The open, laparoscopic, and robotic approaches to distal pancreatectomy offer particular advantages for well-selected patients and specific clinicopathological contexts; therefore, clearly demonstrating the most suitable use and superiority of one technique over another remains challenging.

Background The latest studies on surgical and cost-analysis outcomes after laparoscopic distal pancreatectomy (LDP) highlight mixed and insufficient results. Conclusions In response to the recent considerable controversy surrounding the costs and surgical outcomes of LDP vs. ODP, our results show that LDP for PNETs is cost-neutral and significantly reduces postoperative morbidity without compromising oncologic outcomes and survival.

We recommend caution in using mesh when performing a ventral hernia repair with a simultaneous bowel resection because of significantly increased postoperative infectious complications. Drain use, defect size, and bowel resection type did not influence outcomes.

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Perioperative risk factors for prolonged OpTime and hospital LOS are relatively consistent across open, laparoscopic, and robotic approaches to PD. Particular attention to these factors may help identify opportunities to improve perioperative quality, enhance patient satisfaction, and ensure an efficient allocation of hospital resources.

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PURPOSE ALT is used to detect NAFLD and has been associated with increased risk of metabolic syndrome and T2DM. Bariatric procedures result in significant weight-loss and a rapid resolution of T2DM. We aimed to study the impact of bariatric interventions on ALT levels in patients with or without T2DM, and compare this effect between different types of weight-loss procedures. METHODS We reviewed 756 patients undergoing bariatric surgery. Demographics, co-morbidities, baseline and postoperative ALT and HbA1C levels, weight-loss data and diabetes status were recorded. ALT levels were compared between different procedures and between diabetics and non-diabetic patients. Chi-square test, ANOVA and t-test were used to evaluate outcomes. RESULTS Males and diabetics had significantly higher ALT at baseline. Both RYGB and LAGB resulted in significant reduction in ALT levels beginning at the 3rd postoperative month (20% and 17% respectively compared to baseline, p<0.001). ALT remained at the new low level up to year-3 after surgery. The degree of reduction was similar for both procedures and independent of the degree of weight-loss. In diabetics, ALT reduction was associated with improvement in disease but in T2DM patients who remained on insulin, ALT remained elevated. CONCLUSIONS RYGB and LAGB decrease ALT levels to the same degree and independent of weight loss. Our data confirm higher ALT in diabetics and demonstrate a rapid normalization after bariatric surgery with a simultaneous decrease in HbA1C. These results suggest that ALT may be used as a marker of metabolic improvement after bariatric surgery.