Introduction: Postoperative peritoneal adhesions remain an almost inevitable consequence of abdominopelvic surgery, causing small bowel obstruction, infertility, chronic pain, and significant healthcare costs. Numerous adhesion prevention agents have been introduced, yet their comparative efficacy and safety remain uncertain.Methodology: This systematic review was conducted in accordance with PRISMA guidelines. Electronic databases including PubMed, Web of Science, and Google Scholar were searched up to August 2025. Randomized controlled trials (RCTs) and controlled clinical studies evaluating adhesion prevention agents in abdominal or pelvic surgery were included. Data extraction focused on study characteristics, interventions, adhesion-related outcomes, complications, and follow-up.Results: Ten eligible trials were analyzed. Hyaluronic acid/carboxymethylcellulose (HA/CMC) gels and membranes demonstrated consistent reductions in adhesion severity and extent, with Guardix-sol, Guardix-SG, and TCD-11091 showing the most favorable outcomes. Starch-based polysaccharides (4DryField PH) achieved up to an 85% reduction in adhesion scores at second-look laparoscopy and were associated with improved fertility and pain outcomes, though safety concerns were reported in pediatric and retrospective cohorts. Collagen membranes (COVA+), thermosensitive gels (Mediclore, Actamax), and fibrin sealants (Adhexil) showed promising early results but require larger confirmatory studies. Conversely, icodextrin (Adept) and spray powders such as Sepraspray yielded inconsistent benefit. Safety was generally acceptable, though powders occasionally correlated with higher complication rates.Conclusion: Evidence supports the selective use of HA/CMC-based gels and starch-derived barriers for adhesion prevention in high-risk surgical contexts. However, heterogeneity across trials, short follow-up, and lack of standardized adhesion scoring limit definitive recommendations. Adhesion barriers should be considered as adjuncts to meticulous surgical technique rather than substitutes. Future directions include bioactive, multifunctional platforms (Janus hydrogels, plasma-activated solutions, metabolic modulators, phytochemicals) and robust RCTs incorporating fertility, obstruction, pain, and cost-effectiveness as patient-centered endpoints.PROSPERO ID: CRD420251119090
Introduction: Non-pharmacological strategies are gaining interest in perioperative care to improve recovery and reduce opioid dependence. This study was designed to evaluate the impact of intraoperative religious chanting on postoperative pain, opioid consumption, and early mobilisation in patients undergoing laparoscopic cholecystectomy.Methodology: A prospective, double-blinded randomised controlled trial was conducted involving 60 patients scheduled for elective laparoscopic cholecystectomy at a single tertiary centre. Participants were randomised to receive either religious chanting (n = 30) or silence (control, n = 30) through headphones intraoperatively. The primary outcome was postoperative pain measured using the Visual Analogue Scale (VAS) at 6, 12, and 24 hours. Secondary outcomes included cumulative opioid requirement, early mobilisation (within 6 hours), and incidence of postoperative nausea and vomiting (PONV).Results: Patients exposed to religious chanting had significantly lower VAS pain scores at 6 hours (3.2 vs. 4.7, p<0.01), 12 hours (2.7 vs. 4.1, p=0.01), and 24 hours (1.8 vs. 3.2, p=0.03). Mean total opioid consumption was reduced by 35% in the chanting group (p=0.02). Early mobilisation was achieved in 70% of the chanting group compared to 43% in controls (p=0.04). No significant difference was observed in PONV rates.Conclusion: Intraoperative religious chanting is a safe, low-cost, and effective adjunct to reduce postoperative pain and opioid use, and to enhance early recovery in laparoscopic cholecystectomy. These findings support the integration of culturally appropriate non-pharmacological interventions into multimodal perioperative care protocols.Sri Lanka clinical trial registry (Reference Number: SLCTR/2024/031)
Introduction: Colorectal cancer (CRC) is a major cause of cancer morbidity and mortality worldwide and its incidence is increasing in many Asian populations, including Sri Lanka. Evaluating surgical outcomes and prognostic determinants is essential for improving colorectal cancer management in this setting.Methodology: A retrospective cohort study was conducted including all patients who underwent colorectal cancer resection at a tertiary referral centre in Sri Lanka between 2019 and 2023. Clinicopathological variables were extracted from histopathology reports and hospital records. Survival outcomes were determined through hospital documentation and telephone tracing where possible. Kaplan-Meier methods were used to estimate survival, and differences between groups were assessed using the log-rank test. Multivariable Cox proportional hazards regression analysis was performed to identify independent predictors of survival.Results: A total of 570 patients underwent colorectal cancer resection during the study period. Survival status could be verified in 135 patients (23.7%), while 435 patients (76.3%) remained untraced. Among the traced patients, 47 deaths occurred during follow-up. Estimated overall survival rates were 77.8% (95% CI 70.5-85.1%) at 12 months, 71.1% (95% CI 62.9-79.3%) at 24 months, 65.5% (95% CI 56.4-74.6%) at 36 months, and 59.9% (95% CI 49.8-70.0%) at 60 months. Patients with lymph node yield ≥12 nodes demonstratedsignificantly improved survival compared with those with <12 nodes retrieved (log-rank p<0.001). Tumour stage was also significantly associated with survival, with T4 disease demonstrating poorer outcomes (p<0.001). In multivariable Cox regression analysis, lymph node yield ≥12 (HR 0.22, 95% CI 0.10-0.46) and T4 disease (HR 3.42, 95% CI 1.74-6.71) remained independent predictors of survival.Conclusion: Adequate lymph node harvest and tumour stage are key determinants of survival following colorectal cancer surgery. However, substantial loss to follow-up limited survival analysis to a subset of patients, highlighting the need for strengthened cancer registries and structured follow-up systems to improve long-term outcome surveillance in Sri Lanka.
Introduction: External ventricular drainage (EVD) is critical in managing neurocritical patients. Proper nursing care is essential for infection prevention, troubleshooting, and routine maintenance of EVD. This study aims to assess the knowledge among the nursing officers working at a tertiary care neurocritical care center in Sri Lanka regarding the principles and practices of EVD management.Methodology: This study employed a descriptive cross-sectional design to assess nursing officers' knowledge and practices regarding EVD management. Data were collected using a pre-tested, self-administered questionnaire designed to evaluate key domains, including EVD function, maintenance, infection prevention, and troubleshooting.Results: There were 172 nursing officers, their mean age of 30.34 ± 4.98, and the majority (94.2%) were females. Out of the sample, 29% had more than 5 years of clinical experience, and 92.4% had not received formal training on nursing care on EVD.The mean knowledge was 84.45%, and more than 88% had over 75% score.Knowledge was significantly associated with having a formal training in EVD care (p=0.025). Conclusion: Most nursing officers in neurocritical care have good knowledge about EVD management. More than 88% scored above 75%. Having formal training would enhance the level of knowledge. This shows that formal training is important to keep improving care for patients with EVD.
Introduction: Surgical management is the primary treatment for many pathological lesions of the orofacial region. Despite advances in technique and perioperative care, postoperative complications remain a major determinant of treatment outcomes. This study assessed the incidence, characteristics, and risk factors for postoperative complications among patients undergoing surgery for oral and maxillofacial tumors and tumor-like lesions in a tertiary hospital in Tanzania.Methodology: This was an analytical prospective hospital-based study carried out at the Muhimbili National Hospital (MNH) between April 2022 and March 2023. It included all patients managed surgically for the tumor and tumor-like lesions involving the oral and maxillofacial region. Results: A total of 132 patients, with 29 different types of tumors and tumor-like lesions, were managed during the study period. Most procedures (56.8%) were non-ablative. Immediate, intermediate, and late post-operative complications occurred in 67.2%, 12.1%, and 10.6% of patients, respectively. Male patients had higher odds of immediate complications, whereas female patients had increased odds of late complications. Malignancy (AOR = 26.44; 95% CI 2.71–258.2; p = 0.005) and operative duration exceeding 2 hours (AOR = 6.62; 95% CI 1.26–34.88; p = 0.026) were independently associated with intermediate complications.Conclusion: Immediate post-operative complications are the most Conclusion common following head and neck surgery, while intermediate and late complications are less frequent. Patient sex influenced the development of immediate and late complications, whereas malignancy and prolonged operative duration were key predictors of intermediate post-operative complications.
Introduction: Developing countries such as Sri Lanka are seeing an increase in the prevalence of diabetes mellitus and related complications, including major lower limb amputations. This leads to high morbidity and mortality.Objectives: To evaluate the outcomes of diabetes mellitus-associated major lower limb amputations at a specialised tertiary care centre in Sri LankaMethodology: Patients who underwent major lower limb amputations due to diabetes mellitus-related complications from June 2022 to July 2023 were voluntarily recruited. Patients were followed up for a year at clinics and via telephone calls. Student's t-test, chi-squared test, regression models and Kaplan-Meier survival tables were used for results analysis.Results: Of the 149 patients, the mean age was 63.7 years (SD 10.7). 30.9% (n=46) were females, and 83.9% (n=125) of the patients had undergone below-knee amputations (BKA). After one year, 28.2% (n=42) of patients were deceased and the commonest cause of death was myocardial infarction (59.6%, n=25). Of postoperative complications, surgical site infection was the commonest immediate complication (14.8%, n=22); phantom limb sensation was the commonest late-onset local complication (49.7%, n=74) and myocardial infarction was the most common late-onset systemic complication (37.6%, n=56). In multivariate analysis, binary logistic regression identified smoking (current or previous) as a significant independent predictor of one-year mortality (95% CI: 1.5–4.5, p=0.018). According to Cox regression, both smoking (95% CI: 1.8–6.0, p=0.015) and fasting blood glucose levels (95% CI: 1.0–1.3, p=0.017) significantly reduced survival time. Other risk factors were not statistically significant.Conclusion: Diabetes-related major lower limb amputations are associated with substantial one-year mortality, largely attributable to myocardial infarction, alongside a high burden of postoperative complications. Both immediate complications, particularly surgical site infections, and late complications such as phantom limb phenomena and cardiovascular events were common. Long-term functional recovery was limited. Smoking and elevated fasting blood glucose emerged as significant predictors of reduced survival. Elevated fasting plasma glucose was significantly associated with reduced survival time in the Cox regression model, but it was not a significant predictor of one-year mortality in the binary logistic regression analysis, indicating an effect on the timing rather than the occurrence of death.
Adult Idiopathic Scoliosis is a three-dimensional spinal deformity with an aetiology that remains largely unknown. The development of an ideal classification system, identification of risk factors for curve progression, and determination of optimal treatment methods continue to present challenges in the field. Although various surgical and nonsurgical interventions have been employed, the efficacy and advancement of these techniques over recent decades remain uncertain. This narrative review examines these factors to elucidate current best practices in the management of Adult Idiopathic Scoliosis.
Introduction: Simulation-based surgical training (SBST) is increasingly used to address reduced operative exposure and patient safety concerns. However, access to simulation alone does not ensure effective learning. Deliberate practice (DP) provides a theoretical framework for structured skill acquisition, yet its enactment within everyday surgical training environments remains poorly understood, particularly in low- and middle-income countries.Methodology: A sequential mixed-methods design was used. The quantitative phase involved 53 participants (38 trainees, seven trainers, eight expert surgeons) who completed a structured questionnaire examining SBST access, training practices, and alignment with DP principles. The qualitative phase included 22 semi-structured interviews exploring lived experiences of simulation use, feedback, and institutional influences on practice. Quantitative data were analysed using descriptive and non-parametric statistics. Qualitative data were analysed using systematic text condensation guided by the DP framework.Results: Expert surgeons demonstrated greater alignment with DP principles than trainees, particularly in goal setting, reflective self-monitoring, and feedback utilisation. Trainees reported more opportunistic use of simulation, limited task progression, and weaker alignment between task difficulty and competence level. Although most centres had simulation access, its use was inconsistent and rarely embedded within longitudinal curricula. Qualitative findings identified institutional barriers including limited protected training time, heavy clinical workload, absence of structured progression pathways, inconsistent faculty training in feedback delivery, and lack of scheduled simulation sessions.Conclusion: Effective enactment of deliberate practice in SBST depends on curricular integration, structured feedback processes, and institutional support. Strengthening these elements may enhance the educational impact of simulation in resource-constrained training environments.
Background This study examines the incidence patterns of hypospadias in this region and investigates the management strategies employed for its repair. The aim is to gain insight into the factors influencing surgical decision-making, potential complications, and the reasons behind these complications. Materials and methods This research was conducted at our centre from January 2019 to July 2024, involving all male patients of any age who came in with hypospadias. Data was collected from the hospital's database and analysed using SPSS (Statistical Package for Social Sciences). Results 214 patients with a mean age of 8.13 (SD = 5.03 years) were included in the study. The most common type of hypospadias found was mid-penile. Chordee was found in 75.5% of the boys, an abnormal opening of the urethra in 9.7%, undescended testes in 2.7%, and an inguinal hernia in 2.2%. Repairs were performed using the TIP (tubularized incised urethral plate) method in 20.9% of the cases, while a notable 75.5% chose to undergo two-stage (Bracka) repairs along with various other techniques. The most common complications identified were oedema and urethrocutaneous fistula. Surgeries performed by specialists had fewer complications compared to those done by residents, with a significant difference (p-value = 0.0087). Single-stage repairs resulted in fewer complications than two-stage repairs, with a p-value of 0.0001. Conclusion Hypospadias repair is a complex procedure that requires considerable practice, patience, and surgical expertise, particularly when utilising magnification techniques. However, single-stage repairs are encouraged due to fewer post-operative complications.
