Effect of Enhanced Recovery After Surgery (ERAS) Protocols on Surgical Outcomes in Abdominal Surgeries

The most important factors for a successful colon capsule endoscopy (CCE) study are the quality of bowel preparation and the capsule excretion during battery life. Incomplete conventional colonoscopy is one of the main indications for CCE. The aim of this study was to analyze clinical and demographic factors for incomplete CCE after an incomplete conventional colonoscopy. A retrospective single-center study was conducted including patients who underwent CCE after an incomplete colonoscopy (IC). Complete CCE was defined as capsule excretion or visualization of hemorrhoidal pedicles within battery time. Demographic (gender and age) and clinical data (obesity, smoking history, diabetes mellitus, hypothyroidism, constipation, depression, psychotropic medication use and history of abdominal or pelvic surgery) were collected. A total of 197 patients were included (mean age 67±10years; 71.6% female). Complete CCE was achieved in 133 (67.5%) of cases. Adequate bowel preparation was observed in 145 (73.6%) of cases. The most common causes of incomplete conventional colonoscopy were colonic fixed angulation (56.3%) and irreducible loop (42.1%), with no significant difference in capsule completion between these groups (p=0.770). Obesity (OR 5.328; 95% CI 1.735-16.369; p = 0.003) and constipation (OR 2.999; 95% CI 1.264-7.114; p = 0.013) were independently associated with incomplete CCE. Obesity and constipation are risk factors for incomplete CCE. Adjustments or intensification of bowel preparation protocols may improve completion rates in these patients.

Incisional hernias are a common complication after abdominal surgery with an incidence of 5-25% in general population after laparotomy. It is therefore necessary to reduce the potential occurrence of abdominal hernia development. For this, understanding the mechanical behaviour of the different abdominal wall structures is important to develop good predictive models. Unfortunately, very few experimental studies have addressed the different structures of the abdominal wall. To gain a better understanding of their mechanical behaviour, samples were extracted from pigs (for protocol validation) and then from two abdominal human cadavers, with different orientations (vertical, horizontal or oblique) on the different tissues. The mechanical characterization was obtained from quasi-static uniaxial tensile tests. The results showed anisotropic behaviour depending on the location and orientation of the tissue, as well as the type of tissue (muscle, aponeurosis or peritoneum). Inter-individual variability was also demonstrated. This study highlights the heterogeneity of the biomechanical properties of the abdominal wall and provide new values and interpretations to help improve the development of new predictive numerical models.

BackgroundComputed tomography (CT) is the preferred imaging modality for diagnosing acute appendicitis in adults. However, the optimal contrast protocol remains debated, balancing diagnostic accuracy, operational efficiency, and patient safety.ObjectiveTo systematically compare the diagnostic accuracy and operational efficiency of different CT contrast protocols-oral, intravenous (IV), combined oral + IV, and non-contrast-in adult patients with suspected acute appendicitis.MethodsA comprehensive search of MEDLINE, Embase, Cochrane Library, and Web of Science was conducted from inception to April 2025. Eligible studies compared CT contrast protocols in adults (≥18 years) and reported diagnostic or operational outcomes. Two independent reviewers screened articles, extracted data, and assessed risk of bias using the QUADAS-2 tool. Primary outcomes were sensitivity, specificity, positive predictive value, and negative predictive value; secondary outcomes included time to CT completion and emergency department (ED) length of stay.ResultsSeventeen studies involving 5033 patients met inclusion criteria. Non-contrast CT demonstrated sensitivity of 82.4-90.5% and specificity of 75-100%. Oral contrast-only protocols showed sensitivity of 73.5% and specificity of 80%. Combined oral + IV protocols achieved sensitivity of 89.4-100% and specificity of 54.5-98.5%. IV-only protocols provided sensitivity of 77.8-100% and specificity of 87-100%. Across studies, eliminating oral contrast reduced ED length of stay by 29-91 minutes without compromising diagnostic accuracy.ConclusionsIV-only or non-contrast CT protocols offer comparable diagnostic accuracy to oral contrast approaches while significantly improving workflow efficiency. Protocol selection should consider clinical setting and patient factors, reserving oral contrast for select groups such as oncology patients or those with prior abdominal surgery.

Laparoscopic cholecystectomy is the gold standard for gallbladder disease, but the decision to switch to open surgery is still a critical one. The purpose of the study was to determine the conversion rate, to identify predictive risk factors and to analyze the results of the institution-wide conversion rate. A retrospective cohort study was conducted in the Department of Surgery, Community Based Medical College, Bangladesh (CBMC,B), Mymensingh, Bangladesh, between January 2020 and December of 2022, to assess factors leading to the change from laparoscopic to open cholecystectomy and analyze the impact of early change on patient safety and post-operative outcomes. Medical records of 320 patients, who had a laparoscopic cholecystectomy course for symptomatic gallbladder disease. Demographics, pre-operative findings, operative details and post-operative results were collected. Conversion from laparoscopic cholecystectomy to open cholecystectomy rate was 4.7% (n=15). Bivariate analysis revealed age at surgery (p=0.001), particularly age 50-59 years (20.8% change), gender (19.1% vs. 2.2%, p=0.002), and history of upper abdominal surgery (26.7% vs. 3.6%, p=0.008). A slight positive correlation between age (r=0.42) and gender (r=0.36) was confirmed by Pearson correlation. The main causes of change were thickened adhesions (40%) and acute inflammations (33.3%). The converted group had significantly more time to return to activity (92.5±18.3 vs. 54.2±12.5 minutes, p=0.001) and more hospital stays (5.8±1.6 vs 2.3±0.8 days, p=0.001). The patient profile for transfer from laparoscopic cholecystectomy to open cholecystectomy was clear for high-risk patients. We observed that time-oriented transformation guided by pre-operative risk factors and intra-operative challenges are key surgical judgement that reduces the risk of major complications and prioritises patient safety in favour of procedural rigour. CBMJ 2026 January: vol. 15 no. 01 P:127-133

Background: Chronological age inadequately captures biological vulnerability among surgical patients. Frailty and muscle strength reflect physiological reserve, yet their combined contribution to postoperative length of stay (LOS) remains insufficiently explored. Methods: We conducted a prospective multicenter observational cohort study including 223 adults undergoing elective abdominal surgery. Frailty was assessed using the Fried phenotype, and admission handgrip strength (HGS) was measured with a calibrated dynamometer. Prolonged LOS was defined as >10 days (75th percentile) and also analyzed continuously using ln(LOS + 1). Multivariable logistic and linear regression models adjusted for age, sex, frailty status, and surgical indication. Patients were additionally stratified into four physiological reserve phenotypes combining frailty and HGS. Results: LOS ranged from 0 to 68 days; a total of 48 patients (21.6%) experienced prolonged hospitalization. In multivariable logistic regression, frailty (adjusted OR 3.12, 95% CI 1.72–5.67) and oncologic surgery (adjusted OR 7.63, 95% CI 3.12–18.65) were independently associated with prolonged LOS, whereas chronological age was not. Female sex was associated with lower odds of prolonged LOS (adjusted OR 0.39, 95% CI 0.18–0.87). Similar associations were observed when LOS was analyzed continuously. Physiological reserve phenotyping revealed graded LOS distributions: Fit–Strong patients had the shortest stays (mean 5.5 ± 4.3 days), while Frail–Weak patients experienced the longest and most variable hospitalization. Conclusions: Postoperative LOS clusters according to multidimensional physiological reserve rather than chronological age. Integrating frailty and muscle strength identifies clinically meaningful phenotypes that may improve perioperative risk stratification beyond age-based approaches and inform personalized perioperative planning, resource allocation, and patient-centered decision-making across heterogeneous surgical populations in worldwide settings.

Many patients undergoing abdominal surgery are considered at-risk of malnutrition and may have a multitude of modifiable risk factors for adverse surgical outcomes. Prior to surgery, risk factors should be identified and mitigated via prehabilitation. This review aims to highlight recent research in nutritional screening, assessment and interventions being incorporated into surgical prehabilitation programmes. Nutritional screening identifies at-risk patients most likely to benefit from prehabilitation. Assessment of body composition using radiological methods provides an integrated accurate means of risk stratification, allowing intervention in those most likely to benefit. Biochemical immune-nutrition prognostic markers may provide a useful adjunct but lack robust clinical evidence. Unimodal nutritional prehabilitation interventions have mixed evidence of benefit in improving clinical outcomes, such as infectious complications and length of stay. Multimodal interventions are considered more pragmatic and may positively impact functional outcomes and reduce complication rates. Utilizing nutrition as part of multimodal prehabilitation shows promise for improving clinical and functional outcomes yet requires strong collaboration between key stakeholders. Significant heterogeneity in study designs and patient characteristics renders difficulties in establishing the most efficacious approaches. Further research is required to determine optimal strategies and the cost effectiveness of such programmes.

BackgroundThe present study aimed to (1) develop a digital game focusing on the roles of surgical nurses (scrub and circulator nurses) in laparoscopic surgeries, (2) conduct a randomized controlled trial (RCT) comparing this digital game-based learning (GBL) approach with a conventional teaching method, and (3) assess students’ reasoning and user satisfaction.MethodThis randomized controlled trial (RCT) was conducted at Shahid Sadoughi University of Medical Sciences. The study comprised three phases: development of the digital game titled ‘Co-Surgeon,’ implementation of the educational interventions, and evaluation of outcomes. The digital game aimed to enhance students’ understanding of laparoscopic surgeries and the specific roles of surgical nurses (circulator and scrub), focusing on tasks such as task recognition, laparoscopic instrument identification and utilization, procedural steps, and the development of clinical reasoning for selecting appropriate tools during common laparoscopic procedures. Fifty-seven surgical nursing students were randomly assigned to either an intervention group, which utilized digital game-based learning, or a control group, which received conventional lecture-based education. The digital GBL application included 40 distinct laparoscopic tools and equipment organized into 8 categories, 8 puzzles related to surgical nurse roles in abdominal laparoscopic surgeries, 15 Mayo stand setups, and 60 instrument identification puzzles. User satisfaction was measured via the Questionnaire for User Interface Satisfaction (QUIS), and students’ reasoning was assessed through the Key Feature (KF) examination. Data were summarized using descriptive statistics (mean, standard deviation, and percentage). Pearson correlation coefficient, independent t-test, and paired t-test were used for data analysis.ResultsThe mean (SD) scores of students’ reasoning in the intervention group (19.51 ± 3.36) were significantly higher than those in the control group (13.92 ± 4.15). (p < 0.001), with a large educational effect size reported (Partial eta squared = 0.35). Student perception scores indicated a good level of satisfaction (184.85 ± 6.79).ConclusionThe diverse and complex responsibilities of surgical nurses make it essential to enhance the learning outcomes for surgical nursing students. Implementing digital game-based learning can positively impact these outcomes. Therefore, it is recommended to incorporate digital games as a supplement in clinical education and workplace-based training.

Incisional hernia (IH) is a common complication of abdominal surgery, and the optimal suture technique for midline fascial closure remains controversial. This study compared continuous barbed sutures with interrupted non-barbed sutures in patients who underwent minimally invasive colorectal cancer surgery. We retrospectively evaluated 299 patients who underwent laparoscopic or robotic radical colorectal resection between 2020 and 2023. Of these, 228 who underwent a small midline umbilical incision were included. Fascial closure was performed using either continuous barbed absorbable sutures (n = 60) or interrupted non-barbed absorbable sutures (n = 162). Propensity score matching (PSM) was performed at a 1:1 ratio, yielding 51 matched pairs for comparison. Primary outcome was IH incidence as confirmed by computed tomography or physical examination. Secondary outcomes focused on infectious complications as well as postoperative morbidity, mortality, and hospital stay. After PSM, the incidence of IH was significantly lower in the continuous barbed group than that in the interrupted non-barbed group (7.8% vs. 33.3%, P = 0.001). In non-obese patients (Body mass index < 25), barbed closure reduced the IH incidence (2.7% vs. 23.5%, P = 0.006). In obese patients, the difference was not statistically significant (21.4% vs. 52.9%, P = 0.07), likely reflecting limited power. Although ileus was more frequent in the interrupted non-barbed group (7.8% vs. 0%, P = 0.02), infectious complications were comparable between groups. Multivariable analysis identified interrupted non-barbed sutures and obesity as independent risk factors for IH. Continuous barbed fascial closure was associated with a significantly lower IH incidence after minimally invasive colorectal cancer surgery without increasing infectious complications. These findings support the effectiveness of a barbed-continuous closure strategy for midline extraction incisions.

Abstract Background Wearable sensors offer a scalable alternative to cardiopulmonary exercise testing for assessing cardiorespiratory fitness, and there is growing evidence to support their use for remote VO 2 max estimation. This study investigated whether heart rate variability (HRV) measures derived from wearable ECG sensors improve VO 2 max estimations in a preoperative cohort and compared the relative contributions of short- and long-term HRV features. ECG and accelerometer data from 198 participants scheduled for major abdominal surgery (REMOTES study, ClinicalTrials.gov: ID NCT06042023) were collected over 72 h. Measures including physical activity, steps, heart rate, and HRV were extracted. Short-term (5-minutes) and long-term (24-hour) heart rate variability features were extracted from free-living ECG data. Two LASSO regression models with five-fold cross-validation were developed: a baseline model (excluding HRV) and a HRV model. Results After exclusions, 163 participants were included in analyses. The HRV model outperformed the baseline across all metrics, achieving a higher R 2 (0.47 ± 0.12 vs. 0.42 ± 0.13) and lower mean absolute error (2.63 ± 0.34 vs. 2.77 ± 0.38 ml/kg/min), root mean square error (3.38 ± 0.53 vs. 3.54 ± 0.57 ml/kg/min) and absolute percentage error (15.55 ± 2.19% vs. 16.22 ± 2.45%). Analysis of feature contributions identified long-term HRV (SDANN HR 24), age, gender, and step-counts as key contributors to model performance. Conclusion HRV features from wearable data, especially long-term measures, can improve remote VO 2 max predictions in a clinical cohort. While performance gains were small, these findings support the integration of HRV features into remote monitoring systems in real-world settings. Long-term HRV measures derived from heart rate signals offer a practical option for cardiorespiratory fitness assessment, requiring minimal additional processing. Trail registration This study was registered at ClinicalTrials.gov (Clinical trial number: NCT06042023) and was registered retrospectively on 11/09/2023.

BackgroundIncisional hernia remains a common complication following abdominal surgery with significant implications for patient quality of life and healthcare costs. This systematic review and meta-analysis aim to evaluate the relationship between various abdominal incision types and the development of hernias, while identifying key risk factors.MethodsA comprehensive literature search was conducted across multiple databases for studies published between January 2000 and January 2025. Studies reporting incisional hernia rates following abdominal surgery with clearly documented incision types and a minimum follow-up of 6 months were included. Data extraction included study characteristics, patient demographics, incision types, hernia rates, and associated risk factors. Random-effects meta-analysis was performed to calculate pooled hernia rates and odds ratios.ResultsForty studies comprising 183496 patients were included. Midline incisions were associated with the highest hernia rates (12.8-35%, pooled rate 18.7%) compared to transverse incisions (4.8-10.2%, pooled rate 7.4%; OR 0.38, 95% CI 0.26-0.57). In colorectal surgery specifically, midline incisions carried an odds ratio of 11.7 (95% CI 3.3-42.0) for hernia formation compared to transverse approaches. Paramedian, oblique, and Pfannenstiel incisions demonstrated lower hernia rates (2.1-8.6%). Significant patient-related risk factors included obesity (OR 4.74, 95% CI 1.42-15.55), male gender (HR 2.2), COPD (HR 2.35, 95% CI 1.16-4.75), and wound infection (HR 3.66). Most hernias (54-80%) developed within the first year after surgery, though continued development was observed for up to 10 years.ConclusionsTransverse, paramedian, and Pfannenstiel incisions offer significant advantages over midline approaches for reducing incisional hernia risk. Patient-specific factors, particularly obesity and pulmonary comorbidities, substantially influence hernia development. A tailored approach to incision selection based on patient risk profile, coupled with meticulous technique and wound management, is recommended to minimize hernia occurrence.

Cannabis use is increasing and is of particular interest to patients with cancer. There is no prospective data regarding its impact on perioperative outcomes. We asked how chronic usage of cannabis compounds (cannabinoids) impacted postoperative pain, opiate use, and complications after abdominal surgery for the treatment of cancer. This was a single center prospective observational cohort study conducted from 9/2021-3/2024 of patients 21+ years old, undergoing abdominal surgery for the treatment of cancer, and either chronic cannabinoid users (≥1x/week for last 3months) or non-users (for the last year). Plasma cannabinoids were measured preoperatively on the day of surgery. Of 223 patients screened, 64 subjects completed enrollment (24 chronic cannabinoid users, 40 non-users). Most were male (67%) and underwent an open abdominal surgery (75%). 41% developed complications, 23% of which were severe (grade 3+) complications. Chronic users with detectable cannabinoid levels had significantly higher pain scores, which persisted in multivariable analysis. Chronic users also received significantly more morphine milligram equivalents (MME) (8-hours postoperatively: 28.8 vs 9.8, p=0.036, during the total hospitalization: 273 vs 202.1, p=0.046, prescribed: 150 vs 100, p=0.047, taken through POD30: 67.5 vs 5, p=0.03). Differences in MME prescribed and taken postoperatively persisted in multivariable analysis. Chronic users had fewer overall complications (5/23 (22%) vs 21/41 (51%), p=0.025), but similar frequency to non-users for severe complications (2/23 (8.7%) vs 4/41 (9.8%), p=0.33). Chronic cannabinoid use increased postoperative pain and MME use for patients undergoing abdominal surgery for the treatment of cancer, but did not increase complications. Further study regarding preoperative cannabinoid cessation and use of cannabinoids for postoperative pain is warranted.

The fascial plane blocks in the upper arm surgery and trauma: A narrative review.

Comparing the Comprehensive Complication Index and Clavien-Dindo classification for evaluating postoperative complication severity in major abdominal surgery.

In high-risk neonates, such as very low birth weight infants or those undergoing abdominal surgery, elevated direct bilirubin (DB) levels are frequently observed. Under such conditions, unbound bilirubin (UB) measured using peroxidase-based analyzers may appear spuriously elevated, complicating clinical interpretation. Retrospective analysis was performed on laboratory datasets with complete measurements of total bilirubin (TB), DB, UB, and albumin from January 2021 to December 2023. DB was measured enzymatically using the Nescauto VL D-bil bilirubin oxidase method. Indirect bilirubin (iDB) was calculated as TB minus DB, and its molar ratio to albumin (iDB/albumin) was evaluated for correlation with UB across varying DB levels and DB/TB ratios. Outlier-high UB values were defined as those exceeding the 95% confidence interval of the iDB/albumin ratio within the physiological range (DB < 1 mg/dL and DB/TB < 10%). A total of 5970 datasets from 1386 neonates were analyzed. As DB levels and DB/TB ratios increased, the correlation between the iDB/albumin ratio and UB weakened, and the regression slope became steeper. The proportion of outlier-high UB values rose significantly: 4.9%, 10.8%, 32.5%, and 92.2% for DB <1, 1-2, 2-3, and ≥3 mg/dL, respectively; and 4.2%, 10.3%, 17.2%, and 51.7% for DB/TB <10%, 10%-20%, 20%-30%, and ≥30%. UB values tend to rise spuriously as DB increases, particularly when DB ≥2 mg/dL or DB/TB ≥20%. In such situations, estimating UB from the iDB/albumin ratio may provide a more reliable basis for risk assessment.

The recto-intercostal fascial plane block is a novel regional anaesthetic technique proposed for cardiac and upper abdominal surgery, with limited evidence for its use in laparoscopic cholecystectomy. We report a series of seven patients undergoing elective laparoscopic cholecystectomy under general anaesthesia, one of whom required a xipho-umbilical incision for common bile duct exploration. All patients received a recto-intercostal fascial plane block prior to surgical incision. Postoperative analgesia included paracetamol 1000 mg for all patients, with one patient additionally receiving diclofenac 75 mg. At 1, 3, 6, 12 and 24 h postoperatively, pain scores remained low (numerical rating scale 0-2 at rest and 2-3 on movement), no rescue opioids were required and all patients had an uncomplicated recovery with early discharge. These cases illustrate the feasibility of incorporating recto-intercostal fascial plane block into multimodal analgesia after laparoscopic cholecystectomy.

Fluid management of patients undergoing abdominal surgery - more questions than answers: RETRACTION.

Tubal patency testing in women with polycystic ovary syndrome - is it worth before ovarian induction: Cost-effectiveness analysis.

A giant incisional hernia is a common health complication characterised by the loss of abdominal wall integrity. It is typically observed in patients who have undergone abdominal surgery. Incisional hernias present a significant burden in healthcare, particularly in cases involving laparoscopic surgeries. They occur when abdominal contents protrude through inadequately healed surgical incisions, with surgical history and obesity being major risk factors. Colossal incisional hernias are generally defined by their large size (&gt;15 centimeters). Here, the authors present a case of a 45-year-old male who has had a large lump in his abdomen for the past two years. The lump worsened when the patient stood and improved when he lay down. The patient underwent umbilical hernia surgery eight years ago and has a history of heavy weight lifting. A positive cough impulse was observed, along with an old surgical scar. The patient underwent surgery that included adhesiolysis, omentectomy, omphalectomy, reduction of the hernia contents, closure of the defect with polypropylene loop sutures, and placement of a polypropylene mesh over the rectus sheath. The patient was discharged on the seventh Postoperative Day (POD). A six-month follow-up showed no signs of recurrence, indicating a favorable prognosis post-surgery. Anatomical knowledge is crucial for the effective management of any hernia. These hernias are managed through an interdisciplinary approach tailored to patient-specific factors.

Acquired diaphragmatic hernia (ADH) is an uncommon yet relevant complication after pediatric liver transplantation (pLTx). True incidence and risk factors remain poorly defined, largely due to limited screening, heterogeneous imaging practices, and the absence of validated predictive models. This study aimed to determine the incidence, presentation, and risk factors for ADH and to compare surgical repair techniques and short-term outcomes of thoracoscopic versus open approaches.We performed a retrospective review of all children undergoing pLTx at our institution (2014 and 2024). Demographic and transplant-related data were analyzed in patients with and without ADH. Operative approach, postoperative recovery, and 6-month follow-up were assessed. Findings were placed into context by comparison with published series.Among 246 pediatric transplant recipients, 8 children developed ADH (3.3%). Two patients had bilateral defects; each side was repaired electively in separate, staged procedures. Counting each side as a distinct repair event yielded 10 ADH repair procedures for analysis. Children who developed ADH were significantly younger at transplantation (mean 9.7 months vs. 64.0 months, p = 0.002) and had lower body weight (7.8 kg vs. 20.7 kg, p = 0.004). Prior abdominal surgery was common (five-eighths). Seven patients received a left lateral segment graft (LLS); graft-to-recipient weight ratio was 3.8% versus 3.2% in non-ADH patients (p = 0.107). Most hernias were right-sided, with presentations ranging from respiratory symptoms to incidental imaging findings. Surgical repair was performed via laparotomy in six cases and thoracoscopy in four, with one conversion to thoracotomy. Short-term outcomes were favorable in both groups, with only one recurrence (after laparotomy) and no mortality during follow-up.ADH after pLTx occurred in a minority of recipients and was associated with younger age, low body weight, prior abdominal surgery, and LLS grafts. However, the specific contribution of these variables remains unclear. Persistent research gaps include the lack of standardized screening protocols, uncertainty regarding cumulative long-term risk, and the absence of predictive models to identify high-risk patients. Addressing these issues requires multicenter collaboration and prospective surveillance strategies. Thoracoscopic repair was feasible in selected patients and may be considered when suitable.