Patients with high pre-treatment CA19-9 levels show significantly poorer prognoses than those with normal levels. Neoadjuvant treatment (NAT) markedly enhances survival for these patients, with optimal outcomes for those achieving normalized CA19-9 or sufficient reduction post-treatment. Stratification reveals that patients with levels under 296 u/ml and over 40% reduction mirror the prognosis of those with normalized levels, while those with higher post-NAT levels face dire outcomes.
A newly validated nomogram accurately predicts postoperative recovery outcomes for patients undergoing pancreaticoduodenectomy for invasive intraductal papillary mucinous neoplasm (IPMN). Analyzing data from 479 patients, it identifies four key predictors: severe COPD, hypertension, elevated INR, and prolonged operative time, achieving a textbook outcome in roughly half the cases. This tool enhances preoperative planning and risk stratification, facilitating better shared decision-making and clinical benchmarking.
The gut microbiome significantly influences recovery trajectories after surgery and trauma, reshaping patient outcomes beyond genetic predispositions. Individual life histories dictate microbiota composition, which can affect organ systems such as the liver, kidneys, and brain. This review shifts the focus from solely pathogenic bacteria to the complex interactions among pathogens, hosts, and the microbiome, termed the “interactome,” highlighting its critical role in disease progression and recovery in critical care settings.
The intricate vascular anatomy of the pancreas, rife with variations, profoundly impacts surgical and interventional outcomes. Key arterial and venous structures, including the superior pancreaticoduodenal arteries and the gastrocolic trunk, require careful consideration to ensure effective surgical planning. Advances in imaging technologies now allow for precise mapping of these high-risk vascular variants, enhancing the safety of procedures like pancreaticoduodenectomy and transplantation. Multidisciplinary collaboration among surgeons, radiologists, and anatomists is essential to integrate this knowledge into clinical practice.
Over 56% of patients with persistent gas-bloat symptoms after antireflux surgery were SIBO-positive, experiencing significantly worse symptoms. After antibiotic treatment, severe bloating dropped from 77.5% to 23.1%, with substantial improvements in gas-bloat scores and patient satisfaction. SIBO testing emerged as a critical tool for diagnosing and managing post-surgical bloating, guiding targeted therapies that markedly enhance outcomes in these patients.
A streamlined approach to pancreatic and hepatocellular cancer treatment in Scotland significantly slashed the time from diagnosis to definitive treatment. Median treatment initiation for hepatocellular carcinoma (HCC) decreased from 98 to 62 days, while for pancreatic cancer (PC) the timeline shortened from 54 to 38 days. Enhanced communication and centralized oversight under the pathway improvement project led to swift alerts and improved care coordination, expediting critical interventions for nearly 400 patients.
Cholecystectomy performed during index admission for acute cholangitis significantly reduces in-hospital mortality and lowers 30- and 90-day readmission rates. In a study of over 29,000 patients, those who underwent surgery exhibited a 60% lower risk of death and nearly halved their likelihood of readmission compared to non-surgical counterparts. These benefits persisted across varying severity levels of cholangitis, suggesting a pressing need for revised surgical guidelines in managing this condition.
Laparoscopic repair of incarcerated inguinal hernias, combined with an enhanced recovery after surgery (ERAS) protocol, significantly reduces postoperative complications. In a comparison involving 200 patients, those undergoing laparoscopy reported only 9% complications, compared to 38% in the open surgery group. This paradigm shift not only streamlines recovery but also positions laparoscopic techniques as the preferred standard in emergency herniology.
Adhesions are one of those surgical complications we’d all prefer to never think about—but we don’t get that luxury. They’re common, costly, and often underestimated. Whether it’s a patient returning with chronic abdominal pain, secondary infertility, or adhesive small bowel obstruction, adhesions remain a persistent reminder that the operation doesn’t end when the skin is closed.
The good news: prevention is possible. Not perfect prevention—at least not yet—but with the right strategies, we can meaningfully reduce risk. Below, We’ll walk through the most effective, evidence-based approaches, the pitfalls to avoid, and where innovation might take us next.
1. Meticulous Surgical Technique: The Non-Negotiable Foundation
Let’s start with the obvious: no technology or pharmacological trick can replace good surgery. Gentle tissue handling, meticulous hemostasis, minimizing trauma, and avoiding desiccation and ischemia remain the backbone of adhesion prevention. Every unnecessary suture, every bit of char from cautery, every missed bleeder that leaves a hematoma—all of these set the stage for peritoneal inflammation and adhesion formation [Schnüriger et al., 2011; Koninckx et al., 2016; Robb & Mariette, 2014].
Shorter operative times also matter. The longer the peritoneum is exposed to trauma, ischemia, and air, the more likely adhesions will form. Thorough peritoneal lavage at the end of surgery is a simple but underused step that helps clear debris and pro-inflammatory material [Robb & Mariette, 2014].
Takeaway: every surgeon already knows this—but the difference between “good enough” and “meticulous” can translate into fewer complications months or years later.
2. Laparoscopy: Less Trauma, Fewer Adhesions
The transition from open surgery to minimally invasive techniques hasn’t just reduced recovery times—it’s also reshaped adhesion risk. Multiple studies show that laparoscopy is associated with lower adhesion rates compared to open surgery, except in appendicitis where the data is mixed [Schnüriger et al., 2011; ten Broek et al., 2016; Mais, 2014].
Why? Reduced tissue trauma, less desiccation, and less exposure to foreign material. In short: less inflammation.
But here’s the nuance: laparoscopy is not adhesion-proof. Adhesions still form, and the clinical consequences can still be significant. So, while laparoscopy is part of the solution, it’s not the solution alone.
3. Bioabsorbable Adhesion Barriers: The Best Evidence-Based Add-On
When the surgical field is hostile—prior surgery, extensive dissection, high risk of bowel obstruction—adhesion barriers are the next line of defense.
Meta-analyses and systematic reviews demonstrate that these agents reduce the incidence, extent, and severity of adhesions, and in some cases reduce reoperations for adhesive small bowel obstruction [Robb & Mariette, 2014; ten Broek et al., 2014; Huy et al., 2025].
The American Society for Reproductive Medicine specifically recommends hyaluronic acid–based barriers in gynecologic surgery [Fertility and Sterility, 2006]. In randomized trials, adhesion reduction is consistently in the 40–60% range, which is clinically meaningful [ten Broek et al., 2014].
Cautionary note: Seprafilm® should not be placed directly over fresh bowel anastomoses—it increases risk of abscess and leak [Zeng et al., 2007; Kumar et al., 2009]. Interceed® is safer but must be placed in a hemostatic field to be effective. Icodextrin® is generally well tolerated, though rare cases of sterile peritonitis have been reported [Catena et al., 2012; diZerega et al., 2002].
Takeaway: barriers aren’t perfect, but in high-risk cases, they’re one of the few interventions proven to matter.
4. Emerging Biomaterials: Hydrogels and Zwitterionic Polymers
If the past decade has taught us anything, it’s that biomaterials evolve quickly. Hydrogel-based barriers are now being engineered for better coverage and resistance to protein and cell adhesion, while zwitterionic polymers show almost complete resistance to fouling in experimental models [Lin et al., 2025; Zhang et al., 2020].
The clinical data isn’t here yet, but the lab results are promising. Think of these as the next generation of adhesion prevention—potentially superior in biocompatibility, handling, and long-term outcomes.
5. Adjunctive Strategies: Experimental, but Intriguing
Several adjunctive strategies are being investigated:
Peritoneal conditioning with cooling, humidified gas, or nitric oxide supplementation
Pharmacologic modulation with agents like dexamethasone
Stay curious—emerging biomaterials and adjunctive strategies may reshape prevention in the next decade.
Final Thoughts
Adhesion prevention isn’t glamorous. It doesn’t end up on conference slides as often as robotic platforms or new suture technologies. But it’s one of the most tangible ways we can improve long-term outcomes for our patients.
The real opportunity lies in combining what we already know—meticulous technique, minimally invasive approaches, selective barrier use—with the innovations on the horizon. If the next generation of biomaterials delivers on its promise, we might finally move from “adhesion reduction” toward “adhesion elimination.”
Until then, the responsibility sits squarely with us: to operate as though every unnecessary adhesion is preventable—because more often than not, it is.
Intracorporeal ileocolic anastomosis (ICA) significantly reduces incisional hernia rates in laparoscopic right hemicolectomy compared to extracorporeal anastomosis (ECA). Despite a longer mean operative time (190 vs. 170 minutes), the 24-month hernia incidence plummeted to 1.2% with ICA versus 14.7% with ECA. Patients also benefited from shorter hospital stays and fewer wound complications, solidifying ICA’s advantage despite its technical demands.
