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Medicina
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Abdominal Surgery: Clinical Updates and Future Perspectives
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Abdominal Surgery: Clinical Updates and Future Perspectives

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: 25 August 2026 | Viewed by 1605

Special Issue Editors

Dr. Victor Dan Eugen Strâmbu

E-Mail Website
Guest Editor
Tenth Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
Interests: abdominal surgery; colorectal surgery; endocrine surgery; minimally invasive surgery; general surgery
Dr. Petru Adrian Radu

E-Mail Website
Guest Editor Assistant
Tenth Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
Interests: abdominal surgery; general surgery; inguinal hernia repair

Special Issue Information

Dear Colleagues,

Abdominal surgery has evolved significantly over recent decades, shaped by continuous progress in imaging, minimally invasive and robotic techniques, perioperative care, and enhanced recovery pathways. These advancements have reduced morbidity and mortality while expanding the range of complex procedures that can be performed safely. At the same time, the field is undergoing a conceptual shift toward precision medicine, patient-centred outcomes, and value-based care. Despite major improvements, important challenges remain, including optimal management of difficult cases, reduction in postoperative complications, refinement of surgical decision-making, and long-term follow-up tailored to individual patient needs. As abdominal surgery continues to advance, there is a growing need for up-to-date syntheses of evidence, critical evaluation of new technologies, and dissemination of innovative approaches that can guide future clinical practice.

This Special Issue, “Abdominal Surgery: Clinical Updates and Future Perspectives,” aims to provide an integrated overview of modern developments while highlighting promising research directions that may redefine the field. We seek contributions addressing contemporary surgical techniques, progress in perioperative optimization, and new tools supporting diagnosis, planning, and postoperative management. Of particular interest are studies exploring minimally invasive and robotic platforms, artificial intelligence applications, advanced imaging modalities, intraoperative navigation, and biomarker-guided therapies. Work that bridges basic science with clinical application, enhances our understanding of pathophysiology, or proposes innovative strategies for improving outcomes is especially welcome. Research focusing on surgical and simulation—areas crucial for preparing the next generation of abdominal surgeons—is also encouraged.

Dr. Victor Dan Eugen Strâmbu
Guest Editor

Dr. Petru Adrian Radu
Guest Editor Assistant

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • abdominal surgery
  • minimally invasive surgery
  • robotic surgery
  • perioperative management
  • enhanced recovery protocols (ERAS)
  • surgical innovation
  • artificial intelligence in surgery
  • postoperative outcomes
  • translational research
  • surgical oncology

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Published Papers (3 papers)

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Research

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19 pages, 1159 KB  
Article
Inguinal Hernia Recurrence in Adults in Romania: A Five-Year Nationwide Analysis of Surgical Practice and Health System Disparities
by Anca Tigora, Dragos Garofil, Mihai Zurzu, Vlad Paic, Mircea Bratucu, Florian Popa, Valeriu Surlin, Sandu Ramboiu, Daniela Marinescu, Victor Strambu and Petru Radu
Medicina 2026, 62(2), 391; https://doi.org/10.3390/medicina62020391 - 17 Feb 2026
Viewed by 406
Abstract
Introduction: Recurrent inguinal hernia remains a clinically relevant outcome that is difficult to quantify in the absence of national prospective registries. In Romania, structural differences between public and private hospitals may further influence recurrence-related care, access to minimally invasive surgery, and resource [...] Read more.
Introduction: Recurrent inguinal hernia remains a clinically relevant outcome that is difficult to quantify in the absence of national prospective registries. In Romania, structural differences between public and private hospitals may further influence recurrence-related care, access to minimally invasive surgery, and resource utilization. This study aimed to assess recurrence patterns after inguinal hernia repair at a national level, with emphasis on reinterventions, patient-related risk factors, and health system disparities. Methods: A nationwide retrospective cohort study was conducted using administrative DRG data from the Romanian National Health Insurance House. All adult patients undergoing inguinal hernia repair in 2019 were identified and followed for five years (2019–2023). Reintervention was used as a proxy for recurrence. Surgical approach, hospital sector, length of stay, reimbursement, patient migration, geographic distribution, and comorbidities were analyzed using descriptive statistics and multivariable logistic regression to explore factors associated with laparoscopic approach and reintervention. Results: Among the 18,185 patients who underwent inguinal hernia repair in 2019, reintervention rates during follow-up ranged from 0.58% to 4.88%, a variability that reflects inherent limitations of administrative coding. Most reinterventions occurred in the year of the index surgery, suggesting early technical failure. Public hospitals managed the majority of cases and disproportionately absorbed recurrent and clinically complex patients. Access to laparoscopic repair was uneven and concentrated in large academic centers. Length of hospital stay declined gradually in public hospitals but remained consistently shorter in private institutions, reflecting differences in patient selection and care pathways. Reimbursement by The National Health Insurance House was similar for open and laparoscopic procedures. Conclusions: Recurrent inguinal hernia care in Romania is shaped by system-level disparities extending beyond surgical technique. Further progress requires reimbursement reform, establishment of a national hernia registry, and expansion of laparoscopic training to ensure equitable access to high-quality hernia care. Full article
(This article belongs to the Special Issue Abdominal Surgery: Clinical Updates and Future Perspectives)
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14 pages, 423 KB  
Article
Integrating Bayesian Inference and Machine Learning to Evaluate TAP and Trypsin-2 as Early Biomarkers of Systemic Inflammation in Acute Pancreatitis
by Alina Calin Frij, Cristian Velicescu, Andrei Andone, Roxana Covali, Alin Ciubotaru, Roxana Grigorovici, Cristina Popa, Daniela Cosntantinescu, Mariana Pavel-Tanasa and Alexandru Grigorovici
Medicina 2026, 62(1), 116; https://doi.org/10.3390/medicina62010116 - 5 Jan 2026
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Abstract
Background and Objectives: Acute pancreatitis (AP) has a wide range of clinical severity, and early prediction of disease progression is still challenging. Trypsinogen-activating peptide (TAP) and trypsin-2 serve as direct biomarkers for intrapancreatic proteolytic activation and may provide earlier pathophysiological information compared with [...] Read more.
Background and Objectives: Acute pancreatitis (AP) has a wide range of clinical severity, and early prediction of disease progression is still challenging. Trypsinogen-activating peptide (TAP) and trypsin-2 serve as direct biomarkers for intrapancreatic proteolytic activation and may provide earlier pathophysiological information compared with traditional markers. Materials and Methods: In this retrospective cohort analysis involving 54 AP patients, we evaluated 24 h serum and urinary TAP and trypsin-2 concentrations by Bayesian correlation, mediation analysis, unsupervised K-means clustering, and supervised machine learning (Elastic Net and Random Forest). The analyses investigated the relationships of biomarkers with inflammation (CRP), enzymatic activities (amylase, lipase), and clinical factors, as well as inflammation severity (CRP levels). Results: Bayesian correlations indicated moderate evidence for a relationship between serum TAP and CRP (BF10 = 8.42), as well as strong evidence linking age to serum TAP (BF10 = 12.75). Serum trypsin-2 showed no correlation with CRP, while urinary trypsin-2 had a correlation with amylase (BF10 = 6.89). Mediation analysis indicated that TAP and trypsin-2 accounted for 42–44% of the impact of CRP on pancreatic enzyme elevation. Clustering revealed three phenotypic subgroups (“Mild Activation”, “Moderate System”, and “Severe Pancreatic-Renal”), the latter showing the highest levels of CRP and biomarkers. Machine learning models highlighted urinary trypsin-2 and age as the most significant predictors of inflammation, with Random Forest achieving the highest performance (R2 = 0.53). Conclusions: Early urinary trypsin-2 outperforms serum markers as a predictor of systemic inflammatory intensity, indicating total proteolytic impairment and renal clearance. This integrative analysis reveals unique biological phenotypes and highlights the potential of these biomarkers for early assessment of the inflammatory burden. Their role in predicting clinical disease progression requires prospective validation. Integrative biomarker analysis reveals unique biological phenotypes and improves assessment of inflammatory burden in PA. Larger cohorts are required for prospective validation to incorporate these biomarkers into precision-based diagnostic frameworks. Full article
(This article belongs to the Special Issue Abdominal Surgery: Clinical Updates and Future Perspectives)
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Other

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22 pages, 5271 KB  
Systematic Review
Perioperative Outcomes of No-Drain Strategy in Primary Repair of Perforated Peptic Ulcer: A Systematic Review and Meta-Analysis
by Lorenzo Dell’Atti, Maurizio Zizzo, Andrea Morini, Federica Mereu, Marco Scarpa, Quoc Riccardo Bao, Silvia Negro, Emanuele Damiano Luca Urso, Dario Parini and Massimiliano Fabozzi
Medicina 2026, 62(5), 1003; https://doi.org/10.3390/medicina62051003 - 21 May 2026
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Abstract
Background and Objectives: Perforated peptic ulcer (PPU) is an emergent condition managed by surgical intervention. No conclusive evidence has been produced regarding the need for drain placement after primary repair. Our meta-analysis aimed to provide insight into the short-term outcomes by comparing the [...] Read more.
Background and Objectives: Perforated peptic ulcer (PPU) is an emergent condition managed by surgical intervention. No conclusive evidence has been produced regarding the need for drain placement after primary repair. Our meta-analysis aimed to provide insight into the short-term outcomes by comparing the two strategies of drain omission or intra-operative placement of at least one drain. Materials and Methods: We performed a systematic review following the PRISMA guidelines. PubMed/MEDLINE, Web of Science, Cochrane Library, and Embase databases were utilized to identify articles of interest. Meta-analysis was performed using RevMan Version 5.4. Eligible studies were comparative studies (RCTs and observational studies) enrolling adult patients (≥18 years) undergoing emergency primary repair for PPU, with or without prophylactic intra-abdominal drain placement; case reports and series of fewer than 10 patients were excluded. The literature search covered January 2010 to 22 February 2026. Risk of bias was assessed using the Cochrane RoB 2.0 tool for RCTs, and the ROBINS-I V2 tool for observational studies; certainty of evidence was graded using the GRADE framework. Pooled effect estimates were calculated using a random-effects model and expressed as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI); statistical heterogeneity was quantified using the I2 statistic. Results: Five studies were considered for comparison, for a total of 1354 patients (744 and 610 in the drain and no-drain groups, respectively). Three were randomized controlled trials, and two were retrospective cohort studies, conducted across four countries (India, the USA, Egypt, and Japan). Meta-analysis of the pooled results showed that drain omission was associated with a shorter length of stay (LOS) (MD −2.13, 95% CI [−3.91–−0.35], p < 0.0001) and a lower rate of superficial surgical site infections (SSIs) (16.7% vs. 52.7%, OR 0.24, 95%CI [0.11–0.55], p = 0.0007). No difference was observed regarding the rate of leaks, reoperation, or deep SSIs. Low-certainty evidence suggested higher postoperative mortality in the no-drain group (OR: 1.96; 95% CI: 1.10 to 3.48; p = 0.02; I2 = 0%), largely driven by retrospective studies with a high risk of bias. This mortality finding is of very low certainty and is most likely attributable to confounding in the observational studies rather than a true causal effect of drain omission. Several outcomes were based on data from only two to three studies, and the overall certainty of evidence was low to very low. Conclusions: Drain omission after primary repair for PPU may be associated with better outcomes in terms of LOS and superficial SSIs, primarily in lower-acuity patients, as reflected by the inclusion criteria of the contributing RCTs. Pooled analysis showed a higher postoperative mortality in the no-drain group; however, given the significant biases among included studies, our results should be interpreted as non-causal and thus require careful interpretation. Further research encompassing the full clinical spectrum of PPU is needed to confirm our results. Evidence certainty was low to very low across all outcomes, primarily due to a risk of bias, high heterogeneity (I2 up to 95% for LOS), indirectness, and imprecision. Full article
(This article belongs to the Special Issue Abdominal Surgery: Clinical Updates and Future Perspectives)
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