after ultrasound‑guided hydrostatic reduction:presence of hematochezia （OR=2.079; 95% CI：1.256-3.441）, higher body weight （OR = 1.990; 95%CI：1.265-3.129）, larger target‑sign diameter （OR = 2.143; 95%CI：1.392-3.298）, and longer pseudokidney/sleeve‑sign length （OR=2.123; 95% CI:1.440-3.130） （all P < 0.05）. Conclusion In this cohort, pediatric primary intussusception most commonly affected children aged 1 and <3 years,with abdominal pain/paroxysmal crying and vomiting as leading symptoms; ultrasound‑guided hydrostatic enema reduction was the mainstay of treatment. Concomitant hematochezia, greater body weight, and larger ultrasound‑measured target and pseudokidney/sleeve dimensions independently predicted recurrence after hydrostatic reduction.

Objective To investigate the feasibility and clinical efficacy of preserving the round ligament of the uterus using an L-shaped peritoneal incision in laparoscopic transabdominal preperitoneal hernia repair in female patients. Methods A retrospective analysis was performed on the clinical data of 54 female patients with inguinal hernia admitted to Wuhan No.1 Hospital from January 2022 to October 2025.According to the intraoperative peritoneal incision approach, patients were assigned to the L-shaped peritoneal incision group（28 cases） and the T-shaped peritoneal incision group（26 cases）. General characteristics,perioperative indicators, postoperative complications, and follow-up outcomes were compared between the two groups. Results All 54 patients successfully underwent surgery without conversion to open laparotomy. The operation time in the L-shaped peritoneal incision group（ [39.8±2.3] min） was shorter than that in the T-shaped peritoneal incision group（ [45.7±3.0] min）,with a statistically significant difference（t=-8.084, P<0.001）. The peritoneal closure time was also shorter in the L-shaped peritoneal incision group （5.0 [4.8, 6.0] min） than in the T-shaped peritoneal incision group（8.0 [8.0, 9.0] min）, with a statistically significant difference（Z=-5.250,P<0.001）.There were no statistically significant differences between the two groups in intraoperative blood loss or postoperative hospital stay（both P>0.05）.Postoperative complications were mainly seroma and labial edema. In the L-shaped peritoneal incision group,2 cases（7.1%） developed seroma; in the T-shaped peritoneal incision group, 4 cases（15.4%） developed seroma. No labial edema occurred in the L-shaped peritoneal incision group, while 1 case（3.8%） occurred in the T-shaped peritoneal incision group.These differences were not statistically significant（all P>0.05）.All patients completed follow-up, and there was no statistically significant difference in follow-up duration between the two groups（P>0.05）.No incision infection, chronic pain,or recurrence was observed in either group. Conclusion Both surgical approaches are safe and feasible for preserving the round ligament of the uterus in transabdominal preperitoneal hernia repair. Compared with the T-shaped peritoneal incision, the L-shaped approach shortens the operation time and peritoneal closure time and provides greater benefit to patients.

Objective To investigate the predictive value of preoperative inflammatory-nutritional indicators and tumor markers for the efficacy of neoadjuvant chemoradiotherapy（nCRT） in rectal cancer, and to construct and validate a nomogram model. Methods A retrospective analysis was performed on the clinical data of 296 rectal cancer patients who underwent radical surgery after nCRT at Cangzhou Central Hospital from January 2023 to June 2025. Preoperative inflammatory-nutritional indicators, tumor markers, and clinicopathological features were collected. According to postoperative tumor regression grade（TRG）,the treatment response was evaluated：TRG 0-1 was classified as the effective group（151 cases）, and TRG 2-3 as the ineffective group（145 cases）. Univariate and multivariate logistic regression analyses were used to identify independent predictive factors, on the basis of which a nomogram model was developed to assess its predictive performance and clinical value. Using a random number table method, patients were assigned to a training set（207 cases） and a validation set（89 cases） at a ratio of 7∶3 for internal validation. Results Univariate analysis showed that the effective and ineffective groups differed significantly in neutrophil-to-lymphocyte ratio （NLR）, systemic inflammatory response index, prognostic nutritional index, carcinoembryonic antigen, clinical N stage, and maximum tumor diameter （all P<0.05）. Multivariate analysis showed that all six indicators were independent predictors of nCRT efficacy：NLR （OR=0.542,95% CI：0.368-0.798,P=0.002）,systemic inflammatory response index（OR=0.485, 95%CI：0.312-0.754, P=0.001）, prognostic nutritional index （OR=2.145,95%CI：1.423-3.234,P<0.001）,carcinoembryonic antigen（OR=0.612,95%CI：0.432-0.867,P=0.006）,clinical N stage（OR=0.598,95%CI：0.423-0.846,P=0.004）,and maximum tumor diameter（OR=0.723,95%CI：0.536-0.976,P=0.034）.Before model construction, baseline characteristics were balanced between the training and validation sets,and the results confirmed effective balance.The nomogram model built on these indicators achieved area under the curve values of 0.842 in the training set and 0.825 in the validation set, with good calibration. Based on the model scores,patients were stratified into low-, intermediate-,and high-risk groups. In the training set, the nCRT response rates in these three groups were 73.91%（51/69）,52.94%（36/68）, and 34.29%（24/70）,respectively, and a consistent trend was observed in the validation set. Conclusion The nomogram model constructed from preoperative inflammatory-nutritional indicators and tumor markers can effectively predict the efficacy of nCRT in rectal cancer and may provide a reference for individualized treatment decision-making.

Biliary tract cancer（BTC） is a malignant tumor with a poor prognosis, and most patients have already lost the opportunity for surgery at the time of diagnosis. In recent years, immunotherapy has opened a new direction for BTC treatment. Immune checkpoint inhibitors（ICIs） are the most extensively studied area in BTC therapy. Among them, single-agent programmed death receptor 1/programmed death receptor ligand 1 inhibitors as later-line treatment have shown some, but limited, efficacy in patients with advanced disease. The key progress in BTC treatment lies in combination strategies:the global phase Ⅲ clinical trials TOPAZ-1 and KEYNOTE-966 established ICIs （durvalumab or pembrolizumab） combined with gemcitabine plus cisplatin chemotherapy as the new first-line standard for advanced BTC, significantly prolonging overall survival. In addition, combinations of ICIs with targeted agents, such as lenvatinib, as well as dual immune checkpoint blockade,have also shown preliminary promise.Other immunotherapies,such as tumor vaccines and adoptive cellular immunotherapy, have yielded some positive results in early exploration, but most remain in the clinical research stage, and their efficacy and safety still need to be confirmed by large-scale randomized controlled trials. In the future, the optimized combination of immunotherapy with chemotherapy, targeted therapy, and different immunotherapeutic approaches,together with biomarker-guided precision application, will be important research directions for improving the prognosis of patients with BTC.

Cholangiocarcinoma, especially hilar cholangiocarcinoma, is a highly complex surgical disease that depends heavily on expert resources. Owing to its low latency and highly reliable network connectivity, 5G-enabled telerobotic surgery allows remote experts to perform or guide delicate procedures and may help alleviate the uneven distribution of medical resources. his article breaks down the system setup of this tech （main control unit, network layer, and slave control unit）, how it's used and helpful for planning surgeries and remote operations for bile duct cancer, and highlights the main challenges right now, like network stability, force feedback, emergency safety setups, and non-technical hurdles like regulations. On this basis, the article points out that the integration of artificial intelligence, the tactile internet, and specialized robotic systems will be important future directions. At present, this technology remains in the exploratory stage. To move toward routine clinical application, further breakthroughs are still needed in technical reliability, clinical safety, and the development of a comprehensive supporting ecosystem.