Abstract:Hiatal hernia (HH) is highly prevalent in individuals with obesity and is closely associated with gastroesophageal reflux disease (GERD), making it a common and clinically important comorbidity in metabolic bariatric surgery (MBS). Currently, standardized diagnostic and therapeutic strategies for obese patients with different types of HH remain lacking. To improve the standardization and consistency of HH management during MBS in China, the Chinese Society for Metabolic and Bariatric Surgery, together with multiple academic societies, organized 93 national experts to develop a consensus based on the latest evidence and clinical experience. The consensus addresses 12 key issues, including preoperative evaluation, intraoperative diagnosis and differentiation, the necessity of dissecting tissues around the gastroesophageal junction, strategies for concomitant repair, procedure selection according to HH subtype, and reinforcement or fixation of the gastric sleeve. This consensus aims to provide evidence-based guidance for diagnosis, classification, procedure selection, and intraoperative management of HH in obese patients undergoing MBS. It also highlights the current limitations in available evidence and emphasizes the need for further high-quality studies to optimize future clinical guidelines.

Abstract:In recent years, the scale of extracranial carotid artery stenting (CAS) procedures in China has continued to expand. Establishing a scientific quality evaluation system, optimizing standardized surgical workflows, and effectively improving the survival quality of patients with carotid stenosis and occlusive diseases have become urgent challenges in the field of vascular surgery. After thorough discussions by the Expert Working Group on Carotid Artery Diseases of Expert Committee of the National Center for Medical Quality Control in Peripheral Vascular Interventional Technology, seven safety indicators were proposed: risk-adjusted 30-day postoperative mortality, risk-adjusted non-rehabilitative discharge rate, risk-adjusted in-hospital stroke/transient ischemic attack incidence, risk-adjusted 30-day unplanned carotid reintervention rate, risk-adjusted postoperative acute coronary syndrome incidence, risk-adjusted acute kidney injury incidence, and risk-adjusted access vessel reintervention rate. In addition, five technical indicators were established: pre- and postoperative antiplatelet medication use rate, preoperative carotid stenosis assessment rate, preoperative intracranial vascular evaluation rate, preoperative coronary artery assessment rate, and intraoperative cerebral protection device utilization rate. The promotion of these key quality indicators is expected to enhance the consistency of CAS surgical quality across medical institutions of different levels and regions.