Preoperative weight loss resulted in higher postoperative weight loss at 1 year and in shorter operative times with LRYGBP. No differences in correction of co-morbidities or complication rates were found with preoperative weight loss in this study. Preoperative weight loss should be encouraged in patients undergoing bariatric surgery.

Differences in training background of the surgeons resulted in significant differences in outcome, including EBL, LOS, ICU admission and intraoperative and late complication rates. Lower assistant training levels significantly impacted efficiency through lengthened operative times and increased EBL, as well as increased intraoperative complication rates and re-admission rates. Our results suggested that participating in a laparoscopic fellowship and operating with a more experienced assistant may improve outcomes during the learning curve.

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Orogastric tube complications can occur during laparoscopic RYGBP, but are seldom reported and can be associated with significant morbidity. Treatment options are dependent upon the situation. More importantly, prevention strategies must include constant communication with the anesthesiologist and removal or manipulation of an OGT prior to stapling or suturing, use of large bore OGTs for increased visual or tactile recognition, retraction of the OGT proximal to the anastomosis during gastrojejunal construction and employing alternatives to esophageal temperature probes (i.e. Foley temperature probes).

Introduction There are varied approaches for conducting varicocelectomy and penile venous surgery, which are not unified or conspicuously, being not above controversy in the later type either in methodology or routes for accessibility thus far. Objective We sought to present this innovative method in a novel combination of a physiological penile venous stripping and bilateral varicocelectomy via a single longitudinal pubic wound on an ambulatory basis. Methods From July 2012 to December 2021, 63 consecutive patients underwent this combined surgery. Primary diagnosis tools are dual cavernosography and doppler sonography. A 4-5cm longitudinal pubic incision is two-thirds above the penile pubic fold. A blunt dissection maneuver using a hemostat or finger creates a space between the Colles' and Buck's fascia. The entire penis is then released with an inside-out maneuver resulting in Buck's fascia being exposed exclusively, followed by firmed ligation of every emissary vein of the corpora cavernosa via 6-7 open-to-open schemes on Buck's fascia, subsequently stripping of the deep dorsal vein (DDV) and paired cavernosal veins (CVs). In contrast, the para-arterial veins are just ligated segmentally. Reduction of the penis is made after Buck's openings are repaired with not too tight square knots with 6-0 nylon. The stripping of the DDV and CVs is completed after 125-137 ligatures until the infra-pubic angle. Finally, the spermatic cord is hooked below the inguinal canal outlet level. On each side of the varicocele, ligation of 8-11 spermatic veins is macroscopically performed at no expense of ruining all other tissues, even the fragile lymphatic vessel. Then meticulous repair is obtained layer by layer. This novel approach is likely the most appropriate method for making a milking maneuver which is helpful in vascular differentiation on both corpora cavernosa and pampiniform plexus during the entire procedure to prevent residual veins from offensive. Results The average follow-up period is 5.3±0.5 years. There is a significant (9.6±2.7 vs. 20.9±2.3; P<0.01) between the preoperative and postoperative IIEF-5 scores. So does the EHS scale (1.6±0.3 vs. 2.9±0.3; P<0.01) between the preoperative and postoperative status. The radiopacity was unexceptionally enhanced postoperatively. Although the intracorporeal retention and erection quality improvement were unexceptional, the satisfaction rate is just 71.4% (45/63). Penile length resumed 3.5 months postoperatively, although two patients initially complained about 1-2 cm postoperative shortage. Conclusions From the physiology viewpoint, we would like to recommend this promising method with which the shortcut to express. Disclosure No