World Journal of Emergency Surgery最新文献

{"title":"Surgical stabilization of rib fractures improves survival in functionally dependent trauma patients","authors":"Yi-Yu Lin, Yi-Jung Chen, Chih-Po Hsu, Jen-Fu Huang, Ya-Chiao Lin, Ling-Wei Kuo, Chi-Tung Cheng, Chien-Hung Liao","doi":"10.1186/s13017-025-00634-2","DOIUrl":"https://doi.org/10.1186/s13017-025-00634-2","url":null,"abstract":"Rib fractures are frequently encountered in trauma care and are particularly hazardous for functionally dependent patients, leading to increased morbidity and mortality rates. Surgical stabilization of rib fractures (SSRF) improves outcomes in selected populations; however, its role in functionally dependent individuals remains underexplored. A retrospective cohort analysis was conducted using the American College of Surgeons-Trauma Quality Improvement Program dataset from 2020 to 2022. Patients with three or more rib fractures and AIS (Abbreviated Injury Scale) greater than 3 for the rib and thoracic wall, along with documented functional dependency, were included. Propensity score matching (3:1) was applied to reduce the selection bias between patients receiving SSRF and those managed conservatively. The main outcomes of interest were in-hospital mortality, acute respiratory distress syndrome, unplanned intensive care unit (ICU) admission, unplanned intubation, and ventilator-associated pneumonia (VAP). A subgroup analysis compared early (≤ 72 h) versus late SSRF. Among 18,643 eligible patients, 359 (1.9%) underwent SSRF. Before matching, patients with SSRF had higher Injury Severity Scores (ISS), ICU admissions, and complication rates. After matching (294 SSRF vs. 883 conservative patients), SSRF was associated with significantly lower mortality (4.8% vs. 8.7%, p = 0.038) despite higher rates of unplanned ICU admission (11.2% vs. 7.0%, p = 0.031), unplanned intubation (10.2% vs. 6.1%, p = 0.026), and VAP (3.1% vs. 0.6%, p = 0.002). In the subgroup analysis, early SSRF led to fewer ventilator days (p = 0.013), and shorter ICU (p < 0.001), and hospital length of stays (LOS, p < 0.001), with no difference in mortality compared with late SSRF. However, the late SSRF group still had significantly lower in-hospital mortality compared to the conservative treatment group (3.8% vs. 10.9%, p = 0.023). SSRF in functionally dependent trauma patients with multiple rib fractures and significant chest wall injury (AIS ≥ 3) is associated with a significant reduction in in-hospital mortality compared to conservative management, despite a higher incidence of complications and prolonged ICU LOS. Early SSRF further improves clinical outcomes by decreasing ventilator duration and overall hospital LOS. These findings support the consideration of SSRF—particularly when performed early—as a beneficial strategy for managing rib fractures in functionally dependent patients. Even when performed at a later stage, SSRF still offers advantages over conservative treatment in reducing mortality. prospective studies are warranted to validate these results and establish clear patient selection criteria.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"21 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593914","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":"Neoampulla of vater creation to treat traumatic intrapancreatic common bile duct injury","authors":"Ercolani Giorgio, Santandrea Giorgia, Fabbri Carlo, Bisulli Marcello, Agnoletti Vanni, Giampalma Emanuela, Vallicelli Carlo, Catena Fausto","doi":"10.1186/s13017-025-00621-7","DOIUrl":"https://doi.org/10.1186/s13017-025-00621-7","url":null,"abstract":"Pancreatic and extrahepatic biliary tree traumas are rare traumas, due to specific trauma dynamics. They may require both non-operative and operative management, according to the severity of injury. In the case of operative management, a multidisciplinary approach is crucial to improve clinical outcomes, to reduce complications and to ensure complete management of injuries. The case presented is an example of such a multidisciplinary approach in polytrauma, in which the combination of surgical and endoscopic approach allowed to manage severe common biliary duct and pancreatic head injury, creating a “neoampulla”. This is the first case described in literature of such an approach in common bile duct traumatic injury.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"685 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568810","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":"Clinical patterns and predictors of trauma-related mortality over 13 years: a retrospective analysis from a Level 1 National trauma center","authors":"Ayman El-Menyar, Sandro Rizoli, Ahammed Mekkodathil, Mohammad Asim, Sajid Atique, Abdel-Aziz Hammo, Hisham Jogol, Ahad Kanbar, Khalid Ahmed, Rafael Consunji, Husham Abdelrahman, Asmaa Al-Atey, Ahmad Kloub, Fernando Spencer Netto, Gustav Strandvik, Hassan Al-Thani","doi":"10.1186/s13017-025-00633-3","DOIUrl":"https://doi.org/10.1186/s13017-025-00633-3","url":null,"abstract":"Qatar is one of six neighboring countries in the Gulf Cooperation Council region that form a political and economic alliance to foster multilateral cooperation. Given the shared challenges in trauma care, there is a need for a collaborative network to develop region-specific injury prevention strategies. For example, this study examines the clinical patterns and predictors of hospital mortality among trauma patients in Qatar. A retrospective analysis of trauma-related deaths (2010–2023) was conducted. Patients were stratified into early hospital mortality (EHM, ≤ 48 h) and late hospital mortality (LHM, > 48 h) groups. Further analyses examined in-hospital mortality (24 h, 24–48 h, 3–7 days, and > 7 days), age groups, injury mechanisms, and severity. A multivariable regression analysis identified predictors of early mortality. Among 2,452 trauma-related deaths, 59% occurred in pre-hospital, while 41% occurred in-hospital. Compared to LHM (47%), EHM (53%) was associated with a younger age (35 vs. 39 years; p = 0.002), higher systolic blood pressure (0.82 vs. 0.67; p = 0.002), and diastolic blood pressure (2.03 vs. 1.75; p = 0.001). Motor vehicle crash (MVC) was the leading cause of death (35.3%), with vulnerable road users (VRU) the commonest in EHM (p = 0.004) and falls in LHM (p = 0.004). LHM was associated with a higher injury severity score (p = 0.001). On-admission systolic shock index independently predicted EHM (OR 2.23; 95% CI 1.09–4.52), while head (OR 7.14; 95% CI 2.44–20.00) and pelvic injuries (OR 3.70; 95% CI 1.19–11.11) and sepsis (OR 6.25; 95% CI 1.22–33.33) predicted LHM. In-hospital deaths exhibited a bimodal distribution, with peaks at 24 h (15%) and between the third and seventh days (10%). EHM showed an upward trend over the years (R² = 0.312), while LHM remained stable. Trauma-related mortality rates declined from 10.4 to 5.0 per 100,000 population (2011 and 2017) before rising to 9.7 by 2022. Pre-hospital deaths followed a similar pattern to the overall mortality, while the in-hospital rates remained steady. VRU-related injuries persisted at a high level, accounting for 26–43% of cases throughout the study period. This study highlights distinct trauma-related mortality patterns, with EHM linked to hemorrhage and shock, while LHM is associated with severe head injuries and sepsis. These findings underscore the need for targeted interventions to optimize bleeding control and address predictors such as shock indices for EHM and head injuries for LHM.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"20 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565767","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 on the prognosis with the creation of a dedicated stroke to mesenteric ischaemia","authors":"Victor Rudondy, Pierre-Antoine Barral, Thibaut Markarian, Sophie Chopinet, Marine Barraud, Marine Gaudry, Jeremy Bourenne, Cyril Nafati, Benedicte Grigoresco, David Lagier, Alexandre Rossillon, Diane Mege","doi":"10.1186/s13017-025-00627-1","DOIUrl":"https://doi.org/10.1186/s13017-025-00627-1","url":null,"abstract":"Acute mesenteric ischaemia (AMI) is an emergency with a poor prognosis. In France, a structure dedicated to AMI has been created in Paris in 2016 (SURVI), with promising results. A similar organization has been created in Marseille in 2021 (SOS AMI). Our aim was to compare the results of SOS AMI with those of a previous cohort of AMI patients managed without any dedicated structure. The first 100 patients with AMI, managed by the SOS AMI, between November 2021 and December 2023 were prospectively included. They were compared with 100 AMI patients from a previous retrospective cohort (from January 2017 to December 2020), managed without any dedicated structure in the same center. The first 100 AMI patients managed by SOS AMI have similar demographic characteristics to those previously managed without SOS. The vascular causes of AMI were also similar between groups: arterial occlusive (61 vs. 56%, p = 0.5), venous occlusive (17 vs. 13%, p = 0.5), or non occlusive (22 vs. 31%, p = 0.2). AMI patients managed by SOS AMI were more frequently transferred from another center (41 vs. 19%, p = 0.001), had a shorter median time between CT scan and intervention (4 [range, 1-129] vs. 5 [0-285] hours, p = 0.05), a higher revascularisation rate (61 vs. 28%, p = 0.02), and lower 30-day (32 vs. 58%, p < 0.001) and 90-day (45 vs. 62%, p = 0.02) mortality rates. The creation of SOS AMI has significantly improved the management of AMI patients, by better organizing the role of the various specialties involved, particularly in terms of revascularisation and survival rates. These promising results support the further development and expansion of this dedicated structure.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"74 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565768","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":"Tourniquet-related complications in extremity injuries: a scoping review of the literature.","authors":"Anaida Xacur-Trabulce,Gessner Casas-Fuentes,Veronica Ruiz-Vasconcelos,Marianne Marchini Reitz,Sharon M Henry,Thomas M Scalea,Marcelo A F Ribeiro","doi":"10.1186/s13017-025-00625-3","DOIUrl":"https://doi.org/10.1186/s13017-025-00625-3","url":null,"abstract":"BACKGROUNDTourniquets are crucial for controlling life-threatening hemorrhage and, therefore, in preventing avoidable deaths in both military and civilian settings. Its increased use since the launch of the Stop the Bleed campaign, however, has raised concerns regarding possible complications associated with its application, including limb ischemia and amputation. The objective of this study was to synthesize the existing evidence regarding complications associated with the use of tourniquets for extremity injuries and identify gaps in knowledge to guide future research on this topic.METHODSA review of the literature between 2016 and 2024 was performed including open access retrospective studies, case series, clinical cases, and systematic reviews that addressed tourniquet use in a civilian or military setting in patients with extremity injuries, following the PRISMA-ScR 2018 checklist. PubMed, ScienceDirect, and Cochrane databases were queried, identifying 1,398 articles on the use of extremity tourniquets in military and civilian contexts, focusing on complications. Of these, 1,343 articles were excluded due to duplication or irrelevance based on the title. From the 55 remaining, 37 were excluded after abstract review for not meeting inclusion criteria. Of the 18 full-text articles reviewed, 10 were excluded due to insufficient data, leaving 8 studies for detailed analysis.RESULTSProlonged application in emergency situations may lead to severe complications, such as nerve injuries, post-tourniquet syndrome and thromboembolic event risks. Nerve palsy has been identified as the most prevalent complication associated with prolonged tourniquet use.CONCLUSIONImproved training is essential to help providers accurately assess bleeding severity and apply appropriate interventions, reducing complications and enhancing outcomes. Future research opportunities should consider: (1) prospective interventional randomized controlled studies aiming to compare the use of tourniquets to different methods of hemorrhage control; (2) development and validation of easy-to-use scores predicting complications and the need of amputation in both civilian and military settings including upper and lower extremities, to better guide clinical decisions and future guidelines; (3) development of better ways to teach lay providers to recognize life threatening bleeding; and (4) development of guidelines for timing of tourniquet loosening, removal or conversion.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"45 1","pages":"57"},"PeriodicalIF":8.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478765","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":"Completely thoracoscopic surgical stabilization of rib fractures: balancing minimally invasive benefits against technique-specific complications: a single-center retrospective study","authors":"Yang Yang, Zexin Xie, Jiantao Zhang, Xuetao Zhou, Zheng Liang, Chunjuan Hou, Jin Zhang, Dongsheng Zhang","doi":"10.1186/s13017-025-00629-z","DOIUrl":"https://doi.org/10.1186/s13017-025-00629-z","url":null,"abstract":"This study aimed to investigate the surgical outcomes and complications of completely thoracoscopic surgical stabilization of rib fractures (cTSSRF) in patients with rib fractures in the posterior chest wall area. A retrospective analysis was conducted on 30 patients who underwent completely thoracoscopic surgical stabilization of rib fractures (cTSSRF) between September 2019 and October 2023. Clinical data were gathered to compare and analyze the clinical outcomes of complications of cTSSRF and open surgical stabilization of rib fractures (oSSRF). A total of 201 rib fractures were repaired in 30 patients, including 79 rib fractures in the posterior chest wall (an average of 2.63 rib fractures/person) that were fixed by cTSSRF, and 122 rib fractures (an average of 4.06 rib fractures/person) fixed by oSSRF. No obvious thoracic collapse deformity was observed postoperatively in any patient. The median duration of chest tube removal after surgery was 3 (3–4) days, and the chest drainage volume was 586.33 ± 232.4 ml. The numeric rating scale score (NRS) was 3 (2–3.25), which was significantly lower than the preoperative score of 7 (6–8), z = -4.826, P < 0.001). The rate of implant displacement of the cTSSRF was 6.33% (5/79), which was significantly higher than that in the oSSRF of 0(0/122), χ2 = 5.53, P = 0.019. The rates of fracture malalignment were high in the cTSSRF (21.52% [20/79] vs2.46% [3/122], P < 0.001). The incidence of postoperative encapsulated pleural effusion—defined as a maximum anteroposterior fluid thickness > 20 mm surrounding the internal fixation device on axial CT scans—was 46.7% (14/30 cases) during the 7–14 day postoperative period. All patients were followed-up in outpatient clinics or by telephone for 6–24 months, and all resumed their work capacity without obvious symptoms of chest discomfort. The application of cTSSRF is a safe, feasible and minimally invasive surgical option, particularly in cases of rib fractures in the posterior chest wall, which are challenging to address using conventional open surgery. However, the postoperative implant displacement and fracture malalignment rates are higher than those observed in conventional surgery, which still needs to require careful evaluation of the risks and benefits of routinely performing cTSSRF.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"25 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144371080","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":"Magnitude, outcome, and predictors of mortality in perforated peptic ulcer disease: a retrospective study in Jigjiga town, Ethiopia","authors":"Abdirahman Burale, Bedhaasa Beyene, Musse Ahmed, Abdullahi Hussen, Mohamed Said Hassan, Shamsedin Mahdi Hassan, Hassan Sh Abdirahman Elmi","doi":"10.1186/s13017-025-00628-0","DOIUrl":"https://doi.org/10.1186/s13017-025-00628-0","url":null,"abstract":"Peptic ulcer perforation (PUP) is a surgical emergency and life-threatening complication affecting 2–10% of peptic ulcer disease (PUD) patients. Delayed diagnosis and surgical management are associated with significant morbidity and mortality. This study assessed the magnitude and outcome of PUP among patients operated on at two public hospitals in Jigjig town, Ethiopia. A 3-year hospital-based retrospective cross-sectional study was conducted on 130 patients operated for PUP at the study hospitals in Jigjig from April 1st, 2018, to July 30th, 2021. Data were collected from medical records. Bivariate analysis identified key factors impacting outcomes in PUP patients. The cohort had a male-to-female ratio of 8.7:1, and a mean age of 38 ± 13.3 years, with 48.8% smokers and 56.6% chat chewers. Duodenal perforations accounted for 93.7% of cases, with post-operative complications in 29.1% and an in-hospital mortality rate of 5.5%. Significant predictors of morbidity and mortality included advanced age (AOR 23.88), comorbidities (AOR 26.80), pre-operative hypotension (AOR 32.33), and delayed hospital presentation (AOR 30.10). Male predominance, younger age, high smoking and chat chewing rates, and primarily duodenal perforations are common in perforated peptic ulcer cases. Advanced age, comorbidities, pre-operative hypotension, and delayed hospital presentation significantly increase postoperative complications and mortality, emphasizing the need for timely intervention and targeted public health measures to improve patient outcomes. Early intervention and careful management of comorbidities are crucial to improve survival and reduce complications in patients with PUP.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"19 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144371072","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":"Homocysteine(HCY), a novel biomarker for predicting irreversible transmural intestinal necrosis in patients with adhesive small bowel obstruction: results from a prospective observational study","authors":"Youlong Zhu, Ruming Liu, Xuan Geng, Dakun Li, Bin Quan, Feifei Kong, Defei Hong","doi":"10.1186/s13017-025-00632-4","DOIUrl":"https://doi.org/10.1186/s13017-025-00632-4","url":null,"abstract":"Whether elevated homocysteine level is causally associated with small bowel necrosis remains unestablished. We conducted a prospective observational study to analyze the value of serum homocysteine (HCY) in predicting irreversible transmural intestinal necrosis (ITIN) of adhesive small bowel obstruction (ASBO). This prospective observational study was performed between Feb 2023 and Feb 2025 in patients with adhesive small bowel obstruction. The primary outcome was the occurrence of ITIN. The serum levels of different biomarkers in different groups were calculated and compared. Univariable analysis and multivariable analysis were used to assess the association between different biomarkers and ITIN. The Receiver Operating Characteristic Curve (ROC) was used to assess the value for predicting ITIN. The patients comprised 129(58.37%) male and 92(41.63%) female with a median age of 70(60–78)(range 18–85 years). Of the 221 patients included, 88(39.82%) received non-operative treatment, and 133(60.18%) underwent surgery. Intestinal resection and ITIN concerned 89(66.92%) and 68(51.13%) of patients who underwent surgery, respectively. Patients underwent surgery had significantly higher serum levels of HCY, ENDOTOXIN, IL-5, IL-6, Hs-CRP, IL-1β, and PCT (p<0.0001, respectively) than patients receiving non-operative treatment. The levels of the above seven markers (p<0.05, respectively) in patients with ITIN were significantly higher than in patients with non-necrosis. Univariable analysis and multivariable analysis showed that HCY、ENDOTOXIN and Hs-CRP were independent predictors for small bowel necrosis (odds ratio = 1.420, 1.061 and 1.032; p = 0 0.000, p = 0.001 and, p = 0.019, respectively). The AUC of HCY (0.9253, p<0.0001) was higher compared with ENDOTOXIN (0.8291, p<0.0001) and Hs-CRP (0.7023, p<0.0001). HCY had highest sensitivity (89.71%) and specificity (83.03%) compared with ENDOTOXIN (82.83%, 62.08%) and CRP (73.53%, 50.77%) for predicting small bowel necrosis. The serum HCY cutoff level for the diagnosis of small bowel necrosis was 15.53µmol/L. This study provides compelling evidence that homocysteine (HCY) levels can be a useful predictor of irreversible transmural intestinal necrosis that necessitates surgical resection in the setting of adhesive small bowel obstruction. Close monitoring of the HCY serum level could help avoid unnecessary laparotomy and resection, as well as complications due to unnnecessary surgery, and potentially decrease overall mortality rates.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"66 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144371074","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":"Laparoscopic appendectomy as the gold standard: What role remains for open surgery, conversion, and disease severity?","authors":"Claus Schildberg, Ulrike Weber, Volker König, Marius Linnartz, Sophie Heisler, Jennifer Hafkesbrink, Marcia Fricke, René Mantke","doi":"10.1186/s13017-025-00626-2","DOIUrl":"https://doi.org/10.1186/s13017-025-00626-2","url":null,"abstract":"Acute appendicitis is a common abdominal surgical emergency and is a major cause of acute abdomen in more than 20% of cases. Although various studies have been conducted in recent years on topics such as surgical techniques and antibiotic treatment of appendicitis, today there is a lack of large-scale studies focused on the different severity levels of acute appendicitis and their management. The study aimed to analyze the severity, types of surgical techniques, and mortality associated with acute appendicitis to identify possible developments. We conducted a retrospective multicenter observational study based on routine data from 2010 to 2022. Patients over 18 years old with acute appendicitis were included and the following data were collected: patient demographics, comorbidities, type of surgery, complications, admission to ICU, length of stay, and in-hospital mortality. A total of 31,988 patients were included in the study. At the end of the study, 97.0% (P < .001) of the patients underwent laparoscopic appendectomy, with 86% of cases involving closure of the appendix stump by stapler (P < .001). It was only from 2014 onwards that more than 90% of surgeries were performed laparoscopically, and from 2017, this figure rose to 95%. Complicated appendicitis was present in 27.4% of cases. The distribution of severity was as follows: unspecified acute appendicitis in 39.5%, appendicitis with local peritonitis in 33.1%, appendicitis with local peritonitis and perforation in 17.1%, appendicitis with peritoneal abscess in 5.4%, and appendicitis with generalized peritonitis in 4.9%. Women had a significantly lower risk for conversion to an open operation than men (P < .001). The highest morbidity was observed in the group that converted from laparoscopy to open surgery (P <.001). Non-surgical treatment of appendicitis was not relevant, accounting for only 4% of cases. Since 2017, primary laparoscopic appendectomy has been the gold standard for even complicated acute appendicitis (> 95% annually). Over three-quarters of patients undergo an appendectomy with a stapler, making this surgical technique the preferred method of laparoscopic surgery in Germany. Patients who undergo an interoperative switch to open therapy should be considered a subgroup at risk of increased mortality. ClinicalTrials.gov ID: NCT06558760.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"35 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312180","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 clinical efficacy and safety of ERCP in traumatic pancreatic injuries: a systematic review and meta-analysis","authors":"Hulusi Can Karpuzcu, Çağdaş Erdoğan","doi":"10.1186/s13017-025-00631-5","DOIUrl":"https://doi.org/10.1186/s13017-025-00631-5","url":null,"abstract":"Traumatic pancreatic injuries (TPI) are rare, critical complications increasingly managed by minimally invasive Endoscopic Retrograde Cholangiopancreatography (ERCP). We systematically reviewed and meta-analyzed ERCP’s efficacy and safety for TPI regarding pancreatic duct integrity and clinical outcomes in diverse populations. PubMed, Scopus, Cochrane Library, and Web of Science were searched (2000–2024) for studies reporting on ERCP for TPI. Primary outcomes were pancreatic duct integrity and complications; secondary outcomes included mortality and hospital stay. Pediatric and adult populations were compared via subgroup analysis. Publication bias was assessed. Fifteen studies comprising 1,823 patients (54% male, 32% pediatric) were included in the meta-analysis. ERCP demonstrated a pooled clinical success rate of 89% (95% CI: 83–93%) and significantly improved pancreatic duct integrity (OR for pancreatic duct integrity: 9.17, 95% CI: 6.73–12.49). Complication rates ranged from 4 to 17%, with pancreatitis and bleeding being the most common adverse events. Mortality rates were low (3–5%), and ERCP significantly reduced hospital stay by an average of 3.1 days compared to surgical interventions. Pediatric patients had slightly lower success rates (OR: 6.73, 95% CI: 4.01–11.31) compared to adults (OR: 10.87, 95% CI: 7.40–15.98). ERCP is an effective and safe modality for managing TPI in both pediatric and adult patients, yielding high success rates in maintaining ductal integrity and reducing complications, although interpretation requires caution due to potential publication bias. Further prospective studies are required to optimize standardized protocols.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"5 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311918","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}