Gynecology and surgery: A mutual symbiosis

Background: Gynecology and general surgery share significant anatomical and procedural overlap, particularly in the pelvic and abdominal regions. Although gynecologists are trained in operative techniques, complex intraoperative and postoperative complications often require the expertise of general surgeons. This interdisciplinary interaction represents a mutual symbiosis aimed at improving patient outcomes.

This study aimed to explore the anatomical and procedural overlap between general surgery and gynecology, highlight clinical scenarios requiring collaborative management, evaluate the benefits of interdisciplinary teamwork in complex and emergency cases, and promote integrated patient-centered care to minimize surgical risks and delays in treatment. Methodology: A retrospective observational study was conducted over three years (January 2022 to December 2024). The study included 140 patients aged 25-65 years who had previously undergone gynecological procedures and subsequently required surgical intervention. Data were collected from operation theatre registers and departmental records. Variables analyzed included patient age, type of gynecological procedure, nature of complication, and mode of management (medical or operative).

Among the 140 patients, the majority of complications included postoperative paralytic ileus, Surgical Site Infections (SSI), bladder perforation, acute appendicitis in pregnancy, bowel adhesions, and chronic sinus formation, accounting for 79.2% (N=111) of cases. More severe complications such as wound dehiscence, intestinal perforation, rectovaginal fistula, vesicovaginal fistula, and internal iliac artery ligation comprised 20.7% (N=29). Operative management was required in 63.5% of patients, while 36.5% were managed conservatively. Paralytic ileus (19.5%) and SSI (15.6%) were the most common complications.

The findings underscore the essential collaborative relationship between gynecology and general surgery in managing postoperative complications. Strengthening interdisciplinary coordination, improving perioperative protocols, and emphasizing early recognition of complications are crucial to enhancing patient outcomes and reducing morbidity.

Gynecology, general surgery, surgical site infection, paralytic ileus, postoperative, omplications, interdisciplinary collaboration, pelvic surgery, wound dehiscence

The specialty of gynecology frequently intersects with surgery, particularly when operative interventions are required for reproductive tract diseases or when complications arise. While gynecologists are trained in many operative techniques, complex surgical complications often demand the expertise of general surgeons. This creates a mutual symbiosis between the two specialties. All surgical procedures have potential risk of complications of which obstetrics and gynecological surgeries are no exception [1]. However, the prognosis of such encounters depends on prompt diagnosis and timely interventions in this scenario by the general surgeon the surgical intervention can be through surgical management, medical management including latest advances like Negative pressure wound therapy. Some of the common encounters include the surgical sit infections after an Operative procedure, Acute Appendicitis in pregnancy, vesicovaginal fistula, Intestinal perforation, paralytic ileus and many more.

 To explore the anatomical and procedural overlap between general surgery and gynecology, especially in the pelvic and abdominal regions.  To highlight the clinical scenarios where collaborative efforts between general surgeons and gynecologists improve diagnostic accuracy and treatment outcomes . International Journal of Surgery Science https://www.surgeryscience.com ~ 20 ~  To evaluate the benefits of interdisciplinary training and teamwork in managing complex cases, emergencies, and perioperative complications.  To promote integrated patient-centered care through collaboration, minimizing redundancy, surgical risks, and delays in treatment Methodology and Subjects This is a retrospective study conducted over a span of 3 years from January 2022 to December 2024. The study subjects include all the patients in the gynecology and general surgery department that had pervious history of a gynecological treatment that later required a surgical intervention. The criteria used include patient’s age, gynecology procedure done followed by the surgical intervention and treatment. Observations A data of 140 patients were collected in a whole from the reproductive age group and post menopause (starting from 25 years to 65years of age). Majority of the pts include postoperative paralytic ileus, wound infections, bladder perforation managed. Acute appendicitis in pregnancy, bowel adhesions and chronic sinus formation. These cover about 79.2% of the patients (I.e. 111). The cases include wound dehiscence, Intestinal perforation, Rectovaginal fistula, Vesicovaginal fistula and internal artery ligation in uterine bleeding in placenta previa. This includes20.7% of the cases (I.e.29 patients). Fig 1: Total Number of subject collected Fig 2: Bar chart of number of patient’s vs diagnosis Out of the subjects taken only 51 patients (I.e.36.5%) treated with medical management and the rest 89 patients (I.e. 63.5%) were surgically managed. The anatomical overlap is seen mainly when there is involvement of appendix or perforation of viscous (like Intestinal, rectum or bladder). It can also be seen in the form of wound dehiscence causing hollow vicous to herniated out. Intestinal perforation and Burst open abdomen are less common amongst all the patients attended only 8.6% compared to Bladder perforation that is 14.2% of the cases. International Journal of Surgery Science https://www.surgeryscience.com ~ 21 ~ Fig 3: The above figure gives detailed information regarding the proportion or more specifically the percentage of different complications. It can be observed 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%) or Rectovaginal (1.44%) or Cystovaginal (1.44%) fistula comprise only small proportion of the group Operative management-63.5%, Medical management-36.5 Burst open abdomen for which tension band wiring was done Figure shows wound infection in post hysterectomy patient

For a surgical resident, the importance of understanding gynecological procedures lies not only in operative assistance but also in independently recognizing and managing surgical complications. This interrelationship highlights the concept of mutual symbiosis between gynecology and surgery. International Journal of Surgery Science https://www.surgeryscience.com ~ 22 ~ Intra-abdominal catastrophes during gynecological operations (e.g., bowel, bladder, and ureteric injuries) should be approached with surgical precision. Bowel injury: Primary repair if recognized early; diversion stoma if contamination is significant. Bladder injury: Requires layered closure and catheter drainage [2]. Common intraoperative complications where surgical assistance is crucial massive hemorrhage. Vessel ligation, compression sutures, pelvic packing, or internal iliac artery ligation. Surgeon’s Role involves Rapid control of bleeding and damage-control laparotomy in unstable patients [3]. Adhesions develop after hysterectomy, oophorectomy, or endometriosis surgery that can lead to small bowel obstruction. Surgical Relevance includes Adhesiolysis. This may be open or laparoscopic [4]. Wound infection, burst abdomen or wound dehiscence managed by giving higher spectrum of antibiotics, Tension band wiring or Resuturing and negative-pressure therapy etc. Paralytic ileus after many gynecological procedures like hysterectomy, adenexal surgery with bowel involvement or endometriosis excision etc. Thus is mainly managed by supportive and conservative management ment as mainstay of treatment [5]. Chronic sinus formation after gynecological surgery is a troublesome complication, leading to persistent discharge, delayed wound healing, and repeated infections. Major causes included involvement of foreign body like (gauze or sponge) or a non-absorbable suture metarial (like silk or prolene). Port site sinus formation mainly laparoscopic hysterectomy was very much common. Another case identified was post episiotomy sinus formation after a normal vaginal delivery. Major surgeon involvement includes sinus tract excision (sinusectomy) and removing the underlying pathology of super metarial, gauze pieces or any abcess cavity underlying the sinus tract [6].

You are a true surgeon from the moment you are able to deal with your complications”, Professor Owen H Wangensteen [7]. Every surgeon tries to perform surgeries in the best possible way without any complications or harm to their patient; however, despite their best possible efforts, complications can arise in any surgery, thereby affecting the prognosis. In our study conducted of 138 patients majority of them had complication of wound infection (SSI) and paralytic ileus or chronic sinus formation. Minor categories include Cystovaginal or Rectovaginal fistula, Intestinal perforation or internal artery ligation. As a whole SSI include 15.6% of cases that is higher compared to another Indian study that had 10.34% [8] highlighting the importance of hygiene factors intraoperatively and ppostoperatively. Comparing all the results it is observed that there were highr rates of SSI which suggests that a lot of improvement is still required in maintaining hygiene and sterility. Urological procedure were also higher 15.9% compared to Ortiz-Martí Nez, et al . [9] examined the prevalence of urological injuries in gynaecological surgeries and found that bladder injury was seen in 0.34% of cases. Paralytic ileus and chronic sinus formation also include majority of cases. Paralytic ileus was mainly 25 cases (17.86%). The main reason was observed to be electrolyte imbalance low potassium and magnesium and dehydration. Basic fluid management and electrolyte correction lead to improvement in these patients. Chewing gum and early start of diet have shown to stimulate the vagal tone and reduces the inflammatory effect. Intestinal perforation and Burst open abdomen are less common amongst all the patients attended only 8.6% compared to Bladder perforation that is% of the cases. Further research needs to be conducted on this topic to design necessary strategies to decrease the burden on patients facing these complications.

The major limitation of this study is that we included data from only one institution and only a single of 3years, which cannot be generalised to the general population. Another major limitation in this procedure is that only patients between 25 to 65 years age group were included excluding the age related surgical complications in the study. The chance of underreporting of cases is very minimal in our study as records were extracted from both operation theatre registers and from departmental file records. We believe that this study constitutes a unique addition to the currently available literature on surgical complications since it has included and analysed even minor complications.

1. Wichendu PN, Eli S, Omietimi J. General surgery encounter following obstetrics and gynaecological surgeries: A 10 year review at a university teaching hospital. Mother Baby Adolescent Care Glob Found. 2021;3(2):10-15. 2. Williams NS, O'Connell PR, McCaskie AW, editors. Bailey & Love’s short practice of surgery. 28 th Ed. Boca Raton: CRC Press; 2022. 3. Shaw RW, Luesley DM, Monga A, editors. Shaw’s textbook of gynecology. 17th Ed. New York: Elsevier; 2022. 4. DeWilde RL, Trew G. Postoperative abdominal adhesions and their prevention in gynecological surgery. Expert Rev Obstet Gynecol. 2007;2(1):89-100. 5. Venara A, Neunlist M, Slim K, Barbieux J, Colas T, Hamy A, et al . Postoperative ileus: Pathophysiology, incidence, and prevention. J Visc Surg. 2016;153(6):439-446. 6. Gupta N, Gupta V, Gupta N, Mittal S. Tubercular sinus tracts in gynecology: diagnostic challenges and management. J Obstet Gynaecol India. 2017;67(5):353-357. 7. Hakim NS, Papalois VE, editors. Surgical complications: diagnosis and treatment. London: Imperial College Press; 2007. p. 1-40. 8. Pathak A, Mahadik K, Swami MB, Roy PK, Sharma M, Mahadik VK, et al. Incidence and risk factors for surgical site infections in obstetric and gynecological surgeries from a teaching hospital in rural India. Antimicrob Resist Infect Control. 2017;6:66. DOI: 10.1186/s13756-017-0223-y. 9. Martínez ORA, Canas BAJ, Nanez BDM, Narvaez CT, Portilla ED, Victoria FO. Prevalence of surgical complications in gynecological surgery at the Hospital Universitario San José in Popayán, Colombia. Rev Fac Med. 2018;66(4):529-535. How to Cite This Article Ananthshree S, Shah T, Sheth D, Suvera M. Gynecology and surgery: A mutual symbiosis. International Journal of Surgery Science. 2026;10(1):19- 22. Creative Commons (CC) License This is an open-access journal, and articles are distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 International (CC BY-NC-SA 4.0) License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.