World Journal of Emergency Surgery : WJES最新文献

{"title":"Correction: Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines.","authors":"Belinda De Simone, Elie Chouillard, Almino C Ramos, Gianfranco Donatelli, Tadeja Pintar, Rahul Gupta, Federica Renzi, Kamal Mahawar, Brijesh Madhok, Stefano Maccatrozzo, Fikri M Abu-Zidan, Ernest E Moore, Dieter G Weber, Federico Coccolini, Salomone Di Saverio, Andrew Kirkpatrick, Vishal G Shelat, Francesco Amico, Emmanouil Pikoulis, Marco Ceresoli, Joseph M Galante, Imtiaz Wani, Nicola De'Angelis, Andreas Hecker, Gabriele Sganga, Edward Tan, Zsolt J Balogh, Miklosh Bala, Raul Coimbra, Dimitrios Damaskos, Luca Ansaloni, Massimo Sartelli, Nikolaos Pararas, Yoram Kluger, Elias Chahine, Vanni Agnoletti, Gustavo Fraga, Walter L Biffl, Fausto Catena","doi":"10.1186/s13017-022-00460-w","DOIUrl":"https://doi.org/10.1186/s13017-022-00460-w","url":null,"abstract":"","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"58"},"PeriodicalIF":8.0,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9641895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40687126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consequences of the spilled gallstones during laparoscopic cholecystectomy: a systematic review.","authors":"Paschalis Gavriilidis, Fausto Catena, Gianluigi de'Angelis, Nicola de'Angelis","doi":"10.1186/s13017-022-00456-6","DOIUrl":"10.1186/s13017-022-00456-6","url":null,"abstract":"<p><strong>Introduction: </strong>Complications secondary to spilled gallstones can be classified in the category of disease of medical progress because prior to advent of laparoscopic cholecystectomy very few reports published on the topic. The aim of the present study was to investigate the predisposing factors and the complication rate of spilled gallstones during laparoscopic cholecystectomy over the past 21 years.</p><p><strong>Methods: </strong>Embase, Pubmed, Medline, Google scholar and Cochrane library were systematically searched for pertinent literature.</p><p><strong>Results: </strong>Seventy five out of 181 articles were selected including 85 patients; of those 38% were men and 62% women. The median age of the cohort was 64 years old and ranged between 33 and 87 years. Only 23(27%) of the authors reported the incident of spillage of the gallstones during the operation. Time of onset of symptoms varied widely from the second postoperative day to 15 years later. Ten of 85 patients were asymptomatic and diagnosed with spilled gallstones incidentally. The rest of the patients presented with complications of severe morbidity and almost, 87% of the patients needed to be treated with surgical intervention and 12% with US ± CT scan guidance drainage. Only one perioperative death reported.</p><p><strong>Conclusions: </strong>Symptomatic patients with lost gallstones present with severe morbidity complications and required mostly major surgical procedures. Therefore, standardisation of the management of spilled gallstones is needed urgently. Hospitals need to review their policy with audits and recommendations and clinical guidelines are needed urgently.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"57"},"PeriodicalIF":0.0,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9632095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40443131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of morbidity in revisional bariatric surgery and bariatric emergencies at an MBSAQIP-accredited community hospital.","authors":"Daniel Tomey,&nbsp;Alessandro Martinino,&nbsp;Joseph Nguyen-Lee,&nbsp;Alfred Lopez,&nbsp;Priya Shenwai,&nbsp;Zhuoxin Long,&nbsp;Jichong Chai,&nbsp;Tapan Nayak,&nbsp;James Wiseman,&nbsp;Rodolfo Oviedo","doi":"10.1186/s13017-022-00459-3","DOIUrl":"https://doi.org/10.1186/s13017-022-00459-3","url":null,"abstract":"<p><strong>Introduction: </strong>Bariatric surgery revisions and emergencies are associated with higher morbidity and mortality compared to primary bariatric surgery. No formal outcome benchmarks exist that distinguish MBSAQIP-accredited centers in the community from unaccredited institutions.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on 53 bariatric surgery revisions and 61 bariatric surgical emergencies by a single surgeon at a high-volume community hospital accredited program from 2018 to 2020. Primary outcomes were complications or deaths occurring within 30-days of the index procedure. Secondary outcomes included operative time, leaks, surgical site occurrences (SSOs), and deep surgical site infections.</p><p><strong>Results: </strong>There were no significant differences in the demographic characteristics of the study groups. Mean operative time was significantly longer for revisions as compared to emergency operations (149.5 vs. 89.4 min). Emergencies had higher surgical site infection (5.7% vs. 21.3%, p &lt; 0.05) and surgical site occurrence (SSO) (1.9% vs. 29.5%, p &lt; 0.05) rates compared to revisions. Logistic regression analysis identified several factors to be predictive of increased risk of morbidity: pre-operative albumin &lt; 3.5 g/dL (p &lt; 0.05), recent bariatric procedure within the last 30 days (p &lt; 0.05), prior revisional bariatric surgery (p &lt; 0.05), prior duodenal switch (p &lt; 0.05), and pre-operative COPD (p &lt; 0.05).</p><p><strong>Conclusion: </strong>Bariatric surgery revisions and emergencies have similar morbidity and mortality, far exceeding those of the primary operation. Outcomes comparable to those reported by urban academic centers can be achieved in community hospital MBSAQIP-accredited centers.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"55"},"PeriodicalIF":8.0,"publicationDate":"2022-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9618177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40670401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery.","authors":"Miklosh Bala,&nbsp;Fausto Catena,&nbsp;Jeffry Kashuk,&nbsp;Belinda De Simone,&nbsp;Carlos Augusto Gomes,&nbsp;Dieter Weber,&nbsp;Massimo Sartelli,&nbsp;Federico Coccolini,&nbsp;Yoram Kluger,&nbsp;Fikri M Abu-Zidan,&nbsp;Edoardo Picetti,&nbsp;Luca Ansaloni,&nbsp;Goran Augustin,&nbsp;Walter L Biffl,&nbsp;Marco Ceresoli,&nbsp;Osvaldo Chiara,&nbsp;Massimo Chiarugi,&nbsp;Raul Coimbra,&nbsp;Yunfeng Cui,&nbsp;Dimitris Damaskos,&nbsp;Salomone Di Saverio,&nbsp;Joseph M Galante,&nbsp;Vladimir Khokha,&nbsp;Andrew W Kirkpatrick,&nbsp;Kenji Inaba,&nbsp;Ari Leppäniemi,&nbsp;Andrey Litvin,&nbsp;Andrew B Peitzman,&nbsp;Vishal G Shelat,&nbsp;Michael Sugrue,&nbsp;Matti Tolonen,&nbsp;Sandro Rizoli,&nbsp;Ibrahima Sall,&nbsp;Solomon G Beka,&nbsp;Isidoro Di Carlo,&nbsp;Richard Ten Broek,&nbsp;Chirika Mircea,&nbsp;Giovanni Tebala,&nbsp;Michele Pisano,&nbsp;Harry van Goor,&nbsp;Ronald V Maier,&nbsp;Hans Jeekel,&nbsp;Ian Civil,&nbsp;Andreas Hecker,&nbsp;Edward Tan,&nbsp;Kjetil Soreide,&nbsp;Matthew J Lee,&nbsp;Imtiaz Wani,&nbsp;Luigi Bonavina,&nbsp;Mark A Malangoni,&nbsp;Kaoru Koike,&nbsp;George C Velmahos,&nbsp;Gustavo P Fraga,&nbsp;Andreas Fette,&nbsp;Nicola de'Angelis,&nbsp;Zsolt J Balogh,&nbsp;Thomas M Scalea,&nbsp;Gabriele Sganga,&nbsp;Michael D Kelly,&nbsp;Jim Khan,&nbsp;Philip F Stahel,&nbsp;Ernest E Moore","doi":"10.1186/s13017-022-00443-x","DOIUrl":"https://doi.org/10.1186/s13017-022-00443-x","url":null,"abstract":"<p><p>Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"54"},"PeriodicalIF":8.0,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40555701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic versus open emergent colectomy for ischemic colitis: a propensity score-matched comparison.","authors":"Yi-Chang Chen,&nbsp;Yuan-Yao Tsai,&nbsp;Sheng-Chi Chang,&nbsp;Hung-Chang Chen,&nbsp;Tao-Wei Ke,&nbsp;Abe Fingerhut,&nbsp;William Tzu-Liang Chen","doi":"10.1186/s13017-022-00458-4","DOIUrl":"https://doi.org/10.1186/s13017-022-00458-4","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic colectomy is rarely performed for ischemic colitis. The aim of this propensity score-matched study was to compare preoperative characteristics, intraoperative details and short-term outcomes for emergent laparoscopic colectomy versus the traditional open approach for patients with ischemic colitis.</p><p><strong>Methods: </strong>Retrospective review of 96 patients who underwent emergent colectomy for ischemic colitis between January 2011 and December 2020 (39 via laparoscopy, 57 via laparotomy) was performed. We compared short-term outcomes after using a one-to-one ratio and nearest-neighbor propensity score matching to obtain similar preoperative and intraoperative parameters in each group.</p><p><strong>Results: </strong>Patients in the open group experienced more surgical site complications (52.6% vs. 23.0%, p = 0.004), more intra-abdominal abscesses (47.3% vs. 17.9%, p = 0.003), longer need for ventilator support (20 days vs. 0 days, p &lt; 0.001), more major complications (77.2% vs. 43.5%, p = 0.001), higher mortality (49.1% vs. 20.5%, p = 0.004), and longer hospital stay (32 days vs. 19 days, p = 0.001). After propensity score matching (31 patients in each group), patients undergoing open (vs. laparoscopy) had more surgical site complications (45.1% vs. 19.4%, p = 0.030) and required longer ventilator support (14 vs. 3 days, p = 0.039). After multivariate analysis, Charlson Comorbidity Index (p = 0.024), APACHE II score (p = 0.001), and Favier's classification (p = 0.023) were independent predictors of mortality.</p><p><strong>Conclusions: </strong>Laparoscopic emergent colectomy for ischemic colitis is feasible and is associated with fewer surgical site complications and better respiratory function, compared to the open approach.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"53"},"PeriodicalIF":8.0,"publicationDate":"2022-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9563494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33506377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document.","authors":"Mauro Podda,&nbsp;Belinda De Simone,&nbsp;Marco Ceresoli,&nbsp;Francesco Virdis,&nbsp;Francesco Favi,&nbsp;Johannes Wiik Larsen,&nbsp;Federico Coccolini,&nbsp;Massimo Sartelli,&nbsp;Nikolaos Pararas,&nbsp;Solomon Gurmu Beka,&nbsp;Luigi Bonavina,&nbsp;Raffaele Bova,&nbsp;Adolfo Pisanu,&nbsp;Fikri Abu-Zidan,&nbsp;Zsolt Balogh,&nbsp;Osvaldo Chiara,&nbsp;Imtiaz Wani,&nbsp;Philip Stahel,&nbsp;Salomone Di Saverio,&nbsp;Thomas Scalea,&nbsp;Kjetil Soreide,&nbsp;Boris Sakakushev,&nbsp;Francesco Amico,&nbsp;Costanza Martino,&nbsp;Andreas Hecker,&nbsp;Nicola de'Angelis,&nbsp;Mircea Chirica,&nbsp;Joseph Galante,&nbsp;Andrew Kirkpatrick,&nbsp;Emmanouil Pikoulis,&nbsp;Yoram Kluger,&nbsp;Denis Bensard,&nbsp;Luca Ansaloni,&nbsp;Gustavo Fraga,&nbsp;Ian Civil,&nbsp;Giovanni Domenico Tebala,&nbsp;Isidoro Di Carlo,&nbsp;Yunfeng Cui,&nbsp;Raul Coimbra,&nbsp;Vanni Agnoletti,&nbsp;Ibrahima Sall,&nbsp;Edward Tan,&nbsp;Edoardo Picetti,&nbsp;Andrey Litvin,&nbsp;Dimitrios Damaskos,&nbsp;Kenji Inaba,&nbsp;Jeffrey Leung,&nbsp;Ronald Maier,&nbsp;Walt Biffl,&nbsp;Ari Leppaniemi,&nbsp;Ernest Moore,&nbsp;Kurinchi Gurusamy,&nbsp;Fausto Catena","doi":"10.1186/s13017-022-00457-5","DOIUrl":"https://doi.org/10.1186/s13017-022-00457-5","url":null,"abstract":"<p><strong>Background: </strong>In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved.</p><p><strong>Methods: </strong>Using a modified Delphi method, we sought to explore ongoing areas of controversy in the NOM of splenic trauma and reach a consensus among a group of 48 international experts from five continents (Africa, Europe, Asia, Oceania, America) concerning optimal follow-up strategies in patients with splenic injuries treated with NOM.</p><p><strong>Results: </strong>Consensus was reached on eleven clinical research questions and 28 recommendations with an agreement rate ≥ 80%. Mobilization after 24 h in low-grade splenic trauma patients (WSES Class I, AAST Grades I-II) was suggested, while in patients with high-grade splenic injuries (WSES Classes II-III, AAST Grades III-V), if no other contraindications to early mobilization exist, safe mobilization of the patient when three successive hemoglobins 8 h apart after the first are within 10% of each other was considered safe according to the panel. The panel suggests adult patients to be admitted to hospital for 1 day (for low-grade splenic injuries-WSES Class I, AAST Grades I-II) to 3 days (for high-grade splenic injuries-WSES Classes II-III, AAST Grades III-V), with those with high-grade injuries requiring admission to a monitored setting. In the absence of specific complications, the panel suggests DVT and VTE prophylaxis with LMWH to be started within 48-72 h from hospital admission. The panel suggests splenic artery embolization (SAE) as the first-line intervention in patients with hemodynamic stability and arterial blush on CT scan, irrespective of injury grade. Regarding patients with WSES Class II blunt splenic injuries (AAST Grade III) without contrast extravasation, a low threshold for SAE has been suggested in the presence of risk factors for NOM failure. The panel also suggested angiography and eventual SAE in all hemodynamically stable adult patients with WSES Class III injuries (AAST Grades IV-V), even in the absence of CT blush, especially when concomitant surgery that requires change of position is needed. Follow-up imaging with contrast-enhanced ultrasound/CT scan in 48-72 h post-admission of trauma in splenic injuries WSES Class II (AAST Grade III) or higher treated with NOM was considered the best strategy for timely detection of vascular complications.</p><p><strong>Conclusion: </strong>This consensus document could help guide future prospective studies aiming at validating the suggested strategies through the implementation of prospective trauma databases and the subsequent production of internationally endorsed guidelines on the issue.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"52"},"PeriodicalIF":8.0,"publicationDate":"2022-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9560023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33501792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines.","authors":"Belinda De Simone,&nbsp;Elie Chouillard,&nbsp;Almino C Ramos,&nbsp;Gianfranco Donatelli,&nbsp;Tadeja Pintar,&nbsp;Rahul Gupta,&nbsp;Federica Renzi,&nbsp;Kamal Mahawar,&nbsp;Brijesh Madhok,&nbsp;Stefano Maccatrozzo,&nbsp;Fikri M Abu-Zidan,&nbsp;Ernest E Moore,&nbsp;Dieter G Weber,&nbsp;Federico Coccolini,&nbsp;Salomone Di Saverio,&nbsp;Andrew Kirkpatrick,&nbsp;Vishal G Shelat,&nbsp;Francesco Amico,&nbsp;Emmanouil Pikoulis,&nbsp;Marco Ceresoli,&nbsp;Joseph M Galante,&nbsp;Imtiaz Wani,&nbsp;Nicola De' Angelis,&nbsp;Andreas Hecker,&nbsp;Gabriele Sganga,&nbsp;Edward Tan,&nbsp;Zsolt J Balogh,&nbsp;Miklosh Bala,&nbsp;Raul Coimbra,&nbsp;Dimitrios Damaskos,&nbsp;Luca Ansaloni,&nbsp;Massimo Sartelli,&nbsp;Nikolaos Pararas,&nbsp;Yoram Kluger,&nbsp;Elias Chahine,&nbsp;Vanni Agnoletti,&nbsp;Gustavo Fraga,&nbsp;Walter L Biffl,&nbsp;Fausto Catena","doi":"10.1186/s13017-022-00452-w","DOIUrl":"https://doi.org/10.1186/s13017-022-00452-w","url":null,"abstract":"<p><strong>Background: </strong>Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass.</p><p><strong>Method: </strong>A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass.</p><p><strong>Conclusions: </strong>The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (&gt; 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"51"},"PeriodicalIF":8.0,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9516804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40377806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections.","authors":"Po-Han Wu,&nbsp;Kai-Hsiang Wu,&nbsp;Cheng-Ting Hsiao,&nbsp;Shu-Ruei Wu,&nbsp;Chia-Peng Chang","doi":"10.1186/s13017-022-00450-y","DOIUrl":"https://doi.org/10.1186/s13017-022-00450-y","url":null,"abstract":"","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"49"},"PeriodicalIF":8.0,"publicationDate":"2022-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9482730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40364437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for posttraumatic empyema in diaphragmatic injuries.","authors":"Alberto Federico García,&nbsp;Fernando Rodríguez,&nbsp;Álvaro Sánchez,&nbsp;Isabella Caicedo-Holguín,&nbsp;Carlos Gallego-Navarro,&nbsp;María Paula Naranjo,&nbsp;Yaset Caicedo,&nbsp;Daniela Burbano,&nbsp;Diana Felisa Currea-Perdomo,&nbsp;Carlos A Ordoñez,&nbsp;Juan Carlos Puyana","doi":"10.1186/s13017-022-00453-9","DOIUrl":"https://doi.org/10.1186/s13017-022-00453-9","url":null,"abstract":"<p><strong>Background: </strong>Penetrating diaphragmatic injuries are associated with a high incidence of posttraumatic empyema. We analyzed the contribution of trauma severity, specific organ injury, contamination severity, and surgical management to the risk of posttraumatic empyema in patients who underwent surgical repair of diaphragmatic injuries at a level 1 trauma center.</p><p><strong>Methods: </strong>This is a retrospective review of the patients who survived more than 48 h. Univariate OR calculations were performed to identify potential risk factors. Multiple logistic regression was used to calculate adjusted ORs and identify independent risk factors.</p><p><strong>Results: </strong>We included 192 patients treated from 2011 to 2020. There were 169 (88.0) males. The mean interquartile range, (IQR) of age, was 27 (22-35) years. Gunshot injuries occurred in 155 subjects (80.7%). Mean (IQR) NISS and ATI were 29 (18-44) and 17 (10-27), respectively. Thoracic AIS was > 3 in 38 patients (19.8%). Hollow viscus was injured in 105 cases (54.7%): stomach in 65 (33.9%), colon in 52 (27.1%), small bowel in 42 (21.9%), and duodenum in 10 (5.2%). Visible contamination was found in 76 patients (39.6%). Potential thoracic contamination was managed with a chest tube in 128 cases (66.7%), with transdiaphragmatic pleural lavage in 42 (21.9%), and with video-assisted thoracoscopy surgery or thoracotomy in 22 (11.5%). Empyema occurred in 11 patients (5.7%). Multiple logistic regression identified thoracic AIS > 3 (OR 6.4, 95% CI 1.77-23. 43), and visible contamination (OR 5.13, 95% IC 1.26-20.90) as independent risk factors. The individual organ injured, or the method used to manage the thoracic contamination did not affect the risk of posttraumatic empyema.</p><p><strong>Conclusion: </strong>The severity of the thoracic injury and the presence of visible abdominal contamination were identified as independent risk factors for empyema after penetrating diaphragmatic trauma.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"47"},"PeriodicalIF":8.0,"publicationDate":"2022-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9472425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33465170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review.","authors":"Zhe Zhu,&nbsp;Yong Yu,&nbsp;Kairui Hong,&nbsp;Mengqin Luo,&nbsp;Yefang Ke","doi":"10.1186/s13017-022-00454-8","DOIUrl":"https://doi.org/10.1186/s13017-022-00454-8","url":null,"abstract":"<p><strong>Objective: </strong>Viscoelastic hemostatic assay (VHA) provides a graphical representation of a clot's lifespan and reflects the real time of coagulation. It has been used to guide trauma resuscitation; however, evidence of the effectiveness of VHAs is still limited. This systematic review aims to summarize the published evidence to evaluate the VHA-guided strategy in resuscitating trauma patients.</p><p><strong>Methods: </strong>The PubMed, Embase, and Web of Science databases were searched from their inception to December 13, 2021. Randomized controlled trials (RCTs) or observational studies comparing VHA-guided transfusion to controls in resuscitating trauma patients were included in this systematic review.</p><p><strong>Results: </strong>Of the 7743 records screened, ten studies, including two RCTs and eight observational studies, met the inclusion criteria. There was great heterogeneity concerning study design, enrollment criterion, VHA device, VHA-guided strategy, and control strategy. Thrombelastography (TEG) was used as a guiding tool for transfusion in eight studies, and rotational thromboelastometry (ROTEM), and TEG or ROTEM were used in the other two studies. The overall risk of bias assessment was severe or mild in RCTs and was severe or moderate in observational studies. The main outcomes reported from the included studies were blood transfusion (n = 10), mortality (n = 10), hospital length of stay (LOS) (n = 7), intensive care unit LOS (n = 7), and cost (n = 4). The effect of the VHA-guided strategy was not always superior to the control. Most of the studies did not find significant differences in the transfusion amount of red blood cells (n = 7), plasma (n = 5), platelet (n = 7), cryoprecipitate/fibrinogen (n = 7), and mortality (n = 8) between the VHA-guided group and control group. Notable, two RCTs showed that the VHA-guided strategy was superior or equal to the conventional coagulation test-guided strategy in reducing mortality, respectively.</p><p><strong>Conclusion: </strong>Although some studies demonstrated VHA-guided strategy probable benefit in reducing the need for blood transfusion and mortality when resuscitating trauma patients, the evidence is still not robust. The quality of evidence was primarily downgraded by the limited number of included studies and great heterogeneity and severe risk of bias in these. Further studies are strongly recommended.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"48"},"PeriodicalIF":8.0,"publicationDate":"2022-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9472418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33465799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}