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Introduction: The use of mesh for paraesophageal hernia repair is controversial due to concerns about long-term complications. This study aimed to investigate whether preoperative imaging characteristics of diaphragmatic hernia could predict the need for mesh repair. Methods: The records of all patients who underwent laparoscopic diaphragmatic hernia repair between September 2015 and September 2022 were reviewed. Patients' preoperative computerized tomography (CT) imaging was reviewed and was correlated with mesh repair. Results: A total of 53 patients were included in the study. Volumetric measurements were obtained from preoperative CT scans to assess hiatal defect area (HDA) and hernia sac volume (HSV). Mesh repair was required in 43.4% of cases, all among types II–IV. The mesh repair group had a higher mean hiatal neck height (50.8 ± 16.35 versus 43.22 ± 17.08 mm, P < .032) and higher HSV (708.53 ± 577.6 versus 346.866 ± 321.65 cm3, P < .003). There was also a borderline difference in HDA mean values (23.78 ± 17.22 versus 16.8 ± 10.41 cm2, P < .059). Conclusions: Preoperative HSV on CT scans can be a valuable predictor for the need for mesh repair during hiatal hernia surgery, aiding surgical planning and decision-making. Further research is needed to validate these findings and optimize hernia repair outcomes. [ABSTRACT FROM AUTHOR]

Background: Post-bariatric surgery hypoglycemia has been previously reported. However, its prevalence remains uncertain due to variability of diagnostic criteria, types of bariatric procedures and possible lack of awareness. Objective: To determine the frequency and severity of symptomatic and asymptomatic hypoglycemia in persons following 3 different surgical procedures ≥ 1 years before evaluation, and a group of non-operated obese persons. Design and Setting: Observational cohort study conducted at an out-patient clinic. Fifty-one consecutive individuals were enrolled: post Roux-en-Y gastric bypass (RYGB) (n=16), post omega loop gastric bypass (OLGB) (n=12), post sleeve gastrectomy (SG) (n=15), obese persons prior to surgery (controls) (n=8). Hypoglycemic events (blood glucose ≤ 54 mg/dL) and severe hypoglycemia (blood glucose ≤ 40 mg/dL) were evaluated by: symptoms' questionnaire, mixed meal tolerance test (MMT) and continuous glucose monitoring (CGM). Results: According to questionnaires, meal-related complaints were reported in 11 (26%) of the surgical group and 1/8 of controls. During MMT, 88%, 82% and 67% experienced hypoglycemia in the RYGB, OLGB and SG groups respectively, vs. none in the controls (P < 0.001). Severe hypoglycemia occurred in 38%, 45% and 7% of the RYGB, OLGB and SG groups respectively, (P= 0.025) but only 10 of the total operated group (24%) reported any symptoms. During CGM, fasting hypoglycemic events occurred more in the RYGB and OLGB vs. the SG group: 55%, 63% vs.17% respectively, (P= 0.036). Conclusions: Post-bariatric surgery hypoglycemia is a very common phenomenon after 3 types of bariatric surgery and can be severe especially following bypass procedures. Intriguingly, our results show that hypoglycemia occurs not only in postprandial but also in fasting state, especially following bypass procedures. In many cases there were no specific complaints that may lead to underestimation of this serious complication. Disclosure: H. Knobler: Advisory Panel; Self; AstraZeneca, Novo Nordisk A/S. L. Lazar: None. S. Sapojnikov: None. G. Pines: None. E. Mavor: None. V. Ostrovsky: None. T. Schiller: Advisory Panel; Self; Novo Nordisk Inc., Sanofi-Aventis. T. Zornitzki: None. [ABSTRACT FROM AUTHOR]

Objective: Feasibility of diagnosis of pneumothorax using handheld ultrasound by non-radiologists shows inconsistent results. The aim of this study is to evaluate the feasibility and accuracy of portable ultrasound for immediate diagnosis of pneumothorax by general surgery residents who underwent short training., Methods: Patients who presented to the emergency department of a university hospital with suspected pneumothorax between 10/2018 and 12/2019 were included in the study. Patients underwent ultrasound in 2 points of each hemithorax. Sensitivity and specificity for pneumothorax diagnosis by ultrasound and physical examination were calculated and compared with chest computed tomography (CT). Patients in whom a chest tube was placed prior to ultrasound examination and those who did not undergo a CT scan were excluded from the study., Results: A total of 85 patients met the inclusion criteria. Mean age was 40.7 ± 20.2 years. Pneumothorax was found among 46 patients (54%) per chest CT, and of these, 21 (46%) underwent chest tube placement following imaging. Ultrasound showed the highest sensitivity and specificity (95.6% [95% confidence interval {CI} 85.16% to 99.47%] and 97.44% [95% CI 86.40% to 99.67%], respectively). Chest x-ray had the lowest sensitivity (47.8% [95% CI 32.89% to 63.05%]) for pneumothorax detection. Physical examination showed a moderate sensitivity and specificity (82.6% [95% CI 68.58% to 92.18%] and 77.89% [95% CI 60.67% to 88.87%], respectively) for the diagnosis of pneumothorax., Conclusions: We found high accuracy rates of 2-point ultrasound in immediate pneumothorax diagnosis when performed by surgical residents who underwent a short ultrasound training. This is a fast and repeatable test, and has the potential for successful implementation in prehospital and military scenarios as well, minimizing unnecessary chest tube placements.

Chyle fistula is a challenging complication following neck dissection carrying a high morbidity and mortality rate. Herein we present a challenging case of successful management of high-output left-sided cervical chyle fistula with negative-pressure vacuum (VAC) therapy in a case where all conservative treatments failed. A 40-year-old man with lymphoma and supraglottic carcinoma underwent endoscopic resection and bilateral neck dissections. He developed high-output chyle fistula, nonresponsive to conservative treatments. Double-layered Vicryl mesh was placed between the sponge and the jugular vein to prevent vascular injury. Immediately after initiation of the VAC therapy, the output decreased, and completely stopped after 3 days. The VAC therapy was continued for additional 5 days to ensure complete seal of the fistula by granulation tissue, by which time the wound was primarily closed. VAC therapy seems to be a safe and effective treatment for high-output cervical chyle fistula following neck dissection, avoiding complex surgical interventions. Thoracic surgeons should be aware of this low-morbidity and potentially effective treatment modality for this challenging complication.