Search Results (128)

Hernia is a physiological condition that significantly impacts patients’ quality of life. Surgical treatment for hernias often involves the use of specialized meshes to support the abdominal wall. While this method is highly effective, it frequently leads to complications such as pain, infections, inflammation, adhesions, and even the need for revision surgeries. According to the Food and Drug Administration (FDA), hernia recurrence rates can reach up to 11%, surgical site infections occur in up to 21% of cases, and chronic pain incidence ranges from 0.3% to 68%. These statistics highlight the urgent need to improve mesh technologies to minimize such complications. The design and material composition of meshes are critical in reducing postoperative complications. Moreover, integrating drug-eluting properties into the meshes could address issues like infections and inflammation by enabling localized delivery of antibiotics and anti-inflammatory agents. Mesh design is equally important, with innovative structures like auxetic designs offering enhanced mechanical properties, flexibility, and tissue integration. These advanced designs can distribute stress more evenly, reduce fatigue, and improve performance in areas subjected to high pressures, such as during intense coughing, sneezing, or heavy lifting. Technological advancements, such as 3D printing, enable the precise fabrication of meshes with tailored designs and properties, providing new opportunities for innovation. By addressing these challenges, the development of next-generation mesh implants has the potential to reduce complications, improve patient outcomes, and significantly enhance quality of life for individuals undergoing hernia repair. Full article

Postoperative adhesions are a prevalent complication following abdominal surgeries, often leading to significant clinical challenges. This study introduces an innovative solution utilizing a polyethylene glycol (PEG)-based triblock copolymer to form an injectable, self-healing hydrogel aimed at preventing these adhesions. The hydrogel, formulated with temperature-responsive and self-healing properties through the incorporation of poly (N-isopropyl acrylamide) (PNIPAM) and anion–pi interactions, was synthesized using reversible addition–fragmentation chain transfer (RAFT) polymerization. The hydrogel’s physical properties, biocompatibility, hemostatic effect, and anti-adhesive capabilities were rigorously tested through in vitro and in vivo experiments involving rat models. It demonstrated excellent biocompatibility, effective tissue adhesion, and robust hemostatic properties. Most notably, it exhibited significant anti-adhesive effects in a rat abdominal wall–cecum model, reducing adhesion formation effectively compared to controls. The PEG-based injectable hydrogel presents a promising approach for postoperative adhesion prevention. Its ability to gel in situ triggered by body heat, coupled with its self-healing properties, provides a substantial advantage in clinical settings, indicating its potential utility as a novel anti-adhesion material. Full article

Background and Objectives: At present, intra-abdominal adhesions (IAAs) continue to be an important problem in surgery due to morbidity and mortality risks. Thymoquinone (TQ) and platelet-rich plasma (PRP) are molecules with known anti-inflammatory and antioxidant effects. However, a limited number of studies have investigated their efficacy in IAAs. In this study, we aimed to demonstrate the efficacy of TQ and PRP in reducing the development of IAAs and determine which molecule is more advantageous using an experimental animal model. Materials and Methods: Fifty-five male Wistar albino rats were included in the study. Five rats were used to obtain PRP, while fifty rats were randomly assigned to five groups (n = 10 per group): group I (sham) did not receive any treatment; group II (control) received no treatment after a cecum hemorrhage procedure; group III (saline) received 1 mL of saline treatment around the cecum after hemorrhage; group IV (PRP) received 1 mL of PRP (containing 3 × 10⁶ platelets/mL) around the cecum after hemorrhage; and group V (TQ) received 1 mL of TQ (containing 2 mg/mL TQ) around the cecum after hemorrhage. On the 10th day, IL1-β, TNF-α, E-selectin, and P-selectin levels were measured from the blood serum samples, and the cecum was histopathologically evaluated. Results: The lowest adhesion formation in terms of biochemical parameters was obtained in the TQ group (p < 0.05). Histopathological evaluations showed that saline, PRP, and TQ treatments were all effective, but none was superior. Conclusions: When histopathologically evaluated, saline, TQ, and PRP have similar effects in IAAs. However, when evaluated in terms of biochemical parameters, TQ prevented the formation of intra-abdominal adhesions more effectively than saline or PRP, owing to its strong anti-inflammatory and antioxidant properties. Full article

Postoperative adhesions (POAs) are a common and often serious complication following abdominal and gynecologic surgeries, leading to infertility, chronic pain, and bowel obstruction. To address these outcomes, the development of anti-adhesion barriers using biocompatible materials has emerged as a key area of biomedical research. This article presents a comprehensive overview of clinically relevant natural and synthetic biomaterials explored for POA prevention, emphasizing their degradation behavior, barrier integrity, and translational progress. Natural biopolymers—such as collagen, gelatin, fibrin, silk fibroin, and decellularized extracellular matrices—are discussed alongside polysaccharides, including alginate, chitosan, and carboxymethyl cellulose, focusing on their structural features and biological functionality. Synthetic polymers, including polycaprolactone (PCL), polyethylene glycol (PEG), and poly(lactic-co-glycolic acid) (PLGA), are also examined for their tunable degradation profiles (spanning days to months), mechanical robustness, and capacity for drug incorporation. Recent innovations, such as bioprinted and electrospun dual-layer membranes, are highlighted for their enhanced anti-fibrotic performance in preclinical studies. By consolidating current material strategies and fabrication techniques, this work aims to support informed material selection while also identifying key knowledge gaps—particularly the limited comparative data on degradation kinetics, inconsistent definitions of ideal mechanical properties, and the need for more research into cell-responsive barrier systems. Full article

Tension-free hernioplasty has effectively reduced postoperative recurrence and mitigated complications by employing polymer patches. However, clinically used polymer patches often fall short in terms of the anti-deformation, anti-adhesion, and tissue integration functions, which can result in visceral adhesions and foreign body reactions after implantation. In this study, a Janus three-layer composite patch was developed for abdominal wall defect repair using a combination of 3D printing, electrospraying, and electrospinning technologies. On the visceral side, a dense electrospun polyvinyl alcohol/sodium hyaluronate (PVA/HA) scaffold was fabricated to inhibit cell adhesion. The middle layer, composed of polycaprolactone (PCL), provided mechanical support. On the muscle-facing side, a loose and porous electrospun nanofiber scaffold was created through electrospraying and electrospinning, promoting cell adhesion and migration to facilitate tissue regeneration. Mechanical testing demonstrated that the composite patch possessed excellent tensile strength (23.58 N/cm), surpassing the clinical standard (16 N/cm). Both in vitro and in vivo evaluations confirmed the patch’s outstanding biocompatibility. Compared with the control PCL patch, the Janus composite patch significantly reduced the visceral adhesion and enhanced the tissue repair in animal models. Collectively, this Janus composite patch integrated anti-deformation, anti-adhesion, and tissue-regenerative properties, providing a promising solution for effective abdominal wall defect repair. Full article

Postoperative peritoneal adhesion and high recurrence rates are critical challenges in the clinical treatment of colorectal cancer. In this study, based on amyloid-like protein self-assembly technology, a novel Janus protein film was developed. The protein film encapsulates glucose oxidase (GOx) and catalase (CAT), which is named PTL@GC. Through a one-step method involving cysteine-reduced lysozyme-induced amyloid-like self-assembly, the film was co-loaded with GOx and CAT to achieve synergistic anti-adhesion and anti-tumor recurrence effects. The Janus film features a hydrophobic side that stably adheres to the intestinal surface without exogenous chemical modification and a hydrophilic side that prevents adhesion. The loaded GOx selectively induces disulfidptosis in SLC7A11-overexpressing tumor cells, while CAT degrades H₂O₂ to alleviate hypoxia and inhibit oxidative stress, significantly reducing adhesion-related fibrosis. The experimental results demonstrate that PTL@GC exhibited excellent mechanical properties, high enzyme activity retention (>90%), and controllable degradability (complete metabolism within 50 days). In animal models, PTL@GC reduced postoperative adhesion area by 22.77%, decreased local tumor burden to 28.42% of the control group, and achieved an inhibition rate of 58.49%, without inducing systemic toxicity. This study presents a biologically safe and functionally synergistic approach to addressing dual complications following colorectal cancer surgery, offering potential insights for future research on multifunctional Janus materials. Full article

All parts of Alocasia × amazonica (A. amazonica, Araceae) pose a toxicological risk due to oxalate production. Ingestion of the plant extract may cause multi-organ damage and fatal outcomes. Given the rarity of poisoning cases, its toxicological profile and systemic effects remain insufficiently characterized. This study aimed to investigate and report an appropriate approach to managing a patient intoxicated with A. amazonica (Araceae). A case of intentional self-poisoning with A. amazonica is presented. The patient, a 63-year-old woman, ingested approximately 200–300 mL of liquid prepared from the grated root of the plant. The initial clinical presentation involved localized injuries to the oral cavity and gastrointestinal tract, including severe pain, hoarseness, aphonia, dysphagia, mucosal erosions, and necrosis. Additional symptoms included hematinic vomiting, hemorrhagic diarrhea, and abdominal discomfort. These superficial and mucosal lesions resolved without the development of adhesions. Systemic effects comprised impaired consciousness indicative of encephalopathy, early metabolic acidosis, pulmonary edema with acute respiratory insufficiency, mild liver dysfunction, and hematuria. The therapeutic protocol for oral poisoning management was appropriate, leading to the patient’s discharge after 20 days of hospitalization. Full article

Background: Postoperative adhesions are a common complication following abdominal surgery, affecting over 90% of patients and leading to significant morbidity. Current anti-adhesion strategies, such as the use of physical and chemical barriers, have limitations such as short retention time, mechanical fragility, and inefficient drug delivery. This study developed a pectin-based emulsion gel loaded with celecoxib to prevent adhesions and provide localized pain relief. Methods: Formulations (F1–F4) with different pectin concentrations were evaluated for rheological properties, mucoadhesion, degradation rate, and celecoxib release. In vivo efficacy was evaluated in Sprague−Dawley rats via a standardized model of peritoneal abrasion, in which the formulations were compared to a commercially available anti-adhesion barrier. Results: The optimized emulsion gel (F4) exhibited improved mucoadhesion (9009 mPa·s), prolonged retention, and controlled celecoxib release over 14 days, reaching 80% release by day 9. In vivo, formulation F4 significantly reduced adhesions compared to a commercially available product. Pharmacokinetic analysis showed rapid absorption (T_max = 2 h) and sustained celecoxib plasma levels, confirming its effectiveness as a localized drug-delivery system. The celecoxib-loaded pectin-based gel successfully prevented postoperative adhesions and provided sustained pain relief. Conclusions: These findings suggest its potential clinical utility, though further preclinical and clinical evaluations are required. Full article

This review explores current strategies aimed at reducing complications in gynecologic surgery, focusing on innovations in laparoscopic entry techniques, extraperitoneal lymphadenectomy, and alternative approaches such as gasless laparoscopy. We conducted a comprehensive literature review, including studies and technical descriptions relevant to improved surgical access, lymph node dissection, and overall risk mitigation. Key findings indicate that the individualized selection of entry points—ranging from Palmer’s point in the left upper quadrant to the recently described Jain point—can minimize vascular and bowel injuries, especially in patients with prior abdominal surgeries. Furthermore, extraperitoneal lymphadenectomy appears to lower adhesion formation and bowel handling, potentially decreasing postoperative morbidity in oncologic cases. Gasless laparoscopy may offer comparable surgical outcomes with improved cardiorespiratory stability in high-risk patients, although visualization challenges remain. Overall, the evidence suggests that advanced minimally invasive methods and tailored procedural planning can effectively enhance patient safety and reduce postoperative complications. These approaches, however, demand a high level of surgical expertise, thorough preoperative imaging, and an institutional framework that supports training and ongoing quality monitoring. Continued investigations, including prospective trials and larger sample sizes, are required to validate these findings and further refine protocols aimed at optimizing outcomes in gynecologic surgery. Full article

Endometriosis, a prevalent gynecological condition affecting 10–15% of reproductive-age women, involves the growth of endometrial-like tissue outside the uterine cavity. This chronic inflammatory disease can significantly impact fertility by disrupting ovulation, tubal transport, and implantation. Clinical manifestations vary widely, ranging from asymptomatic cases to severe pelvic pain, dysmenorrhea, and dyspareunia. Accurate diagnosis remains challenging, often requiring a combination of patient history, clinical examination, and imaging studies. This paper will discuss the clinical approach to endometriosis during a first-line gynecological appointment, focusing on patient history, including detailed assessment of menstrual, pelvic, and bowel symptoms, and clinical examination; thorough gynecological examination, including abdominal and pelvic palpation, speculum examination, and bimanual examination; imaging evaluation (particularly of the role of ultrasound in identifying and characterizing endometriotic lesions, including the use of the #ENZIAN classification for deep infiltrating endometriosis and evaluation of fertility impact); and discussion of the Endometriosis Fertility Index (EFI) as a tool for assessing fertility potential. This comprehensive approach aims to guide clinicians in identifying and managing endometriosis effectively, improving patient outcomes and optimizing fertility management strategies. Methods: A literature search for suitable articles published from January 1974 to 2024 in the English language was performed using PubMed. Results: Endometriosis is associated with infertility rates ranging from 20% to 68%, with mechanisms including pelvic adhesions, chronic inflammation, and immune dysregulation. The revised American Society for Reproductive Medicine (rASRM) classification and #ENZIAN classification were identified as essential tools for staging and characterizing the disease. Transvaginal ultrasound (TVS) demonstrated high diagnostic accuracy for deep infiltrating endometriosis, with a sensitivity of up to 96% and specificity of 99%. EFI emerged as a valuable predictor of natural conception post-surgery. Additionally, the review underscores the frequent co-occurrence of adenomyosis in women with endometriosis, which may further compromise fertility. Despite advancements in imaging techniques and classification systems, the variability in symptom presentation and disease progression continues to challenge early diagnosis and effective management. Conclusions: Endometriosis is a prevalent gynecological condition affecting women of reproductive age and is associated with infertility. This paper describes the diagnostic approach to endometriosis during a first-line gynecological appointment, focusing on clinical history, physical examination, and the role of imaging, particularly ultrasound, in identifying and characterizing endometriosis lesions. The adoption of standardized classification systems such as #ENZIAN and EFI enhances disease staging and fertility prognosis, allowing for tailored treatment strategies. Despite improvements in non-invasive diagnostic methods, challenges persist in correlating symptom severity with disease extent, necessitating continued research into biomarkers and novel imaging techniques. Additionally, the frequent coexistence of adenomyosis further complicates fertility outcomes, underscoring the need for comprehensive management strategies. Further research is needed to enhance early detection strategies and optimize fertility preservation techniques for affected women. Full article

Ileus attributable to compression of the small intestine describes extensive constriction of the intestine by nearby space-occupying lesions or other abdominal organs. This retrospective study describes the findings in 35 cows with ileus caused by CSI (compression of the small intestine) by adhesions, abscesses, and the gravid uterus. Colic occurred in 34.3% of the cows. Rumen motility was reduced or absent in all cows, and intestinal motility was decreased in 85.7%. Ballottement and/or percussion and simultaneous auscultation were positive on the right side in 73.5% of the cows. The rectum contained little or no faeces in all cows, and transrectal examination revealed dilated small intestine in 25.7% of the cows, but the actual site of compression could not be palpated. The main ultrasonographic findings were reduced or absent intestinal motility and dilated loops of small intestine. Thirty-one of the thirty-five cows underwent right flank laparotomy; fourteen of these were euthanised intraoperatively, and seventeen recovered and were subsequently discharged. CSI is a rare cause of ileus. Improvements in the diagnosis of CSI are needed to prevent unnecessary laparotomy in cows with a grave prognosis. Full article

There is currently a demand for anti-adhesive materials that are capable of preventing the formation of intra-abdominal adhesions. In this study, electrospun poly(lactide-co-glycolide) scaffolds were dip-coated in aqueous solutions of polyvinyl alcohol with concentrations of 3 wt.%, 6 wt.% and 9 wt.% to obtain a nontoxic and anti-adhesive biomedical material. The viscosities of the applied 3 wt.%, 6 wt.% and 9 wt.% polyvinyl alcohol solutions were 7.7 mPa∙s, 38.2 mPa∙s and 180.8 mPa∙s, respectively, and increased exponentially. It is shown that increasing the viscosity of the polyvinyl alcohol solution from 6 wt.% to 9 wt.% increases the thickness of the polyvinyl alcohol layer from (3.32 ± 0.97) µm to (8.09 ± 1.43) µm. No pronounced polyvinyl alcohol layer can be observed on samples dip-coated in 3 wt.% PVA solution. Increasing the viscosity of the polyvinyl alcohol solution from 3 wt.% to 9 wt.% increases the mechanical properties of the poly(lactide-co-glycolide) samples by a factor of 1.16–1.45. Cytotoxicity analysis of all samples reveals that none is toxic to 3T3-L1 fibroblast cells. A cell adhesion assay indicates that the anti-adhesion properties increase with increasing viscosity of the polyvinyl alcohol solution and the thickness of the polyvinyl alcohol layer on the poly(lactide-co-glycolide) scaffolds. Fluorescence images of the cells show that as the thickness of the polyvinyl alcohol coating increases, the number of cells decreases, and they do not cover the surface of the samples and form spherical three-dimensional agglomerates. The highest mechanical and anti-adhesion properties are obtained with the poly(lactide-co-glycolide) scaffold sample dip-coated in the 9 wt.% polyvinyl alcohol solution. This is because this sample has the thickest polyvinyl alcohol coating. Full article

Background/Objectives: To compare the outcomes of single-port access laparoscopic surgery (SPALS) and single-site robotic surgery (SSRS) for benign gynecological diseases, we retrospectively analyzed clinical data from 367 patients who underwent gynecologic surgery at Sejong Chungnam National University Hospital from October 2020 to December 2023. Methods: Of these 367 patients, 197 underwent SPALS, whereas 170 underwent SSRS. The SPALS group comprised 87 patients who underwent hysterectomy; 107, adnexal surgery (cystectomy: 44, adnexectomy: 63); and 1 myomectomy. The SSRS group included 68 patients who underwent myomectomy; 61, adnexal surgery (cystectomy: 52, adnexectomy: 9); 35, hysterectomy, and 4, sacrocolpopexy. Results: Both surgical techniques were successful, with no patients requiring open surgery. No significant differences were observed in the baseline characteristics between the two groups. Compared with the SPALS group, the SSRS group had a younger age (39.8 ± 9.5 vs. 44.5 ± 12.3 years, p = 0.001). Severe intra-abdominal adhesions were more frequently observed in the SSRS group (p = 0.004). Operation time (118.1 ± 65.9 vs. 57.1 ± 27.3 min, p = 0.001), gas passing time (39.4 ± 15.37 vs. 30.4 ± 13.5 h, p = 0.001), and hospital length of stay (4.26 ± 1.02 vs. 4.02 ± 0.8 days, p = 0.012) were significantly longer in the SSRS group. However, no significant differences were found between the two groups in terms of intraoperative blood loss, intraoperative complications, or readmission rates. Conclusions: SSRS offers a feasible and promising approach for treating gynecological benign diseases. Younger and lower-parity patients tend to undergo SSRS rather than SPALS, with SSRS primarily performed for myomectomy and complex adnexal surgery. However, operation time and gas passing time were significantly longer in the SSRS group. Full article

Introduction: Bouveret syndrome, a rare and often underdiagnosed variant of gallstone ileus, is characterized by the presence of a large gallstone impacted in the proximal duodenum, resulting in significant gastric outlet obstruction and aerobilia. Early identification of Bouveret syndrome is crucial for developing an appropriate surgical strategy. Case 1: A 76-year-old female underwent a contrast-enhanced abdominal CT scan, which revealed a cholecysto-duodenal fistula with a 3.9 cm × 4.0 cm × 4.0 cm gallstone located in the proximal duodenum, along with a distended, fluid-filled stomach and aerobilia. Intraoperatively, due to chronic inflammation and adhesion between the gallbladder and duodenum, a cholecystectomy and fistula repair were performed. Case 2: A 72-year-old female presented with a gastroduodenal passage obstruction confirmed by imaging, which identified a duodeno-biliary fistula. The radiological examination showed oval filling defects in the duodenal bulb consistent with Bouveret’s syndrome, with the largest stone measuring approximately 6 cm in diameter. An enterotomy was performed for stone extraction and was followed by cholecystectomy and duodenal repair with omentoplasty. Conclusions: Bouveret’s syndrome is a rare but clinically significant condition that should be considered in patients presenting with signs of upper gastrointestinal obstruction, particularly in those with a history of chronic cholelithiasis. Early recognition and prompt surgical intervention are essential for obtaining optimal patient outcomes. Full article

Background: Postoperative abdominal adhesion is a prevalent complication following abdominal surgery, with the incidence of adhesion reaching up to 90%, which may precipitate a range of adverse outcomes. Although fibrous membranes loaded with various anti-inflammatory or other drugs have been proposed for anti-adhesion, most of them suffer from drug-induced adverse effects. Methods: In this study, a lecithin-based electrospun polylactic acid (PLA) nanofibrous membrane (L/P-NM) was developed for the prevention of postoperative abdominal adhesion, utilizing the hydration lubrication theory. The loaded zwitterionic lecithin allows the nanofiber surface to strongly bind water molecules to create a hydration lubrication interface. Results: As the TGA results show, the content of bound water in the nanofibers increased significantly with the increase in the lecithin content. Tribological test results show that L/P-NM reached a minimum coefficient of friction (COF) of about 0.112. Additionally, the developed nanofibrous membranes possess favorable tensile property and biocompatibility. Rat postoperative abdominal adhesion model evaluation results demonstrated that L/P-NM possesses significant anti-adhesive performance, with an adhesion score of only 1. Conclusions: Therefore, this study offers a promising strategy for efficiently preventing abdominal adhesion. Full article