{"paper_id":"be25d6cd-61c4-4712-88a4-8d508e1c93f0","body_text":"~ 19 ~ \nInternational Journal of Surgery Science 2026; 10(1): 19-22  \n \nE-ISSN: 2616-3470 \nP-ISSN: 2616-3462 \nImpact Factor (RJIF): 5.97  \n© Surgery Science \nwww.surgeryscience.com \n2026; 10(1): 19-22 \nReceived: 06-12-2025 \nAccepted: 09-01-2026 \n \nSampat Ananthshree  \nBTS, 2nd Year Surgical Resident at \nLG Hospital, Ahmedabad, \nGujarat, India \n  \nDr. Tapan Shah \nProfessor, Department of General \nSurgery, LG Hospital, \nAhemdabad, \nGujarat, India  \n \nDr. Dhruvesh Sheth \nAssistant Professor, Department of \nGeneral Surgery, LG Hospital, \nAhemdabad, \nGujarat, India \n  \nDr. Mukesh Suvera \nProfessor and Head of Unit, \nDepartment of General Surgery, \nLG Hospital, Ahemdabad, \nGujarat, India \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nSampat Ananthshree  \nBTS, 2nd Year Surgical Resident at \nLG Hospital, Ahmedabad, \nGujarat, India \n \nGynecology and surgery: A mutual symbiosis \n \nSampat Ananthshree, Tapan Shah, Dhruvesh Sheth and Mukesh Suvera \n \nDOI: https://www.doi.org/10.33545/surgery.2026.v10.i1.A.1273  \n \nAbstract \nBackground: Gynecology and general surgery share significant anatomical and procedural overlap, \nparticularly in the pelvic and abdominal regions. Although gynecologists are trained in operative \ntechniques, complex intraoperative and postoperative complications often require the expertise of general \nsurgeons. This interdisciplinary interaction represents a mutual symbiosis aimed at improving patient \noutcomes. \nObjectives: This study aimed to explore the anatomical and procedural overlap between general surgery \nand gynecology, highlight clinical scenarios requiring collaborative management, evaluate the benefits of \ninterdisciplinary teamwork in complex and emergency cases, and promote integrated patient-centered care \nto minimize surgical risks and delays in treatment. \nMethodology: A retrospective observational study was conducted over three years (January 2022 to \nDecember 2024). The study included 140 patients aged 25-65 years who had previously undergone \ngynecological procedures and subsequently required surgical intervention. Data were collected from \noperation theatre registers and departmental records. Variables analyzed included patient age, type of \ngynecological procedure, nature of complication, and mode of management (medical or operative). \nResults: Among the 140 patients, the majority of complications included postoperative paralytic ileus, \nSurgical Site Infections (SSI), bladder perforation, acute appendicitis in pregnancy, bowel adhesions, and \nchronic sinus formation, accounting for 79.2% (N=111) of cases. More severe complications such as \nwound dehiscence, intestinal perforation, rectovaginal fistula, vesicovaginal fistula, and internal iliac artery \nligation comprised 20.7% (N=29). Operative management was required in 63.5% of patients, while 36.5% \nwere managed conservatively. Paralytic ileus (19.5%) and SSI (15.6%) were the most common \ncomplications. \nConclusions: The findings underscore the essential collaborative relationship between gynecology and \ngeneral surgery in managing postoperative complications. Strengthening interdisciplinary coordination, \nimproving perioperative protocols, and emphasizing early recognition of complications are crucial to \nenhancing patient outcomes and reducing morbidity. \n \nKeywords: Gynecology, general surgery, surgical site infection, paralytic ileus, postoperative, \nomplications, interdisciplinary collaboration, pelvic surgery, wound dehiscence \n \nIntroduction  \nThe specialty of gynecology frequently intersects with surgery, particularly when operative \ninterventions are required for reproductive tract diseases or when complications arise. While \ngynecologists are trained in many operative techniques, complex surgical complications often \ndemand the expertise of general surgeons. This creates a mutual symbiosis between the two \nspecialties. All surgical procedures have potential risk of complications of which obstetrics and \ngynecological surgeries are no exception [1]. However, the prognosis of such encounters depends \non prompt diagnosis and timely interventions in this scenario by the general surgeon the surgical \nintervention can be through surgical management, medical management including latest \nadvances like Negative pressure wound therapy. Some of the common encounters include the \nsurgical sit infections after an Operative procedure, Acute Appendicitis in pregnancy, \nvesicovaginal fistula, Intestinal perforation, paralytic ileus and many more.  \n  \nObjectives  \n To explore the anatomical and procedural overlap between general surgery and gynecology, \nespecially in the pelvic and abdominal regions.  \n To highlight the clinical scenarios where collaborative efforts between general surgeons and \ngynecologists improve diagnostic accuracy and treatment outcomes\n. \n\n\nInternational Journal of Surgery Science https://www.surgeryscience.com \n~ 20 ~ \n To evaluate the benefits of interdisciplinary training and \nteamwork in managing complex cases, emergencies, and \nperioperative complications. \n To promote integrated patient-centered care through \ncollaboration, minimizing redundancy, surgical risks, and \ndelays in treatment \n  \nMethodology and Subjects  \nThis is a retrospective study conducted over a span of 3 years \nfrom January 2022 to December 2024. The study subjects \ninclude all the patients in the gynecology and general surgery \ndepartment that had pervious history of a gynecological \ntreatment that later required a surgical intervention. The criteria \nused include patient’s age, gynecology procedure done followed \nby the surgical intervention and treatment.  \n  \nObservations \nA data of 140 patients were collected in a whole from the \nreproductive age group and post menopause (starting from 25 \nyears to 65years of age). \nMajority of the pts include postoperative paralytic ileus, wound \ninfections, bladder perforation managed. Acute appendicitis in \npregnancy, bowel adhesions and chronic sinus formation. These \ncover about 79.2% of the patients (I.e. 111). \nThe cases include wound dehiscence, Intestinal perforation, \nRectovaginal fistula, Vesicovaginal fistula and internal artery \nligation in uterine bleeding in placenta previa. This \nincludes20.7% of the cases (I.e.29 patients).\n \n \n \nFig 1: Total Number of subject collected \n \n \n \nFig 2: Bar chart of number of patient’s vs diagnosis \n \nOut of the subjects taken only 51 patients (I.e.36.5%) treated \nwith medical management and the rest 89 patients (I.e. 63.5%) \nwere surgically managed. The anatomical overlap is seen mainly \nwhen there is involvement of appendix or perforation of viscous \n(like Intestinal, rectum or bladder). It can also be seen in the \nform of wound dehiscence causing hollow vicous to herniated \nout. Intestinal perforation and Burst open abdomen are less \ncommon amongst all the patients attended only 8.6% compared \nto Bladder perforation that is 14.2% of the cases. \n\nInternational Journal of Surgery Science https://www.surgeryscience.com \n~ 21 ~ \n \n \nFig 3: The above figure gives detailed information regarding the proportion or more specifically the percentage of different complications. It can be \nobserved that paralytic ileus 19.5% of cases and SSI 15.6% of the cases are the majority of the cases on the other hand intestinal perforation (4.7%) \nor Rectovaginal (1.44%) or Cystovaginal (1.44%) fistula comprise only small proportion of the group \n \n \n \nOperative management-63.5%, Medical management-36.5 \n \n \n  \n \nBurst open abdomen for which tension band wiring was done  Figure shows wound infection in post hysterectomy patient \n \nDiscussion \nFor a surgical resident, the importance of understanding \ngynecological procedures lies not only in operative assistance \nbut also in independently recognizing and managing surgical \ncomplications. This interrelationship highlights the concept of \nmutual symbiosis between gynecology and surgery.  \n\nInternational Journal of Surgery Science https://www.surgeryscience.com \n~ 22 ~ \nIntra-abdominal catastrophes during gynecological operations \n(e.g., bowel, bladder, and ureteric injuries) should be approached \nwith surgical precision. Bowel injury: Primary repair if \nrecognized early; diversion stoma if contamination is significant. \nBladder injury: Requires layered closure and catheter drainage \n[2]. Common intraoperative complications where surgical \nassistance is crucial massive hemorrhage. Vessel ligation, \ncompression sutures, pelvic packing, or internal iliac artery \nligation. Surgeon’s Role involves Rapid control of bleeding and \ndamage-control laparotomy in unstable patients [3].  \nAdhesions develop after hysterectomy, oophorectomy, or \nendometriosis surgery that can lead to small bowel obstruction. \nSurgical Relevance includes Adhesiolysis. This may be open or \nlaparoscopic [4].  \nWound infection, burst abdomen or wound dehiscence managed \nby giving higher spectrum of antibiotics, Tension band wiring or \nResuturing and negative-pressure therapy etc.  \nParalytic ileus after many gynecological procedures like \nhysterectomy, adenexal surgery with bowel involvement or \nendometriosis excision etc. Thus is mainly managed by \nsupportive and conservative management ment as mainstay of \ntreatment [5].  \nChronic sinus formation after gynecological surgery is a \ntroublesome complication, leading to persistent discharge, \ndelayed wound healing, and repeated infections. Major causes \nincluded involvement of foreign body like (gauze or sponge) or \na non-absorbable suture metarial (like silk or prolene). Port site \nsinus formation mainly laparoscopic hysterectomy was very \nmuch common. Another case identified was post episiotomy \nsinus formation after a normal vaginal delivery. Major surgeon \ninvolvement includes sinus tract excision (sinusectomy) and \nremoving the underlying pathology of super metarial, gauze \npieces or any abcess cavity underlying the sinus tract [6].  \n \nConclusion \nYou are a true surgeon from the moment you are able to deal \nwith your complications”, Professor Owen H Wangensteen [7].  \nEvery surgeon tries to perform surgeries in the best possible way \nwithout any complications or harm to their patient; however, \ndespite their best possible efforts, complications can arise in any \nsurgery, thereby affecting the prognosis. \nIn our study conducted of 138 patients majority of them had \ncomplication of wound infection (SSI) and paralytic ileus or \nchronic sinus formation. Minor categories include Cystovaginal \nor Rectovaginal fistula, Intestinal perforation or internal artery \nligation. As a whole SSI include 15.6% of cases that is higher \ncompared to another Indian study that had 10.34% [8] \nhighlighting the importance of hygiene factors intraoperatively \nand ppostoperatively. Comparing all the results it is observed \nthat there were highr rates of SSI which suggests that a lot of \nimprovement is still required in maintaining hygiene and \nsterility. Urological procedure were also higher 15.9% compared \nto Ortiz-Martí Nez, et al . [9] examined the prevalence of \nurological injuries in gynaecological surgeries and found that \nbladder injury was seen in 0.34% of cases. Paralytic ileus and \nchronic sinus formation also include majority of cases.  \nParalytic ileus was mainly 25 cases (17.86%). The main reason \nwas observed to be electrolyte imbalance low potassium and \nmagnesium and dehydration. Basic fluid management and \nelectrolyte correction lead to improvement in these patients. \nChewing gum and early start of diet have shown to stimulate the \nvagal tone and reduces the inflammatory effect. \nIntestinal perforation and Burst open abdomen are less common \namongst all the patients attended only 8.6% compared to \nBladder perforation that is% of the cases. \nFurther research needs to be conducted on this topic to design \nnecessary strategies to decrease the burden on patients facing \nthese complications. \n \nLimitations  \nThe major limitation of this study is that we included data from \nonly one institution and only a single of 3years, which cannot be \ngeneralised to the general population.  \nAnother major limitation in this procedure is that only patients \nbetween 25 to 65 years age group were included excluding the \nage related surgical complications in the study.  \nThe chance of underreporting of cases is very minimal in our \nstudy as records were extracted from both operation theatre \nregisters and from departmental file records. We believe that this \nstudy constitutes a unique addition to the currently available \nliterature on surgical complications since it has included and \nanalysed even minor complications.  \n \nReferences \n1. Wichendu PN, Eli S, Omietimi J. General surgery encounter \nfollowing obstetrics and gynaecological surgeries: A 10 \nyear review at a university teaching hospital. Mother Baby \nAdolescent Care Glob Found. 2021;3(2):10-15. \n2. Williams NS, O'Connell PR, McCaskie AW, editors. Bailey \n& Love’s short practice of surgery. 28 th Ed. Boca Raton: \nCRC Press; 2022. \n3. Shaw RW, Luesley DM, Monga A, editors. Shaw’s \ntextbook of gynecology. 17th Ed. New York: Elsevier; 2022. \n4. DeWilde RL, Trew G. Postoperative abdominal adhesions \nand their prevention in gynecological surgery. Expert Rev \nObstet Gynecol. 2007;2(1):89-100. \n5. Venara A, Neunlist M, Slim K, Barbieux J, Colas T, Hamy \nA, et al . Postoperative ileus: Pathophysiology, incidence, \nand prevention. J Visc Surg. 2016;153(6):439-446. \n6. Gupta N, Gupta V, Gupta N, Mittal S. Tubercular sinus \ntracts in gynecology: diagnostic challenges and \nmanagement. J Obstet Gynaecol India. 2017;67(5):353-357. \n7. Hakim NS, Papalois VE, editors. Surgical complications: \ndiagnosis and treatment. London: Imperial College Press; \n2007. p. 1-40. \n8. Pathak A, Mahadik K, Swami MB, Roy PK, Sharma M, \nMahadik VK, et al. Incidence and risk factors for surgical \nsite infections in obstetric and gynecological surgeries from \na teaching hospital in rural India. Antimicrob Resist Infect \nControl. 2017;6:66. DOI: 10.1186/s13756-017-0223-y. \n9. Martínez ORA, Canas BAJ, Nanez BDM, Narvaez CT, \nPortilla ED, Victoria FO. Prevalence of surgical \ncomplications in gynecological surgery at the Hospital \nUniversitario San José in Popayán, Colombia. Rev Fac \nMed. 2018;66(4):529-535. \n \n \nHow to Cite This Article \nAnanthshree S, Shah T, Sheth D, Suvera M. Gynecology and surgery: A \nmutual symbiosis. International Journal of Surgery Science. 2026;10(1):19-\n22. \n \n \nCreative Commons (CC) License \nThis is an open-access journal, and articles are distributed under the terms \nof the Creative Commons Attribution-Non Commercial-Share Alike 4.0 \nInternational (CC BY-NC-SA 4.0) License, which allows others to remix, \ntweak, and build upon the work non-commercially, as long as appropriate \ncredit is given and the new creations are licensed under the identical terms.","source_license":"CC0","license_restricted":false}