The Royal College of Surgeons of England (RCS England) is an independent professional body and registered charity that promotes and advances standards of surgical care for patients, and regulates surgery and dentistry in England and Wales. The College is located at Lincoln's Inn Fields in London. It publishes multiple medical journals including the Annals of the Royal College of Surgeons of England, the Faculty Dental Journal, and the Bulletin of the Royal College of Surgeons of England.
Post-operative adhesions develop in most abdominal and pelvic surgeries and cause pain, bowel obstruction, infertility, and reoperation. Current measures such as Seprafilm® and NSAIDs provide only partial protection and may cause adverse effects. This review evaluates natural products and biomaterial platforms as potential strategies for adhesion prevention. A structured literature search was performed in PubMed, Scopus, and Google Scholar. Peer-reviewed English-language in vitro, animal, and clinical studies, as well as relevant reviews and meta-analyses, were considered. Studies focusing on natural products and biomaterial-based delivery systems for post-surgical adhesion prevention were screened for mechanistic relevance and translational value, with emphasis on publications from 2015 to 2025. Curcumin, resveratrol, epigallocatechin-3-gallate, bromelain, and vitamin E demonstrated antioxidant, anti-inflammatory, and anti-fibrotic actions that interfere with TGF-β, ROS, cytokines, and extracellular matrix deposition. Hydrogels, bioresorbable films, and nanosystems enhanced local release and added barrier effects. Preclinical data are promising, but clinical evidence is scarce, and issues of bioavailability, safety, and standardisation remain. Natural products combined with biomaterial platforms represent a promising strategy for adhesion prevention, but robust clinical trials are needed to confirm safety and efficacy. Post-surgical adhesions are common complications after abdominal and pelvic surgeries and can cause pain, infertility, and bowel obstruction. This review discusses how natural compounds such as curcumin, resveratrol, bromelain, green tea extracts, and vitamin E may help prevent adhesion formation through anti-inflammatory and antioxidant effects. The article also highlights advanced biomaterial systems, including hydrogels and nanoparticles, that can improve delivery of these compounds. While early research is promising, more clinical studies are needed to confirm their safety and effectiveness in humans.
To critically appraise and evaluate the safety and efficacy of intraoperative tranexamic acid (TXA) administration during transurethral resection of the prostate (TURP). A systematic search of online databases was conducted to identify randomised-controlled trials (RCTs) which compared surgical outcomes and complication rates in patients undergoing TURP for benign prostatic hyperplasia (BPH) who were treated with TXA (intervention) as compared to placebo/none (control). The efficacy of intraoperative TXA was evaluated through outcomes related to blood loss, rate of blood transfusion and operative time. The safety of TXA was evaluated through pooled analysis of both deep venous thrombosis and pulmonary emboli. Nine RCTs met the inclusion criteria for this meta-analysis in which a total of 661 patients underwent TURP for BPH (331 TXA: 330 Control). There was significantly less intraoperative bleeding in the TXA group (MD –40.23 mL [95
Chronic and postoperative wounds remain challenging to manage, with high risks of infection, delayed healing and increased costs. Manuka honey offers antibacterial, anti-inflammatory, antioxidant and tissue-regenerative properties through methylglyoxal, phenolic compounds, high sugar content and low pH. The main objective is to review the mechanisms, clinical outcomes and applications of Manuka honey in wound care. A narrative review of PubMed, Scopus and Google Scholar identified studies on surgical site management, graft or flap bed preparation, chronic wounds and novel delivery systems, prioritising randomised controlled trials and high-quality observational data. Results have shown that Manuka honey demonstrates broad-spectrum antimicrobial and antibiofilm effects, supports non-traumatic debridement and modulates inflammation to promote granulation and re-epithelialisation. Clinical studies show reduced bacterial load, faster healing and improved comfort in surgical and chronic wounds. Operative uses include pre-grafting bed conditioning, adjunctive treatment for infected wounds and integration with negative pressure wound therapy. Emerging delivery approaches, such as bioengineered honey-collagen dressings and nanofibrous scaffolds, show promise for enhancing postoperative outcomes. To conclude, Manuka honey is a versatile and promising adjunct in modern wound care management. Standardised application protocols and robust, high-quality surgical trials are urgently needed to confirm its effective role in perioperative clinical practice.
OBJECTIVE:To critically evaluate the existing evidence base surrounding the efficacy of preoperative 5-alpha reductase inhibitor (5ARI) administration in the reduction of perioperative complication rates in transurethral resection of prostate (TURP). METHODS:In April 2025, a systematic search of on-line databases was conducted to identify randomised controlled trials (RCTs) that compared surgical outcomes and complication rates in patients undergoing TURP for benign prostatic hyperplasia (BPH) who were treated preoperatively with 5ARI (finasteride or dutasteride) as compared to placebo/none. The efficacy of preoperative finasteride was evaluated through outcomes related to blood loss, rate of blood transfusion, and operative time. The physiological mechanism of 5ARI treatment was evaluated through microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression of the resected specimen. RESULTS:A total of 30 RCTs met the inclusion criteria for this meta-analysis in which a total of 2974 patients underwent TURP for BPH (1464 5ARI: 1410 Control). Intraoperative blood loss was significantly lower among 5ARI-treated patients (Z = 6.37, mean difference [MD] = -82.58 mL, 95% confidence interval [CI] -107.98 to -57.18; P < 0.001), which was reflected in a significantly lesser haemoglobin drop on the first postoperative day (Z = 6.84, MD = -0.90 g/dL, 95% CI-1.16 to -0.64; P < 0.001). The MVD was significantly lower in resected specimens from 5ARI-treated patients (MD = -6.18 vessels/mm3, P < 0.001), whilst expressing significantly less VEGF (MD = -3.25, P < 0.001). Patients treated with 5ARI required blood transfusion less frequently than controls (odds ratio 0.31, P < 0.001). The use of 5ARI was associated with shorter operative time (MD = -3.47 min, P = 0.02) and lower volume of irrigation agents (MD = -2.07 L, P < 0.001). CONCLUSION:Preoperative administration of 5ARIs significantly reduces intraoperative blood loss and risk of requiring blood transfusion in patients undergoing TURP for BPH. Even short durations (2 weeks) of 5ARI therapy can significantly reduce prostate vascularity.
