World Journal of Emergency Surgery最新文献

{"title":"Robotic surgery in colorectal emergencies: a systematic review of current evidence.","authors":"Serena Curia, Christophe Taoum, Guglielmo Niccolò Piozzi, Diana Ronconi Di Giuseppe, Abhijeet Beniwal, Sentilnathan Subramaniam, Fausto Catena, Micaela Piccoli, Jim S Khan","doi":"10.1186/s13017-026-00685-z","DOIUrl":"https://doi.org/10.1186/s13017-026-00685-z","url":null,"abstract":"<p><strong>Background: </strong>Although laparoscopy continues to be the predominant minimally invasive approach in most emergency settings, the advantages of robotics, well established in elective surgery, are currently being explored in selected scenarios and specialized centres.</p><p><strong>Methods: </strong>A systematic review was conducted using PubMed, Cochrane Library and Scopus databases until January 2025. Primary outcome was safety and feasibility of robotics in emergency colorectal surgery. Secondary endpoints included perioperative and postoperative outcomes.</p><p><strong>Results: </strong>Fifteen articles were included with a total of 46 robotic emergency colorectal surgical procedures. Most were performed in a tertiary centre with a da Vinci system. Most common procedures were robotic right hemicolectomy for colon cancer and sigmoid colectomy for acute diverticulitis. Mean operating time for robotic right hemicolectomy was 134 min for benign cases and 241 ± 7 min for malignant cases; robotic sigmoid colectomy showed a mean operating time of 171 ± 3 min. No intraoperative complications were recorded. One case required conversion. Intracorporeal anastomosis was performed in most cases (n = 13). Mean length of stay was 5 days. No Clavien-Dindo grade ≥ 3 complications, reoperation or readmission were reported. Five complete mesocolic excisions (CMEs) were performed. Pathology outcomes were available for four CMEs: showing R0 resection with a mean lymph node harvest of 54 ± 13. In four CMEs, the involved team included an on-call robotic colorectal surgeon and an experience theatre team including experienced anaesthetist in robotic procedures.</p><p><strong>Conclusions: </strong>Robotics in emergency settings is feasible and safe but requires additional training and dedicated teams for optimal outcomes.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857505","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":"Impact of transportation methods on pediatric and adolescent severely injured vehicle occupants.","authors":"Fikri M Abu-Zidan,David O Alao","doi":"10.1186/s13017-026-00699-7","DOIUrl":"https://doi.org/10.1186/s13017-026-00699-7","url":null,"abstract":"BACKGROUNDRoad traffic collisions (RTCs) are the leading cause of death globally. Reducing the transportation time to definitive care and training bystanders in trauma management may impact clinical outcome. We aimed to study the impact of transportation methods on pediatric and adolescent severely injured vehicle occupants in Abu Dhabi Emirate, United Arab Emirates.METHODSThe Abu Dhabi Trauma Registry prospectively collects data of all hospitalized trauma patients from seven major trauma centers in Abu Dhabi Emirate. We have studied all severely injured (ISS ≥ 12) road traffic collision patients, who were less than 19 years old (January 2014 to December 2023). Demography and clinical outcome of those transported by ambulance (n = 466) were compared with those transported by private vehicles (n = 47).RESULTSUnivariate analysis showed that patients who were transferred by private vehicles were significantly younger, (median (IQR range) age: 12 (6-15) years compared with 15.5 (12-17) years, p < 0.001), stayed significantly longer in the Emergency Department (median (IQR range) 275 (186-333) minutes compared with 214 (135-299) minutes, p = 0.01), were admitted significantly less to the ICU (31.9% compared with 51.9%, p = 0.009); and had significantly less hospital stay (median (IQR range) 3.5 (1-8) days compared with 7 (3-14) days, p = 0.003). There was no significant difference in mortality between the two groups (2.1% compared with 6.7%, p = 0.34). Logistic regression showed that mode of arrival did not significantly affect ICU admission (p = 0.26). The most significant factors that affected ICU admission were GCS, p < 0.001, OR 0.66 (95% CI 0.57-0.77) and ISS, p < 0.001, OR 1.12 (95% CI 1.08-1.16). A general linear model showed that GCS (p = 0.022) and RTS (p = 0.006) significantly affected length of hospital stay while mode of arrival did not (p = 0.38).CONCLUSIONSPrivate vehicles appear to be safe for the transportation of selected major trauma children and adolescents with no adverse effects on ICU admission, hospital stay, or mortality. The role of bystanders in prehospital management and transportation of RTC victims should be further investigated.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"54 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753282","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":"Role of prophylactic mesh in emergency midline laparotomy: a systematic review and meta-analysis.","authors":"Mahmoud Diaa Hindawi,Abdel-Fattah Kalmoush,Mohamed Gamal Mohamed,Ezzeldin Ahmed Abdelaty,Abdulrahman Faisal Ziada,Waleed Abdelrhman Kotb,Mohamed Mostafa Eisa,Hamdi Elbelkasi,Richard Peter Ten Broek,Edward C T H Tan,Andrew W Kirkpatrick","doi":"10.1186/s13017-026-00697-9","DOIUrl":"https://doi.org/10.1186/s13017-026-00697-9","url":null,"abstract":"PURPOSEThe role of prophylactic mesh reinforcement in emergency laparotomy closure remains controversial. While prophylactic mesh may reduce incisional hernia, its use in unstable and contaminated settings raises concerns regarding operative time, seroma development, and wound complications. This meta-analysis of randomized controlled trials (RCTs) evaluated the safety and efficacy of prophylactic mesh versus primary suture closure in emergency midline laparotomy.METHODSA systematic search was performed for RCTs comparing prophylactic mesh with suture closure in adult patients undergoing emergency midline laparotomy. Primary outcomes were overall wound complications (OWC) and incisional hernia (IH). Secondary outcomes included superficial and deep surgical site infection, wound dehiscence (WD), seroma, hematoma, operative time, postoperative pain, quality of life, hospital and ICU stay, transfusion, and mortality.RESULTSSeven RCTs comprising 643 patients were included. Mesh reinforcement reduced incisional hernia incidence, with significant reductions at 1 month (RR 0.29, 95% CI 0.12-0.68), 6 months (RR 0.11, 95% CI 0.01-0.86), 12 months (RR 0.21, 95% CI 0.09-0.49), and 24 months (RR 0.27, 95% CI 0.15-0.49). Mesh increased seroma risk (RR 2.45, 95% CI 1.38-4.35) and, was associated with higher overall wound complications (RR 1.50, 95% CI 1.04-2.18). No significant differences were found in SSI, wound dehiscence, hematoma, transfusion, ICU or hospital stay, pain, quality of life, or mortality. Operative time was longer with mesh (MD 26 min, 95% CI 15.9-36.9).CONCLUSIONProphylactic mesh in emergency laparotomy closure poses a clinical dilemma: it lowers the risk of incisional hernia but prolongs surgery and increases seroma and wound complications. Current evidence underscores the trade-off between long-term prevention and short-term morbidity. Larger, protocol-driven trials with long-term follow-up are needed to determine in which patients and wound classes mesh reinforcement is justified.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"148 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147739098","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":"A description of patient experience after undergoing an emergency laparotomy.","authors":"Struan Ambrose,Louise Silva,Rachel John-Charles,Hwei Ng,Hannah Javanmard-Emamghissi,Sarah Abbas Mohammed,Rashid Murtaza,Alina Dietrich,Maggie Clark,Simon Baker,Victoria Redfern,Gillian Tierney,Susan Moug,Julie Cornish","doi":"10.1186/s13017-026-00686-y","DOIUrl":"https://doi.org/10.1186/s13017-026-00686-y","url":null,"abstract":"","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"20 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147733806","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":"Polymeric clips versus staplers for appendiceal stump closure in laparoscopic appendectomy: a retrospective observational study.","authors":"Şebnem Çimen,Kemal Berkay Tekin,Ahmet Kamburoğlu,Burak Uçaner","doi":"10.1186/s13017-026-00698-8","DOIUrl":"https://doi.org/10.1186/s13017-026-00698-8","url":null,"abstract":"PURPOSEThe aim of this study was to compare non-absorbable polymeric clips and endostapler techniques used for appendiceal stump closure in laparoscopic appendectomy and to evaluate the outcomes of both methods in terms of clinical safety, complication rates, appendiceal diameter, histopathological stage and cost-effectiveness. Within this scope, the study aimed to determine the most appropriate stump closure technique that could minimize costs while maintaining surgical safety.METHODData from 692 adult patients who underwent laparoscopic appendectomy for acute appendicitis in the general surgery department between January 2022 and December 2024 were retrospectively reviewed. The patients' demographic and clinical characteristics, appendiceal diameter, operative time, stump closure technique, postoperative complications, Clavien-Dindo classification, and pathological findings were recorded. Data were analyzed using the SPSS software version 25.0 and a p-value of < 0.05 was considered statistically significant.RESULTSPolymeric clips were used in 87.6% of the patients, while staplers were used in 12.4%. In the stapler group, age (p < 0.001), Charlson Comorbidity Index (p < 0.001), CRP level (p < 0.001), appendiceal diameter (p < 0.001), and operative time (p = 0.003) were significantly higher. Intraoperative perforation was observed in 53.5% of patients in the stapler group and in 16.7% of those in the clip group (p < 0.001). The overall complication rates were similar between the two groups (p = 0.089). In the subgroup of perforated appendicitis cases (n = 146), no significant differences were observed in complication rates (p = 0.601) or Clavien-Dindo grades (p = 0.653). The mean cost of the polymeric clip was 2.33 USD, whereas the cost of the stapler was 31.35 USD (p < 0.001).CONCLUSIONPolymeric clips represent a safe and cost-effective option for appendiceal stump closure in laparoscopic appendectomy. Postoperative outcomes were similar across techniques, although staplers tended to be used in more complex intraoperative situations.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"22 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719557","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":"Re: Timing of planned reoperation after damage control surgery in patients with trauma-confounding by indication, physiological readiness, and the limits of clock-based thresholds.","authors":"Vukosi Baloyi,Emmanuel Ndaba","doi":"10.1186/s13017-026-00687-x","DOIUrl":"https://doi.org/10.1186/s13017-026-00687-x","url":null,"abstract":"BACKGROUNDSeo and colleagues compared early (≤ 48 h) versus delayed (> 48 h) planned reoperation following damage control surgery (DCS) in trauma patients and reported higher rates of re-bleeding in the early reoperation group. While this addresses an important clinical question, interpretation of these findings requires caution.MAIN POINTSFirst, all included studies were observational, and reoperation timing was determined by clinical judgment, introducing systematic confounding by indication. Physiologically unstable patients are more likely to undergo early re-exploration, while more stable patients are deferred, particularly in resource-constrained settings where system-level triage further shapes timing decisions. Second, the use of a 48-hour cut-off imposes a binary framework on what is inherently a continuous biological process, as physiological recovery varies substantially between patients, injury patterns, and operative burden. Third, pooling heterogeneous DCS indications, including haemorrhage- and contamination-driven strategies, limits the biological plausibility of a single time-based reoperation algorithm across diverse clinical contexts.CONCLUSIONTaken together, the available evidence suggests that timing is not the true causal exposure; rather, physiological readiness is the key determinant of outcomes after DCS. Future research should shift from clock-based thresholds to physiology-guided frameworks using objective markers of recovery to better inform reoperation strategies in trauma care.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"81 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147649007","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":"Letter to the Editor Coccolini F, Cremonini C, Moore EE, Civil I, Balogh Z, Leppaniemi A, Horer T, Reva V, Ball C, Kirkpatrick AW, Colli A. Thoracic trauma WSES-AAST guidelines. World Journal of Emergency Surgery. 2025 Oct 15;20(1):78.","authors":"Yasir Musa Kesgin","doi":"10.1186/s13017-026-00692-0","DOIUrl":"https://doi.org/10.1186/s13017-026-00692-0","url":null,"abstract":"Traumatic diaphragmatic injuries are a significant cause of morbidity and mortality. Particular attention to isolated diaphragmatic injuries and not overlooking them is critical to preventing damage from hernias that may occur immediately or later. The use of a thoracic tube during repair of a diagnosed diaphragmatic injury should be considered a necessary routine procedure. Clearly, the current guidelines resulting from the WSES-AAST collaboration reiterate this traditional recommendation. However, selective tube use should be considered, and the \"one-size-fits-all\" approach should be discussed. This detail deserves reconsideration to minimize patient morbidity and discomfort.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"123 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147649010","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":"Trust, but verify: the importance of additional imaging after BCVI screening.","authors":"Jessica L Masch,John R Austin,Paul Jaffray,Louis Perkins,Jarrett E Santorelli,Jessica L Weaver","doi":"10.1186/s13017-026-00694-y","DOIUrl":"https://doi.org/10.1186/s13017-026-00694-y","url":null,"abstract":"BACKGROUNDClinical practice guidelines recommend screening for blunt cerebrovascular injury (BCVI) based on the Denver Criteria. BCVI is typically treated with antithrombotic therapy, which may be high-risk in patients with concomitant brain or spine injuries. At our center, we often perform additional imaging in high-risk patients after positive initial screening for BCVI. Our study investigates how frequently follow-up imaging changes diagnosis and management of patients screening positive for BCVI.METHODSA cross-sectional study of all trauma patients admitted to a level 1 trauma center with cervical spine or facial fractures between May 2019 and December 2022 was performed. Chart review was conducted to identify all patients who had a positive screening study for BCVI. Individual charts were reviewed for BCVI screening and additional imaging test modality and results, as well as timing and specifics of treatment recommendations.RESULTSA total of 2668 patients met inclusion criteria. 1407 of these patients received BCVI screening, 11 with Magnetic Resonance Angiography (MRA) and 1396 with Computed Tomography Angiography (CTA). Of those screened, 254 (9.5%) had with positive or equivocal findings, of which 197 (77.6%) patients received a second study, including 2 patients who received multiple studies. Additional imaging studies resulted in a change in the diagnosis in 96 patients (48.7%), including 105 studies (53.3%) that found no injury or chronic findings. The results of additional studies changed patient management in in 64 (32.5%) cases.CONCLUSIONSIn our study, follow-up BCVI imaging frequently identified discordant findings in a third of screening tests. This suggests that starting antiplatelet or anticoagulation therapy based on screening studies alone could result in overtreatment in a high-risk patient population.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"2 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147619414","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":"Outcomes of emergency department and operating room preperitoneal pelvic packing in hemodynamically unstable severe pelvic fractures: a retrospective risk-adjusted observational study.","authors":"Seong Hwa Lee,Jihoon T Kim,Seongho Choi,Min Ae Keum,Eun Ji Lee,Hyeonjoon Lee,Kyu-Hyouck Kyoung","doi":"10.1186/s13017-026-00695-x","DOIUrl":"https://doi.org/10.1186/s13017-026-00695-x","url":null,"abstract":"BACKGROUNDHemodynamically unstable patients with pelvic fractures have a high mortality rate. Most bleeding from pelvic fractures originates from venous and bony sources; therefore, direct compression of the pelvic wall can be effective, and preperitoneal pelvic packing (PPP) should be considered as a first-line intervention. PPP can be performed in both the emergency department (ED) and the operating room (OR). However, outcomes according to the location of PPP have not been clearly established. This study evaluated the outcomes of ED-PPP and OR-PPP based on the location where the surgery was performed.METHODSThis single-center, retrospective, observational study included patients who underwent PPP for pelvic fractures with an Abbreviated Injury Scale score of ≥ 4 from July 2015 to June 2025. Data were collected from a prospectively maintained trauma registry. Patients were categorized into ED-PPP and OR-PPP groups according to the site of PPP. Baseline characteristics, injury severity (Injury Severity Score, Revised Trauma Score, and Trauma and Injury Severity Score), and interventions, including ED thoracotomy, resuscitative endovascular balloon occlusion of the aorta, tranexamic acid administration, and time to PPP and transfusion, were compared. Mortality outcome measures were evaluated at 24 h, 7 days, and as overall in-hospital mortality and were risk-adjusted using W- and Z-statistic.RESULTSFifty patients were included, with 17 and 33 in the ED-PPP and OR-PPP groups, respectively. Patients in the ED-PPP group were more critically ill at presentation, with lower systolic blood pressure, lower Glasgow Coma Scale scores, and a higher incidence of cardiac arrest before PPP. Time from scene to PPP (114.4 ± 68.6 vs. 284.3 ± 186.9 min) and to transfusion (84.5 ± 53.3 vs. 126.3 ± 72.5 min) was shorter in the ED-PPP group. The W-statistic demonstrated a greater number of actual survivors than expected in the ED-PPP and OR-PPP groups at 24 h (38.31 vs. 29.69) and 7 days (26.55 vs. 17.57), despite the high crude mortality rates (76.5% vs. 27.3%). Risk-adjusted in-hospital mortality showed no significant difference (W-statistic 3.02 vs. 5.45).CONCLUSIONPPP is associated with improved early and intermediate survival. ED-PPP significantly reduces the time to hemorrhagic control and should be strongly considered as an important rescue damage control intervention for patients with life-threatening pelvic bleeding.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"119 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147617393","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":"Early and late outcomes of component separation with transversus abdominis release with mesh augmentation versus primary suturing for the management of abdominal dehiscence: a retrospective comparative study.","authors":"Tamer A A M Habeeb,Abdulzahra Hussain,Jose Bueno-Lledó,Mariano Eduardo Giménez,Alberto Aiolfi,Ahmed Abdelsamad,Massimo Chiaretti,Igor A Kryvoruchko,Mallikarjuna N Manangi,Mohamed Tag El-Din,Nasreldin Mohammed Algalaly,Mohamed Ibrahim Shalamesh,Mohamed Fathy Labib,Walid Rafat Abdelaty Abdelfattah,Mohammed Abbas,Mostafa Mahmoud Salama Mostafa,Mahmoud E Nagaty,Mohamed Hassan Mohamed Elkaseer,Mahmoud Abd Alhady Abd Alaziz Abd Alhady,Ahmed Fayez Othman,Hamdi Elbelkasi,Mohamed Ibrahim Abo Alsaad,Mahmoud Moustafa Al-Shareef,Amr Khalil,Abouelatta K H Ali,Maged Z Youssef,Mohamed Adel Saqr,Mohamad Naeem Elnahas,Asmaa Mohamed Abdelhady,Mahmoud Abubakr Negm,Mohammed Barakat,Bassam Mousa,Alaa A Fiad,Mahmoud Abdou Yassin,Mostafa M Khairy,Tamer Wasefy,Ahmed M El Teliti,Ahmed Salah Arafa,Hasnaa Metwally,Taha A Biomy,Baher Atef,Adel Morsi,Mohamed Mahmoud Almeniawy,Mohamed Abdallah Zaitoun,Ahmed Attia Saleh,Mohamed Lotfy,Mohamed Mahmoud Mokhtar Mohamed,Abd Elwahab M Hamed","doi":"10.1186/s13017-026-00690-2","DOIUrl":"https://doi.org/10.1186/s13017-026-00690-2","url":null,"abstract":"BACKGROUNDAbdominal dehiscence (AD) is a serious postoperative complication associated with a high risk of morbidity. Traditional primary suture repair (PS) is a simple but biomechanically deficient procedure. This study compared the early and late outcomes of posterior component separation (CS) using the transversus abdominis release (TAR) technique with mesh augmentation (MA) and PS for AD management.MATERIALS AND METHODSThis retrospective study included 252 patients who underwent surgical repair for complete AD Bjork Grade 1 A between January 2014 and September 2020. The patients were divided into two groups: CS + TAR+MA (Group A, n = 107) and primary suture (PS) repair (Group B, n = 145). The primary outcome was short-term morbidity (within 90 days), including surgical site occurrence (surgical site infection [SSI], hematoma, and seroma), pneumonia, ileus, and recurrent AD (RAD). The secondary outcomes were the incidence and risk factors of IH after AD repair. The patients were followed up for 5 years. Statistical analysis was performed using Kaplan-Meier survival analysis and multivariate logistic regression.RESULTSThe baseline characteristics of the two groups were comparable. Group A was associated with a longer median operative time (92 (88-100) vs. 89 (84-91) min, p < 0.001) and mean hospital stay (11.2 ± 1.9 vs. 5.8 ± 1.5 days, p < 0.001), and higher rates of seroma (22.4% vs. 11.0%, p = 0.01) and hematoma (3.7% vs. 0%, p = 0.01). The SSI rates were comparable between the two groups (7.5% vs. 4.1%, p = 0.2). The incidence of IH was significantly lower in Group A than in Group B (5.6% vs. 13.1%, p = 0.04). Kaplan-Meier analysis confirmed the superior long-term IH-free survival in Group A (log-rank test, p = 0.009). Group A also had a lower RAD rate (1.9% vs. 7.6%, p = 0.04). Multivariate analysis revealed that PS repair (OR 40.0, 95% CI 2.1-78.0; p = 0.01), SSI (OR 13.4, 95% CI 2.3-77.6; p = 0.004), pneumonia (OR 12.3, 95% CI 1.9-77.5; p = 0.007), high BMI (OR 2.9, 95% CI 1.06-4.1; p = 0.03), ileus (OR 16.6, 95% CI 2.2-121.9; p = 0.006), RAD (OR 10.7, 95% CI 1.5-73.3; p = 0.01), infected mesh (OR 14.6, 95% CI 1.8-117; p = 0.01), and old age (OR 1.07, 95% CI 1.006-1.15; p = 0.03) significantly increased the risk of IH after AD repair. Elevated serum albumin levels were protective (OR 0.1, 95% CI 0.0-0.7; p = 0.02).CONCLUSIONGroup A repair for AD was associated with a significantly reduced risk of IH and RAD compared to PS. Despite a higher rate of initial complications, such as seroma and hematoma, Group A provided more durable and definitive reconstruction. PS repair confers a 40-fold increased risk of IH and should be reconsidered in favor of tension-free Group A management of AD.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"167 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583844","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}