World Journal of Emergency Surgery最新文献

{"title":"World Congress of Trauma and Emergency Leagues (WCTEL): looking for the future.","authors":"Gustavo P Fraga,Thiago R A Calderan,João Victor Franqueira,Henrique Alexandrino,Antônio C Marttos,Fausto Catena,Ari Leppaniemi,Andréa M A Fraga","doi":"10.1186/s13017-026-00676-0","DOIUrl":"https://doi.org/10.1186/s13017-026-00676-0","url":null,"abstract":"The first World Congress of Trauma and Emergency Leagues (WCTEL) was held at the University of Campinas (Unicamp), Brazil, on July 3rd to 6th, 2025. The meeting was organized by undergraduate medical and nurse students, guided by their professors, and with a support of Brazilian and international societies. Pre-congress activities included a Students World Championship in Emergency and Trauma Simulation. More than 1000 participants from 19 countries attended the WCTEL, enabling exchanges of experiences and the possibility of cooperation between students. This new kind of congress could be a good way to attract young people to work with trauma and emergency surgery in the future.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"30 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535740","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":"Continuous monitoring of intra-abdominal pressure: cumulative pressure exposure predicts early acute kidney injury in animal model.","authors":"Chien-Hung Liao,Chih-Chi Chen,Yu-Hao Wang,Marcelo A F Ribeiro,Wei-Cheng Lin,Dong-Ru Ho,David A Spain,Chi-Tung Cheng","doi":"10.1186/s13017-026-00693-z","DOIUrl":"https://doi.org/10.1186/s13017-026-00693-z","url":null,"abstract":"BACKGROUNDElevated intra-abdominal pressure (IAP) causes organ dysfunction, particularly acute kidney injury (AKI). Current intermittent IAP monitoring methods are inadequate for capturing the dynamic fluctuations. We hypothesize that the cumulative exposure to elevated IAP over time is a predictor of organ injury.METHODSWe evaluated the feasibility of a novel capsular sensor (PressureDOT, PDT) for continuous IAP measurement in six anesthetized porcine subjects. Controlled intra-abdominal hypertension (IAH) was induced using progressive CO2 insufflation. We calculated the cumulative intra-abdominal pressure exposure (cIAPe), defined as the integrated area under the curve of IAP values exceeding 12 mmHg over time. Serial serum creatinine (Cr) estimated glomerular filtration rate (eGFR), and other organ markers were tracked.RESULTSContinuous and high-resolution IAP monitoring was achieved in all subjects. Exposure to IAH significantly increased mean serum Cr (1.69 ± 0.19 to 2.16 ± 0.31 mg/dL; p = 0.01) and reduced eGFR (41.33 to 25.00 mL/min; p < 0.001). A linear correlation was demonstrated between increasing cIAPe and rising Cr ratio (R2 ranging from 0.84 to 0.97). Critically, changes in Cr and eGFR reduction were statistically significant across progressive cIAPe phases (p = 0.048 and p < 0.001, respectively).CONCLUSIONThe use of continuous IAP monitoring by PDT is feasible in this controlled porcine model. Our findings suggest that cIAPe may be a quantifiable marker associated with early renal impairment. Although early detection of physiological renal impairment consistent with early AKI criteria is promising, validation in larger animal studies and future human trials is necessary to determine clinical relevance.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"83 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147492937","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":"Splanchnic venous thrombosis in necrotizing pancreatitis: recanalization and the effectiveness of anticoagulant therapy.","authors":"Aykut Çelik,Leman Damla Ercan,Mehmet İlhan,Hakan Yanar,Kayıhan Günay,Feza Ekiz,Celal Caner Ercan,Edanur Karapınar,Ali Fuat Kaan Gök,Cemalettin Ertekin","doi":"10.1186/s13017-026-00684-0","DOIUrl":"https://doi.org/10.1186/s13017-026-00684-0","url":null,"abstract":"OBJECTIVESplanchnic venous thrombosis (SVT) is a common complication in necrotizing pancreatitis (NP), contributing significantly to increased morbidity and mortality. The role of anticoagulant therapy in the management of SVT remains controversial. This study aims to identify the factors influencing SVT formation and recanalization in patients with NP and to evaluate the efficacy of anticoagulant treatment.MATERIALS AND METHODSA retrospective analysis was conducted on 121 patients diagnosed with NP between July-2013 and August-2022. Sociodemographic and clinical characteristics, comorbidities, anticoagulant use, and computed tomography findings at admission, first week, first month, third month, sixth month, and first-year follow-ups were evaluated.RESULTSSVT was detected in 51 of 121 (42.1%) patients with NP. Thrombosis incidence correlated with higher computed tomography severity index (CTSI) scores. The splenic vein was the most frequent site of thrombus formation. Among patients with SVT, recanalization was observed in 18 of 51 (35.3%) patients. Recanalization rates were significantly lower in cases of total occlusions than partial occlusions (p < 0.001). Diabetes mellitus was associated with lower recanalization rates (p = 0.019). No significant association was found between therapeutic-dose anticoagulant therapy and thrombosis formation (p = 0.239) or recanalization (p = 0.438).CONCLUSIONClinical course of necrotizing pancreatitis is a dynamic and complex process and SVT is strongly associated with both the severity and persistence of inflammation. Recanalization primarily depends on the resolution of inflammation, and therapeutic-dose anticoagulant therapy does not appear to provide significant benefit. Diabetes mellitus negatively affects recanalization outcomes. Total occlusion makes recanalization more difficult.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"103 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147492938","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":"Aetiologies and prognosis of small bowel obstruction in virgin abdomen: a retrospective cohort study.","authors":"Yawei Qian,Yanhui Zhu,Xiaochun Ping","doi":"10.1186/s13017-026-00691-1","DOIUrl":"https://doi.org/10.1186/s13017-026-00691-1","url":null,"abstract":"BACKGROUNDSmall bowel obstruction (SBO) in patients with a virgin abdomen (VA)-no prior abdominal surgery-remains understudied, with traditional assumptions favoring mandatory surgical exploration due to suspected non-adhesive etiologies like malignancy or hernias. However, emerging evidence suggests adhesions are also prevalent in SBO-VA, challenging this paradigm. This study investigates the etiologies, management outcomes, and prognostic factors of SBO-VA to guide evidence-based treatment strategies.METHODSA retrospective analysis was conducted on 312 SBO-VA patients treated at a tertiary center from 2009 to 2020. Patients were categorized into immediate surgery (n = 124), delayed surgery (n = 45), or non-operative (n = 143) groups. Etiologies, imaging findings, surgical outcomes, and recurrence rates were analyzed.RESULTSAdhesions, luminal obstructions, and neoplasms were the leading causes of SBO-VA. The surgical group (n = 169) had a 7.1% mortality rate, highest with volvulus and mesenteric ischemia. Bowel necrosis occurred in 32.5% of adhesive SBO cases, associated with peritonitis or mesenteric edema on CT. The non-operative group had a 4.9% mortality rate, with inflammatory diseases as the predominant suspected etiology. CT accurately predicted surgical findings in 60.1% of cases, with closed-loop signs and ascites indicating necrosis. Recurrence occurred in 23.5% of conservatively managed patients, often within four years.CONCLUSIONSBO-VA exhibits diverse etiologies, with adhesions being the most common. Conservative management is feasible in select patients, particularly those with inflammatory conditions, while early surgery is critical for cases with signs of strangulation or ischemia. CT imaging plays a pivotal diagnostic role. Incorporating water-soluble contrast agents may optimize non-operative management. These advocate for tailored treatment strategies based on etiology and clinical risk stratification.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"16 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454597","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":"Ten years of acute care surgery in Singapore: evolution, outcomes and future challenges.","authors":"Sachin Mathur,Eliza I-Lin Sin,Chris Hang Liang Keh,Sarah Ru Kher Sim,Jerry Tiong Thye Tiong","doi":"10.1186/s13017-026-00688-w","DOIUrl":"https://doi.org/10.1186/s13017-026-00688-w","url":null,"abstract":"BACKGROUNDAcute Care Surgery (ACS) has emerged as a structured solution to challenges in emergency general surgery (EGS), including subspecialisation, fragmented coverage, and delays in operative care.METHODSThis narrative review outlines the global ACS evolution and examines Singapore's experience over the past decade, focusing on implementation models, outcomes, and ongoing challenges.RESULTSSince 2014, Singapore's public hospitals have adopted variations of the ACS framework, ranging from consultant of the week rosters to dedicated full time ACS teams. These models have improved timeliness of care, efficiency, and surgical training. Innovations such as Emergency Laparotomy Pathways and abscess protocols reduced delays and improved perioperative coordination. Local outcomes demonstrate reduced time to intervention by 30-40%, shorter hospital stays by 1-2d and sustained improvements in morbidity and mortality. However, challenges persist in trauma workforce sustainability, registrar training variability, theatre access, and the absence of national credentialing.CONCLUSIONACS has improved the delivery of emergency and trauma surgery in Singapore. To sustain these gains, national credentialing, workforce planning, and structured training frameworks are required to secure ACS as a core part of the surgical system.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"17 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147447020","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":"From molecular networks to precision therapeutics: the evolving landscape of trauma-induced coagulopathy.","authors":"Shouyin Jiang,Lei Wang,Wenqi Qi,Jintao Wei,Taiwen Rao,Xiangkang Lv,Bojin Chen,Xiaojing Guo,Xiaogang Zhao,Shanxiang Xu","doi":"10.1186/s13017-026-00689-9","DOIUrl":"https://doi.org/10.1186/s13017-026-00689-9","url":null,"abstract":"BACKGROUNDTrauma-induced coagulopathy (TIC) affects approximately one quarter of severely injured patients and is linked to markedly increased mortality. Despite improvements in trauma care, understanding of TIC mechanisms and development of targeted treatment strategies remain limited. This review summarizes recent advances in mechanistic studies and translational research that inform targeted approaches for TIC.METHODSA systematic PubMed search identified English-language basic research on TIC published from January 2016 to July 2025. The review focused on studies utilizing established animal models and experimental systems to explore disease mechanisms, intervention strategies, and translational relevance. Included studies were assessed for scientific rigor, clinical significance, and contributions to advancing TIC knowledge.RESULTSRecent research clarifies the contributions of endothelial glycocalyx shedding, platelet dysfunction, and imbalanced coagulation and fibrinolysis to TIC development. Inflammatory processes and immunothrombosis further disrupt hemostasis. Animal studies in a variety of species have improved understanding of the roles of tissue injury, shock, biological sex, comorbidities, and environmental influences. Preclinical progress includes innovations in fluid resuscitation, precise blood component therapy, targeted antifibrinolytics, vasoactive medications, and cellular therapies. Novel diagnostic tools featuring viscoelastic assays and new biomarkers offer promise for earlier detection and better classification of TIC subtypes. However, challenges persist related to species-specific responses, optimal timing of interventions, and individualized treatment.CONCLUSIONIntegrating mechanistic and translational research is transforming the concept of TIC into a dynamic, heterogeneous syndrome that requires individualized therapies. Advances in diagnostics and precision interventions will play a critical role in improving global outcomes for trauma patients with TIC.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"26 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439549","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":"Criteria for the qualification of geriatric patients to the trauma center.","authors":"Małgorzata Sulej-Niemiec,Magdalena Żurowska-Wolak,Andrzej Kopta,Łukasz Kręglicki,Mirosław Szura","doi":"10.1186/s13017-026-00683-1","DOIUrl":"https://doi.org/10.1186/s13017-026-00683-1","url":null,"abstract":"BACKGROUNDThe growth of the geriatric population, resulting in an exponential increase in the number of injured older people, determines the necessity of ensuring adequate access to specialized units such as trauma centers (TCs). The specificity of pathophysiological processes that progress with age, worsening the body's response to trauma, makes it difficult to develop an optimal triage protocol for geriatric patients, reducing high undertriage, i.e., underestimation of injuries and referral to lower-reference units.AIMTo verify the TC qualification criteria for 65+ patients and analyze the weights of individual triage factors for these patients.METHODSThis was a retrospective analysis of the medical records of ED patients from the Clinical Hospital with TC in Poland admitted from 1.01.2017 to 31.12.2020. Among 155,320 ED patients, 6541 who formed Trauma group 65+ were selected, in which the TRISS score was estimated. The TC 65+ group meeting the currently applicable TC qualification criteria was selected. The TRISS cutoff value, TRISS 65+ group and TC-omitted 65+ group were determined. The significance of TC qualification factors was estimated. Receiver operating characteristic (ROC curve) analysis and multiple linear regression analysis were used for statistical classification.RESULTSThe value of ≤ 88.84% determined the threshold for TC qualification, and the leakage of criteria was 58.51%. Six significant factors with different typing weights were identified: GCS ≤ 8 (- 42.90%), extensive crush injury of the extremities (- 33.74%), and RR &lt; 10/min (- 16.16%), blunt injury to thoracic internal organs (- 13.75%), pelvic fracture (- 11.35%) and SBP ≤ 80 mmHg (- 10.41%) were performed. The weight + SD of each factor reduced the potential TRISSe value to ≤ 88.84% (threshold). Modifications of the cutoff values of significant physiological parameters were determined, i.e., GCS ≤ 14 (sensitivity = 79.79%, specificity = 98.25%, AUC = 0.896, Youden index = 0.780) and SBP ≤ 129 mmHg with questionable efficacy of the result.CONCLUSIONSThe current TC qualification criteria require modification for geriatric patients, which would complete the leakage estimated at 58.51% according to the TRISS scale. The leakage results from underestimation of the weight of the 6 triage factors to the TC, and the modification of the criteria should include a reduction in the current requirement of 4 factors to 1 and allow admission to the TC of a 65+ trauma patient with one of the following anatomical injuries: extensive crush injury of extremities, blunt injuries with symptoms of damage to internal thoracic organs, pelvic fracture, or one of the disorders of physiological parameters: GCS ≤ 8, RR &lt; 10/min, or SBP ≤ 80 mmHg. In the other cases, the modification should also take into account the change in the GCS limit value to ≤ 14 (instead of ≤ 8) and the change in the SBP cutoff value from ≤ 80 mmHg to a higher one (but ≤ 129 mmHg) or the use of another factor. To complet","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"56 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147374092","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 impact of injury severity and age on short-and long-term mortality and hospital length of stay after surgical stabilisation of rib fractures (SSRF): a German population-based propensity-score matched investigation.","authors":"Michael David Huelskamp,Martial Mboulla Nzomo,Nicolas Horst,Laura Acar,Helena Duesing,Ursula Marschall,Michael Johannes Raschke,Steffen Rosslenbroich","doi":"10.1186/s13017-026-00682-2","DOIUrl":"https://doi.org/10.1186/s13017-026-00682-2","url":null,"abstract":"BACKGROUNDSurgical stabilisation of rib fractures (SSRF) is a procedure that has been shown to reduce mortality and complications in patients with thoracic trauma. However, correct patient selection is required, since the immunological hit of a thoracic surgery in the context of trauma is not without risk. In this study we aimed to analyse real-world data on the effect of SSRF mortality and hospital length of stay.METHODSA retrospective propensity matched analysis of real-world health claims data of a German statutory health insurance company of Management of serial rib fractures and unstable thorax via SSRF compared to conservative treatment was performed. The primary endpoints were in-hospital mortality, 1 year post hospital mortality and intensive-care unit length of stay. Subgroup analyses with respect to age-group, overall injury severity and time-point of surgery were performed. Multivariate regression was used to confirm these results and analyse interaction between different variables.RESULTSOverall, 62,011 patients with serial rib fractures were identified, of which 532 patients receiving SSRF and 532 receiving conservative management could be matched. The data showed a significant reduction in in-hospital mortality in the SSRF cohort (4.7% for SSRF versus 9.21% for conservative treatment, p = 0.005). Subgroup analysis showed this effect to be most pronounced in patients with high, but not extremely high injury severity (injury severity score (ISS) 16-24). The survival benefit could be demonstrated across age groups, although the extent of the benefit decreased with increasing age. Hospital length of stay was increased in the SSRF cohort, although this effect was driven through an increase in the low injury severity (ISS < 16 subgroup).CONCLUSIONSOverall, the data shows that SSRF can lead to reduced mortality in appropriately selected patients. Based on this real-world data, patients across all age-groups with high but not extreme injury severity (ISS 16-24), in other words patients in whom the thoracic injury is a major component of overall injury severity, appear to benefit most.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"71 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147329540","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":"Interrupted versus continuous fascial closure after emergency midline laparotomy: a systematic review and meta-analysis of randomized controlled trials.","authors":"Abdullah M Alharran, Fahad A Alsaid, Fatemah A Ali, Sara Almutawtah, Sarah Saqer Alblooshi, Sarah M Sabzali, Ibrahim A Alsaoud, Roua Y Abdullah, Abdulhadi A Alawadhi, Mohammad Salem Alajmi, Abrar Awadh, Ahmed Abu-Zaid","doi":"10.1186/s13017-026-00681-3","DOIUrl":"10.1186/s13017-026-00681-3","url":null,"abstract":"<p><strong>Background: </strong>Wound dehiscence after emergency midline laparotomy is a severe complication linked to high morbidity and mortality. While continuous closure is standard in elective surgery, its superiority is not established in high-risk emergency settings, where patient factors like infection and malnutrition can compromise healing. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to compare the efficacy and safety of interrupted versus continuous fascial closure techniques after emergency midline laparotomy.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Scopus, CENTRAL, Google Scholar, and Web of Science was conducted for RCTs up to October 2025. The primary outcome was wound dehiscence. Secondary outcomes included wound infection, incisional hernia, and length of hospital stay (LoS). Risk ratios (RR) and mean differences (MD) were pooled using STATA 19.5, with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Twenty-five RCTs involving 3,548 patients were included. Interrupted closure significantly reduced the risk of wound dehiscence compared to continuous closure (RR: 0.47, 95% CI [0.38, 0.87]; p < 0.001). There was no significant difference in wound infection (RR: 0.91, 95% CI [0.76, 1.09]; p = 0.31) or incisional hernia (RR: 0.83, 95% CI [0.57, 1.22]; p = 0.34). However, interrupted closure was also associated with a significantly shorter LoS (MD: - 3.52 days, 95% CI [- 4.75, - 2.29]; p < 0.001).</p><p><strong>Conclusion: </strong>In the high-risk emergency midline laparotomy setting, current evidence suggests that interrupted fascial closure may be associated with a reduction in wound dehiscence and a shorter LoS compared to continuous closure. However, given the risk of bias and clinical heterogeneity among the included studies, these findings should be interpreted with caution, and further high-quality, standardized trials are warranted.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13059221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318625","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":"Management of percutaneous cholecystostomy drains: a survey of real-world practices across Ireland and the UK.","authors":"Mohammed Al Azzawi, Carolyn Cullinane, Michael Devine, Stephen O'Brien, Nicola Raftery, Conor Toale, Czara Kennedy, Matthew Davey, Aine O'Neil, Noel Donlon, Jessie Elliott, William Robb, Arnold Dk Hill, Jarlath Bolger","doi":"10.1186/s13017-025-00668-6","DOIUrl":"10.1186/s13017-025-00668-6","url":null,"abstract":"<p><strong>Introduction: </strong>Acute calculous cholecystitis (ACC) is a common surgical emergency with varying severity. The Tokyo Guidelines stratified ACC into grades I-III based on severity. Patients with grade III ACC and high ASA scores can be managed with percutaneous cholecystostomy drain (PCD) insertion to control sepsis. There are currently no guidelines in the literature concerning PCD management. This questionnaire highlights the current real-life practices of PCD across Ireland and the UK.</p><p><strong>Methods: </strong>The Irish Surgical Research Collaborative sought to explore PCD practices in Ireland and the UK. This study utilised a 23-item digital questionnaire, which included questions pertaining to indications, follow-up, and scheduling of post-PCD cholecystectomy. The questionnaire was disseminated between August and October 2024 to surgical trainees and consultant surgeons from Ireland and the UK.</p><p><strong>Results: </strong>There were 94 responses from various general surgical subspecialties. Of the respondents, 61% (n = 57) were consultant surgeons, 64% (n = 60) worked in a university hospital, and 66% (n = 61) worked in a hospital without a hepatobiliary department. Forty-three Participants (46%) agreed to perform a laparoscopic cholecystectomy for ACC. However, 40% (n = 38) would insert PCD for ACC with septic shock in surgically unfit patients. Forty-six respondents (49%) chose not to perform a post-PCD cholecystogram during the index admission, and 81% (n = 76) wouldn't remove the PCD during the index admission. Regarding follow-up, forty-six participants (49%) wouldn't perform a clamping test before PCD removal, and fifty-four would schedule an outpatient cholecystogram (57%). The majority agreed that the optimal time for a cholecystectomy is 6-12 (66%) weeks, with the laparoscopic approach (81.3%) being the most commonly chosen.</p><p><strong>Conclusion: </strong>While laparoscopic cholecystectomy remains the gold standard for managing ACC, PCDs are safe, effective, and a commonly used tool in the surgical arsenal for managing acutely unwell patients who are poor surgical candidates. Guidelines regarding management and follow-up are necessary to guide the treatment.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13032317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776888","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}