World Journal of Emergency Surgery最新文献

{"title":"Early inflammatory response is associated with antibiotic treatment outcomes in acute phlegmonous appendicitis: a retrospective cohort study","authors":"Bowen Li,Ruochen Li,Guofeng Zhou,Shuying Chen,Lingqiang Min,Hongyong He","doi":"10.1186/s13017-026-00729-4","DOIUrl":"https://doi.org/10.1186/s13017-026-00729-4","url":null,"abstract":"","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"72 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severity ranking of immunocompromise conditions for patients undergoing emergency surgery: an outcomes-based reassessment of the 2021 consensus classification system published in the World Journal of Emergency Surgery","authors":"Grace E. Kennedy,Griffen I. Allen,Giana H. Davidson,Charles Liu,Mariam N. Hantouli,David R. Flum","doi":"10.1186/s13017-026-00717-8","DOIUrl":"https://doi.org/10.1186/s13017-026-00717-8","url":null,"abstract":"","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"34 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148895795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the calming anxiety and relaxation emergency (Abdominal) surgery (CARES) program on patients’ pre- and postoperative anxiety management and outcomes: a prospective quasi-experimental study","authors":"Wai Lin William Tse,Yue Sun Sunny Cheung,Ho Yu Cheng","doi":"10.1186/s13017-026-00727-6","DOIUrl":"https://doi.org/10.1186/s13017-026-00727-6","url":null,"abstract":"Abstract Background Patients undergoing emergency abdominal surgery often have limited time to prepare. This may lead to anxiety, which can adversely affect postoperative recovery. A structured intervention, Calming Anxiety and Relaxation for Emergency (Abdominal) Surgery (CARES) program, was developed to address this concern. Methods In this prospective quasi-experimental study, the effects of the CARES program on pre- and postoperative anxiety were evaluated among adult patients undergoing emergency abdominal surgery at a regional hospital in Hong Kong. Participants were allocated to either the intervention group (IG) or the control group (CG) based on bed availability. The IG received the CARES program (pre- and postoperative counseling sessions plus daily self-practiced body–mind exercises for five consecutive days) in addition to usual care, while the CG received usual care alone. Pre- and postoperative anxiety and postoperative pain were measured using a visual analog scale and analyzed over time using a generalized estimating equation model. Postoperative analgesic consumption, time to first flatus, and length of hospital stay were compared between the groups using independent t-tests or Mann–Whitney U tests. All analyses adhered to the intention-to-treat principle. Results A total of 120 participants were enrolled and allocated equally to the IG and CG ( n  = 60 per group). The overall discontinuation rate was 3.33%. Compared with the CG, the IG demonstrated significantly lower anxiety immediately before transfer to the operating theatre ( β = −1.67; 95% confidence interval [CI]: −2.18 to − 1.15; p < .01) and on postoperative days one ( β = −1.29; 95% CI: −2.30 to − 0.27; p = .01) and three ( β = −1.47; 95% CI: −2.58 to − 0.35; p = .01). Additionally, the IG demonstrated a significantly shorter time to first postoperative flatus ( p = .01) and length of hospital stay ( p = .02). No significant between-group differences were observed in postoperative pain reduction or analgesic consumption. Conclusion The CARES program was found to be feasible for clinical implementation and significantly reduced pre- and postoperative anxiety, time to first postoperative flatus, and length of hospital stay in patients undergoing emergency abdominal surgery. Trial registration Chinese Clinical Trial Registry (NO. ChiCTR2300076274) on September 28, 2023.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Björck classification of the open abdomen revisited: clarifying concepts for modern complex abdomen management","authors":"Bruno M. Pereira,Martin Björck,Ari Leppäniemi,Andrew W. Kirkpatrick,Michael Sugrue,Pablo R. Ottolino,Marcelo A. F. Ribeiro,Arne Seternes","doi":"10.1186/s13017-026-00724-9","DOIUrl":"https://doi.org/10.1186/s13017-026-00724-9","url":null,"abstract":"Abstract Introduction The open abdomen (OA) has become an integral component of modern acute care, trauma, and vascular surgery. Since 2009, the Björck classification, amended in 2016, has provided a common language for describing the status and progression of the OA and remains the most widely used system worldwide. More than fifteen years of international experience, together with advances in temporary abdominal closure, negative pressure wound therapy, mesh-mediated fascial traction, critical care, more timely effective septic source control and abdominal wall reconstruction, have broadened the spectrum of patients encountered and altered the natural history of the OA. In this setting, certain concepts within the classification—particularly developing fixation and the frozen abdomen—are interpreted inconsistently among surgeons and institutions. Materials and methods In this narrative review, we revisit the contemporary application of the Björck classification and argue that its principal current challenge is one of interpretive consistency rather than validity. Conclusion We distinguish OA from complex abdomen, clarify the practical meaning of each grade, and emphasise that anatomical grade describes a current state rather than an inevitable trajectory. The aim is to preserve the simplicity and structure of the original framework while improving communication, research comparability, and clinical decision-making in the management of patients with complex OA conditions. To this end we propose that interpretation is enhanced by considering two complementary domains: a contamination domain, already embedded in the amended system, and a surgical accessibility domain that describes the progressive loss of operative access from free access through developing fixation to loss of lateral access (the frozen abdomen).","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"10 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accountability in emergency surgery: moving beyond blame toward high reliability: a WSES-JMESE position paper","authors":"Belinda De Simone,Lucienne Kasongo,Fikri M. Abu-Zidan,Evika Karamagioli,Walter L. Biffl,Giuseppe Borzellino,Nikolaos Pararas,Salomone Di Saverio,Arda Işık,Aitor Landaluce-Olavarria,Edoardo Picetti,Huseyin Kemal Rasa,Ciro Paolillo,Ines Rubio-Perez,Tadeja Pintar Kaliterna,Andrew W. Kirkpatrick,Mauro Podda,Giovanna Di Meo,Francesca Dal Mas,Carlo Alberto Schena,Desire Pantalone,Mehmet Eryılmaz,Francesco Marchegiani,Nicola de’ Angelis,Rifat Latifi,Haytham Kaafarani,Elie Chuoillard,Mario Testini,Sara Saeidi,Philip F. Stahel,Robert G. Sawyer,Ernest E. Moore,Manos Pikoulis,Federico Coccolini,Fausto Catena","doi":"10.1186/s13017-026-00723-w","DOIUrl":"https://doi.org/10.1186/s13017-026-00723-w","url":null,"abstract":"","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"50 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of surgical indication strategies and their impact on treatment outcomes in acute superior mesenteric venous thrombosis: a single-center retrospective cohort study","authors":"Ling Chen,Lingqiang Min,Cheng Zhou,Tiangeng Dong,Guochao Zhao,Liheng Liu,Guofeng Zhou,Rongkui Luo,Tiantao Kuang,Dansong Wang","doi":"10.1186/s13017-026-00725-8","DOIUrl":"https://doi.org/10.1186/s13017-026-00725-8","url":null,"abstract":"","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"80 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148895796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global practices and attitudes in acute appendicitis management: the PAMAP-W international survey and Delphi consensus study on the WSES appendicitis grading system.","authors":"Belinda De Simone, Fausto Catena, Fikri Abu-Zidan, Sara Saeidi, Michael Okocha, Haytham Kaafarani, Mauro Podda, Michael Sugrue, Elie Chouillard, Massimo Sartelli, Federico Coccolini, Salomone Di Saverio, Nicola De'Angelis, Ernest E Moore, Walter Biffl, Lucienne Kasongo, Carlos Augusto Gomes","doi":"10.1186/s13017-026-00696-w","DOIUrl":"https://doi.org/10.1186/s13017-026-00696-w","url":null,"abstract":"<p><strong>Background: </strong>Despite the availability of several appendicitis grading systems and ongoing efforts toward standardization, substantial variability persists worldwide in the management of acute appendicitis. Differences are particularly evident in operative approach, stump closure, postoperative antibiotic use and duration, drainage, interval appendectomy after non operative management and follow-up strategies. The PAMAP-W project was designed as a sequential mixed-method study to explore real-world practice patterns and to develop grade-linked expert statements to support clinical and surgical decision-making.</p><p><strong>Methods: </strong>The study consisted of two complementary phases. First, an international cross-sectional web-based survey was conducted among surgeons involved in emergency and acute care surgery to assess practices and attitudes regarding appendicitis severity classification and grade-linked management. The questionnaire explored demographics, surgical approach, appendiceal stump management, intra-abdominal lavage and drainage, postoperative antibiotic therapy, and follow-up strategies according to acute appendicitis severity. Second, a Delphi consensus process involving an international expert panel was carried out to review and refine candidate grade-linked management statements derived from areas of heterogeneity identified in the survey. Consensus thresholds were predefined for each Delphi round.</p><p><strong>Results: </strong>A total of 467 surgeons from 64 countries completed the survey, providing an international snapshot of contemporary appendicitis management. Laparoscopy was the preferred approach across all grades, although increasing disease severity was associated with greater variability in operative choices and postoperative management. Considerable heterogeneity was observed in stump closure techniques, use of drainage, duration of antibiotic therapy, and follow-up strategies, particularly in complicated appendicitis. Fifty international experts were invited to participate in the Delphi process, 37 and 33 completed rounds 1 and 2, respectively. Most candidate statements achieved consensus after two rounds, resulting in a set of grade-linked expert statements intended to support more consistent interpretation and management of appendicitis severity.</p><p><strong>Conclusions: </strong>Marked international heterogeneity persists in the intraoperative and postoperative management of acute appendicitis, particularly in complicated disease. The PAMAP-W project combines real-world practice mapping with expert consensus refinement to support a pragmatic, grade-linked framework for clinical and surgical decision-making. The WSES Acute Appendicitis grading system is intended to complement, not replace, formal evidence-based recommendations. Further studies are needed to assess its reproducibility, implementation, and impact on clinical outcomes.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"21 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic approach for emergency colon resection: a retrospective propensity score-matched study","authors":"Antti J. Lahtinen,Silja A. S. Salo,Viiko Vahtera,Marie T. Grönroos-Korhonen,Jyrki A. O. Kössi","doi":"10.1186/s13017-026-00721-y","DOIUrl":"https://doi.org/10.1186/s13017-026-00721-y","url":null,"abstract":"Abstract Background Despite its routine use in elective procedures, the role of laparoscopy in emergency colorectal surgery remains debated due to limited evidence. This study compared laparoscopic and open surgery regarding complications, mortality, and hospital stay following emergency colon operations. Methods This retrospective study included adult patients treated at Päijät–Häme Central Hospital between 2010 and 2020 who underwent emergency colon resection. Propensity score matching was used to adjust for comorbidities, prior ICU admission, surgical indication, and contamination between laparoscopic and open surgery groups. Results All together 484 patients had an emergency colorectal resection of which 85 (17.6%) were carried out laparoscopically, 31 (6.4%) were converted and 377 (76.0%) were open. In the whole cohort, Comprehensive complication index was lower among laparoscopy patients than open surgery patients if intraoperative conversion to open surgery was avoided (25.8 vs. 34.9, p  = 0.012). The subgroup analysis also showed lower CCI after laparoscopic resection for patients presented with obstruction (21.3 vs. 29.7, p  = 0.046) or colorectal cancer (21.1 vs. 29.4, p  = 0.020) A multivariable regression analysis also showed that starting the procedure laparoscopically predicted lower complication rates. Patients who had a laparoscopic resection also had shorter hospital stay (9.0 vs. 12.9 days, p  &lt; 0.001). Patients with open surgery had significantly more wound complications (10.3% vs. 1.2%, p  = 0.010). Open surgery was also an independent risk factor for higher CCI ( p  = 0.008) and the need for intensive care ( p  = 0.027). Mortality was similar regardless of the approach in short term (30 days, p  = 0.810; 90 days, p  = 0.354) and in long-term survival ( p  = 0.466). Conclusions The laparoscopic technique in colorectal emergencies may offer similar benefits as in elective surgery, with a lower burden of total complications, less wound complications and shorter hospital stay. Laparoscopy was not associated with any unexpected harmful events.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"51 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpreting the evidence for chlorhexidine wound irrigation in contaminated abdominal surgery.","authors":"Imen Ben Ismail, Mariem Marzouki","doi":"10.1186/s13017-026-00722-x","DOIUrl":"10.1186/s13017-026-00722-x","url":null,"abstract":"<p><p>Kultanaruangnonth et al. recently reported a well-conducted double-blind randomized trial comparing intraoperative irrigation with 0.05% aqueous chlorhexidine gluconate (CHG) against normal saline for the prevention of surgical site infection (SSI) in abdominal surgery, concluding that CHG did not significantly reduce SSI. We raise three interpretive points. First, the antimicrobial rationale offered for CHG draws on clean-field trials (arthroplasty, caesarean delivery, breast reconstruction) in which SSI is driven by skin flora, whereas this trial's population was predominantly colorectal and hepatobiliary/contaminated surgery, fields dominated by enteric gram-negative and anaerobic organisms against which chlorhexidine is comparatively less active a plausible explanation for the smaller-than-expected effect. Second, the trial's own 95% confidence interval for the primary risk ratio (0.45-1.25) spans a 55% relative reduction to a 25% relative increase in SSI, and is compounded by a statistically fragile exploratory multivariable model (49 events across eight covariates, several dichotomized); we argue the result is more accurately described as statistically inconclusive than as a negative finding. Third, the Discussion's suggestion of particular benefit 'in high-risk populations' is not supported by any treatment-by-subgroup interaction analysis in the manuscript. We conclude that these findings argue for a larger, stratified, culture-informed confirmatory trial rather than for adopting or abandoning CHG wound irrigation in contaminated abdominal surgery.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"21 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of anterior versus posterior rib fractures and surgical treatment: analysis of 249 patients.","authors":"Ya-Fu Cheng, Chang-Lun Huang, Yu-Jun Chang, Ching-Yuan Cheng, Chia-Che Chang, Bing-Yen Wang","doi":"10.1186/s13017-026-00715-w","DOIUrl":"https://doi.org/10.1186/s13017-026-00715-w","url":null,"abstract":"<p><strong>Background: </strong>Traditionally, rib fracture severity has been quantified by fracture count and radiographic displacement. However, emerging evidence indicates that the outcomes following rib fractures widely vary and are not fully explained by injury burden alone. Whether anterior and posterior fracture locations lead to distinct recovery patterns remains unclear.</p><p><strong>Methods: </strong>A prospective longitudinal cohort study involving patients with traumatic rib fractures was conducted. Fractures were classified as anterior or posterior based on radiographic location. Pain intensity and functional status were serially evaluated for up to 3 months. Multivariable analyses were conducted with adjustment for age, body mass index, injury severity score, fracture number, displacement severity, associated injuries, and surgical stabilization of rib fractures (SSRF).</p><p><strong>Results: </strong>Fracture displacement severity and the number of fracture ribs independently predicted higher pain intensity. After adjustment, anterior and posterior fractures exhibited comparable pain trajectories over time. However, posterior fractures were linked to greater functional status improvement from 1 to 3 months. Surgical stabilization might be associated with greater early pain reduction and higher early functional scores but did not alter the long-term recovery slope. Early health status on day 14 strongly predicted 3-month outcomes, independent of baseline injury severity.</p><p><strong>Conclusions: </strong>The number of fracture ribs and displacement severity appear to reflect injury intensity, whereas fracture location may influence physiologic consequences. Posterior fractures show similar pain levels to anterior fractures but somewhat greater functional recovery.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}