Adhesion barriers in gynecologic surgeries and cesarean section: An Asia-Pacific expert panel consensus recommendation.

Adhesions arising from gynecologic surgeries and cesarean sections pose substantial clinical, social, and economic challenges, leading to issues like pelvic pain, infertility, bowel obstruction, and recurring surgeries. Preventing adhesions is a pressing unmet need, hindered by difficulties in assessing postoperative adhesions and understanding barriers. To bridge adhesion prevention gaps, statements on clinical practices were synthesized to present Asia-Pacific expert perspectives on gynecologic surgery and cesarean section adhesion prevention. An expert panel of eight physicians from various healthcare settings in the Asia-Pacific region was convened and a comprehensive literature search on topics related to adhesion prevention in gynecologic surgeries and cesarean sections was performed. Information from full-text publications was used to develop draft consensus statements, with each statement assigned the highest available evidence level based on a systematic literature review and graded using the Oxford Center for Evidence-based Medicine criteria. A modified Delphi process, involving two rounds of online voting and discussions with an extended group of 109 experts, was employed to reach a consensus on six topics related to adhesion barriers. A set of 15 consensus statements were synthesized. Key topics include adhesion incidence in Asia, cesarean section complications, barrier application status, adhesion formation and prevention, absorbable barriers' effectiveness, recommendations, and future considerations. The statements provide guidance for healthcare professionals, especially in the Asia-Pacific region, to tackle the challenges posed by postoperative adhesions and improve patient outcomes. Further research is needed to enhance understanding and prevention of adhesions in this region.

Validation of VIBe bleeding scale amongst hepatopancreatobiliary surgeons: results from an IHPBA survey.

BACKGROUND: The Validated Intraoperative Bleeding (VIBe) Scale could be used to aid assessment of intraoperative bleeding and guide the use of hemostatic products. The aim of this survey was to determine if the VIBe scale would serve as a generalizable and relevant tool for hepatopancreatobiliary(HPB) surgeons and trainees. METHODS: A standardized online VIBe training module was conducted on 67 respondents from 25 countries, after which they used the VIBe scale to score videos depicting different severities of intraoperative bleeding. Interobserver agreement was assessed using Kendall's coefficient of concordance. RESULTS: Interobserver agreement was excellent amongst all respondents with a Kendall's W of 0.923. Sub-analyses showed a difference based on seniority and level of experience: Attendings/Consultants(0.947) vs Fellows/Residents(0.879); Increasing years of practice >10(0.952) vs <10 years practice(0.890). There was excellent concordance regardless of surgical volume, percentage of procedures performed minimally invasively, area of sub-specialty, and previous involvement with VIBe surveys. CONCLUSION: This international survey in the field of HPB surgery across surgeons of various levels of experience showed that the VIBe scale could serve as an excellent tool to assess the severity of bleeding. This scale would also be useful in guiding the use and choice of hemostatic adjuncts to achieve hemostasis.