Risk Factors for Adhesion-Related Readmission and Abdominal Reoperation after Gynecological Surgery: A Nationwide Cohort Study

Comparative outcomes of Palmer, Umbilical Veress needle, and open entry techniques in robotic-assisted surgery: a propensity-matched analysis of 9482 patients

Robotic-assisted surgery offers several advantages over traditional methods, such as reduced blood loss and fewer complications. Establishing pneumoperitoneum is a critical step, with two primary techniques: the Veress needle (closed) and the Hasson (open) technique. Despite extensive studies in laparoscopic surgery, limited data exist regarding their use in robotic surgery. This study compares complication rates and predictors between Palmer, umbilical Veress needle, and open Hasson techniques in robotic surgery. In this retrospective cohort study of 9482 patients undergoing robotic surgery, we compared palmer, umbilical Veress needle, and Open Hasson techniques using propensity score matching. Primary outcomes were complication rates classified by the Clavien-Dindo system. We used logistic regression to analyze predictors of complications, such as needle attempts and adhesions. One thousand sixteen patients were matched between Palmer and umbilical groups and 310 between Veress needle and open groups. Umbilical insertion was associated with more complications than Palmer (OR 2.14, p = 0.033). Patients requiring more than four needle attempts had higher complication rates (OR 15.43, p = 0.002). Severe adhesions significantly increased complications. After adjustment, the choice of entry method was not independently associated with complications. Surgical entry complications in robotic-assisted surgery are more influenced by needle attempts and adhesions than by the choice of entry technique. Tailoring surgical plans based on patient characteristics and minimizing needle attempts can improve outcomes, underscoring the importance of individualized approaches over standardized methods.

Genome-wide association study on chronic postsurgical pain after abdominal surgeries in the UK Biobank

INTRODUCTION

Chronic pain is one of the most common and severe complications after surgery, affecting quality of life and overall wellbeing of patients. Several risk factors have been identified but the mechanisms of chronic postsurgical pain development remain unclear. This study aimed to identify single-nucleotide polymorphisms associated with developing chronic postsurgical pain after abdominal surgery, one of the most common types of surgery.

METHODS

A genome-wide association study was performed on 27,603 patients from the UK Biobank who underwent abdominal surgery. The robustness of identified loci was validated by split-half validation analysis. Functionally related top loci were selected for expression validation in clinical samples of adhesions from patients with and without pain.

RESULTS

One locus (rs185545327) reached genome-wide significance for association with chronic postsurgical pain development, and 10 loci surpassed the suggestively significant threshold (p < 1 × 10-6). In the robustness analysis, eight loci had at least nominal significance. The loci passing the suggestively significant threshold were mapped to 15 genes, of which two loci contained pain-related genes (SRPK2, PDE4D). Although marginally approaching statistical significance in the expression validation of clinical samples, the detection rate and expression level of PDE4D were modestly higher in patients with pain compared with those in the control group.

DISCUSSION

This study provides preliminary evidence for genetic risk factors implicated in chronic postsurgical pain following abdominal surgery, particularly the PDE4D gene, which has been associated with pain in previous studies. The findings add to evidence suggesting potential for the future development of a clinically applicable tool for personalised risk prediction, aiding clinicians in stratifying patients and enhancing clinical decision-making through individualised risk assessments.

Adhesion Prevention in Gynecologic Surgery: Guidance and Clinical Experience

Postoperative adhesions represent a major medical challenge and are associated with serious health and economic consequences. 4DryField® PH (PlantTec Medical GmbH, Lueneburg, Germany) is a starch-based medical device designed both to prevent adhesions and for hemostasis. This paper explores methods to successfully apply it in gynecological surgery, leveraging the authors' extensive clinical experience. We provide detailed insights into best practices that benefit most patients with conditions such as endometriosis, along with practical tips and guidance on optimizing application and dosage. Our real-world clinical experience across various indications, supported by published data, demonstrates significant patient benefits: reduced adhesion formation, better recovery, less pain, and improved fertility. Patient acceptance and satisfaction are notably high. The device can be applied to surgical wounds as a powder for hemostasis and transformed into a gel in situ or as a premixed gel when adhesion prevention is prioritized. Specific advantages for each method are demonstrated by case studies. When used correctly, 4DryField PH is safe and effective, especially for larger wound areas with a high risk of reoperation and adhesion formation and when pregnancy is desired. It offers great versatility due to its use as either in situ gel or premixed gel with different viscosities. Despite some remaining gaps in clinical evidence and ongoing studies, our personal clinical experience suggests significant benefits with minimal risks. Therefore, we have no concerns regarding the broad use of 4DryField PH in gynecology and other surgical disciplines. Future research should focus on patient-reported outcomes and health economic benefits to support reimbursement efforts.

Global recommendations on adhesion prophylaxis in gynaecological laparoscopic surgery

Adhesions are recognised as one of the most common complications of abdominal surgery; their diagnosis and prevention remains a significant unmet need in surgical therapy, affecting negatively a patient's quality of life and healthcare budgets. In addition, postoperative pelvic adhesions pose a high risk of reduced fertility in women of childbearing age. These 2023 Global Recommendations on Adhesion Prevention in Gynaecological Laparoscopic Surgery provide agreed-upon statements to guide clinical practice, with the ultimate goal of improving patient outcomes.

The risk of postoperative complications is higher in stage I-III colorectal cancer patients with previous abdominal surgery: a propensity score matching analysis

PURPOSE

The aim of this study is to investigate whether previous abdominal surgery (PAS) affected stage I-III colorectal cancer (CRC) patients who underwent radical resection.

METHODS

Stage I-III CRC patients who received surgery at a single clinical center from Jan 2014 to Dec 2022 were retrospectively included in this study. Baseline characteristics and short-term outcomes were compared between the PAS group and the non-PAS group. Univariate and multivariate logistic regression analyses were used to find risk factors for overall complications and major complications. A 1:1 ratio propensity score matching (PSM) was used to minimize the selection bias between the two groups. Statistical analysis was performed using SPSS (version 22.0) software.

RESULTS

A total of 5895 stage I-III CRC patients were included according to the inclusion and exclusion criteria. The PAS group had 1336 (22.7%) patients, and the non-PAS group had 4559 (77.3%) patients. After the PSM, there were 1335 patients in each group, and no significant difference was found in all baseline characteristics between the two groups (P > 0.05). After comparing the short-term outcomes, the PAS group had a longer operation time (before PSM, P < 0.01; after PSM, P < 0.01) and more overall complications (before PSM, P = 0.027; after PSM, P = 0.022) whether before or after PSM. In univariate and multivariate logistic regression analyses, PAS was an independent risk factor for overall complications (univariate analysis, P = 0.022; multivariate analysis, P = 0.029) but not for major complications (univariate analysis, P = 0.688).

CONCLUSION

Stage I-III CRC patients with PAS might experience longer operation time and have a higher risk of postoperative overall complications. However, it did not appear to significantly affect the major complications. Surgeons should take steps to improve surgical outcomes for patients with PAS.

Perspectives in adhesion prevention in gynaecological surgery

Adhesions are a frequent, clinically relevant, and often costly complication of surgery that can develop in any body location regardless of the type of surgical procedure. Adhesions result from surgical trauma inducing inflammatory and coagulation processes and to date cannot be entirely prevented. However, the extent of adhesion formation can be reduced by using good surgical technique and the use of anti-inflammatory drugs, haemostats, and barrier agents. Strategies are needed in the short-, medium- and longer-term to improve the prevention of adhesions. In the short-term, efforts are needed to increase the awareness amongst surgeons and patients about the potential risks and burden of surgically induced adhesions. To aid this in the medium- term, a risk score to identify patients at high risk of adhesion formation is being developed and validated. Furthermore, available potentially preventive measures need to be highlighted. Both clinical and health economic evaluations need to be undertaken to support the broad adoption of such measures. In the longer- term, a greater understanding of the pathogenic processes leading to the formation of adhesions is needed to help identify effective, future treatments to reliably prevent adhesions from forming and lyse existing ones.