World Journal of Emergency Surgery最新文献

{"title":"Surgical management of ostomy complications: a MISSTO-WSES mapping review.","authors":"Dario Parini, Andrea Bondurri, Francesco Ferrara, Gianluca Rizzo, Francesco Pata, Marco Veltri, Cristiana Forni, Federico Coccolini, Walt L Biffl, Massimo Sartelli, Yoram Kluger, Luca Ansaloni, Ernest Moore, Fausto Catena, Piergiorgio Danelli","doi":"10.1186/s13017-023-00516-5","DOIUrl":"10.1186/s13017-023-00516-5","url":null,"abstract":"<p><strong>Background: </strong>The creation of an ileostomy or colostomy is a common surgical event, both in elective and in emergency context. The main aim of stoma creation is to prevent postoperative complications, such as the anastomotic leak. However, stoma-related complications can also occur and their morbidity is not negligible, with a rate from 20 to 70%. Most stomal complications are managed conservatively, but, when this approach is not resolutive, surgical treatment becomes necessary. The aim of this mapping review is to get a comprehensive overview on the incidence, the risk factors, and the management of the main early and late ostomy complications: stoma necrosis, mucocutaneous separation, stoma retraction, stoma prolapse, parastomal hernia, stoma stenosis, and stoma bleeding.</p><p><strong>Material and methods: </strong>A complete literature research in principal databases (PUBMED, EMBASE, SCOPUS and COCHRANE) was performed by Multidisciplinary Italian Study group for STOmas (MISSTO) for each topic, with no language restriction and limited to the years 2011-2021. An international expert panel, from MISSTO and World Society of Emergency Surgery (WSES), subsequently reviewed the different issues, endorsed the project, and approved the final manuscript.</p><p><strong>Conclusion: </strong>Stoma-related complications are common and require a step-up management, from conservative stoma care to surgical stoma revision. A study of literature evidence in clinical practice for stoma creation and an improved management of stoma-related complications could significantly increase the quality of life of patients with ostomy. Solid evidence from the literature about the correct management is lacking, and an international consensus is needed to draw up new guidelines on this subject.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"48"},"PeriodicalIF":8.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10563348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41216829","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":"Enhanced perioperative care in emergency general surgery: the WSES position paper.","authors":"Marco Ceresoli, Marco Braga, Nicola Zanini, Fikri M Abu-Zidan, Dario Parini, Thomas Langer, Massimo Sartelli, Dimitrios Damaskos, Walter L Biffl, Francesco Amico, Luca Ansaloni, Zsolt J Balogh, Luigi Bonavina, Ian Civil, Enrico Cicuttin, Mircea Chirica, Yunfeng Cui, Belinda De Simone, Isidoro Di Carlo, Andreas Fette, Giuseppe Foti, Michele Fogliata, Gustavo P Fraga, Paola Fugazzola, Joseph M Galante, Solomon Gurmu Beka, Andreas Hecker, Johannes Jeekel, Andrew W Kirkpatrick, Kaoru Koike, Ari Leppäniemi, Ingo Marzi, Ernest E Moore, Edoardo Picetti, Emmanouil Pikoulis, Michele Pisano, Mauro Podda, Boris E Sakakushev, Vishal G Shelat, Edward Tan, Giovanni D Tebala, George Velmahos, Dieter G Weber, Vanni Agnoletti, Yoram Kluger, Gianluca Baiocchi, Fausto Catena, Federico Coccolini","doi":"10.1186/s13017-023-00519-2","DOIUrl":"10.1186/s13017-023-00519-2","url":null,"abstract":"<p><p>Enhanced perioperative care protocols become the standard of care in elective surgery with a significant improvement in patients' outcome. The key element of the enhanced perioperative care protocol is the multimodal and interdisciplinary approach targeted to the patient, focused on a holistic approach to reduce surgical stress and improve perioperative recovery. Enhanced perioperative care in emergency general surgery is still a debated topic with little evidence available. The present position paper illustrates the existing evidence about perioperative care in emergency surgery patients with a focus on each perioperative intervention in the preoperative, intraoperative and postoperative phase. For each item was proposed and approved a statement by the WSES collaborative group.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"47"},"PeriodicalIF":8.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10559594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41148512","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":"Self-expanding metal stents versus decompression tubes as a bridge to surgery for patients with obstruction caused by colorectal cancer: a systematic review and meta-analysis.","authors":"Wei Ma, Jian-Cheng Zhang, Kun Luo, Lu Wang, Chi Zhang, Bin Cai, Hua Jiang","doi":"10.1186/s13017-023-00515-6","DOIUrl":"10.1186/s13017-023-00515-6","url":null,"abstract":"<p><strong>Background: </strong>Using self-expanding metal stents (SEMS) and decompression tubes (DT) as a bridge-to-surgery (BTS) treatment may avoid emergency operations for patients with colorectal cancer-caused obstructions. This study aimed to evaluate the efficacy and safety of the two approaches.</p><p><strong>Methods: </strong>We systematically retrieved literature from January 1, 2000, to May 30, 2023, from the PubMed, Embase, Web of Science, SinoMed, Wanfang Data, Chinese National Knowledge Infrastructure, and Cochrane Central Register of Clinical Trials databases. Randomized controlled trials (RCTs) or cohort studies of SEMS versus DT as BTS in colorectal cancer obstruction were selected. Risks of bias were assessed for RCTs and cohort studies using the Cochrane Risk of Bias tool version 2 and Risk of Bias in Nonrandomized Studies of Interventions. Certainty of evidence was determined using the Graded Recommendation Assessment. Odds ratio (OR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze measurement data.</p><p><strong>Results: </strong>We included eight RCTs and eighteen cohort studies involving 2,061 patients (SEMS, 1,044; DT, 1,017). Pooled RCT and cohort data indicated the SEMS group had a significantly higher clinical success rate than the DT group (OR = 1.99, 95% CI 1.04, 3.81, P = 0.04), but no significant difference regarding technical success (OR = 1.29, 95% CI 0.56, 2.96, P = 0.55). SEMS had a shorter postoperative length of hospital stays (MD = - 4.47, 95% CI - 6.26, - 2.69, P < 0.00001), a lower rates of operation-related abdominal pain (OR = 0.16, 95% CI 0.05, 0.50, P = 0.002), intraoperative bleeding (MD = - 37.67, 95% CI - 62.73, - 12.60, P = 0.003), stoma creation (OR = 0.41, 95% CI 0.23, 0.73, P = 0.002) and long-term tumor recurrence rate than DT (OR = 0.47, 95% CI 0.22, 0.99, P = 0.05).</p><p><strong>Conclusion: </strong>SEMS and DT are both safe as BTS to avoid emergency surgery for patients with colorectal cancer obstruction. SEMS is preferable because of higher clinical success rates, lower rates of operation-related abdominal pain, intraoperative bleeding, stoma creation, and long-term tumor recurrence, as well as a shorter postoperative length of hospital stays. Trial registration CRD42022365951 .</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"46"},"PeriodicalIF":8.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10536785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41180340","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":"2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery.","authors":"Nicola de'Angelis, Carlo Alberto Schena, Francesco Marchegiani, Elisa Reitano, Belinda De Simone, Geoffrey Yuet Mun Wong, Aleix Martínez-Pérez, Fikri M Abu-Zidan, Vanni Agnoletti, Filippo Aisoni, Michele Ammendola, Luca Ansaloni, Miklosh Bala, Walter Biffl, Graziano Ceccarelli, Marco Ceresoli, Osvaldo Chiara, Massimo Chiarugi, Stefania Cimbanassi, Federico Coccolini, Raul Coimbra, Salomone Di Saverio, Michele Diana, Marco Dioguardi Burgio, Gustavo Fraga, Paschalis Gavriilidis, Angela Gurrado, Riccardo Inchingolo, Alexandre Ingels, Rao Ivatury, Jeffry L Kashuk, Jim Khan, Andrew W Kirkpatrick, Fernando J Kim, Yoram Kluger, Zaher Lakkis, Ari Leppäniemi, Ronald V Maier, Riccardo Memeo, Ernest E Moore, Carlos A Ordoñez, Andrew B Peitzman, Gianluca Pellino, Edoardo Picetti, Manos Pikoulis, Michele Pisano, Mauro Podda, Oreste Romeo, Fausto Rosa, Edward Tan, Richard P Ten Broek, Mario Testini, Brian Anthony Tian Wei Cheng, Dieter Weber, Emilio Sacco, Massimo Sartelli, Alfredo Tonsi, Fabrizio Dal Moro, Fausto Catena","doi":"10.1186/s13017-023-00513-8","DOIUrl":"10.1186/s13017-023-00513-8","url":null,"abstract":"<p><p>Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"45"},"PeriodicalIF":8.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10212326","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":"Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis.","authors":"Annika Reintam Blaser, Joel Starkopf, Martin Björck, Alastair Forbes, Karri Kase, Ele Kiisk, Kaja-Triin Laisaar, Vladislav Mihnovits, Marko Murruste, Merli Mändul, Anna-Liisa Voomets, Kadri Tamme","doi":"10.1186/s13017-023-00512-9","DOIUrl":"10.1186/s13017-023-00512-9","url":null,"abstract":"<p><strong>Background: </strong>Acute mesenteric ischaemia (AMI) is a disease with different pathophysiological mechanisms, leading to a life-threatening condition that is difficult to diagnose based solely on clinical signs. Despite widely acknowledged need for biomarkers in diagnosis of AMI, a broad systematic review on all studied biomarkers in different types of AMI is currently lacking. The aim of this study was to estimate the diagnostic accuracy of all potential biomarkers of AMI studied in humans.</p><p><strong>Methods: </strong>A systematic literature search in PubMed, The Cochrane Library, Web of Science and Scopus was conducted in December 2022. Studies assessing potential biomarkers of AMI in (at least 10) adult patients and reporting their diagnostic accuracy were included. Meta-analyses of biomarkers' sensitivity, specificity, and positive and negative likelihood ratios were conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study quality was assessed with the QUADAS-2 tool.</p><p><strong>Results: </strong>Seventy-five studies including a total of 9914 patients assessed 18 different biomarkers in serum/plasma and one in urine (each reported in at least two studies), which were included in meta-analyses. None of the biomarkers reached a conclusive level for accurate prediction. The best predictive value overall (all studies with any type and stage of AMI pooled) was observed for Ischaemia-modified albumin (2 studies, sensitivity 94.7 and specificity 90.5), interleukin-6 (n = 4, 96.3 and 82.6), procalcitonin (n = 6, 80.1 and 86.7), and intestinal fatty acid-binding protein (I-FABP) measured in serum (n = 16, 73.9 and 90.5) or in urine (n = 4, 87.9 and 78.9). In assessment of transmural mesenteric ischaemia, urinary I-FABP (n = 2, 92.3 and 85.2) and D-dimer (n = 3, 87.6 and 83.6) showed moderate predictive value. Overall risk of bias was high, mainly because of selected study populations and unclear timings of the biomarker measurements after onset of symptoms. Combinations of biomarkers were rarely studied, not allowing meta-analyses.</p><p><strong>Conclusions: </strong>None of the studied biomarkers had sufficient sensitivity and specificity to diagnose AMI, although some biomarkers showed moderate predictive accuracy. Future studies should focus on timing of measurements of biomarkers, distinguishing between early stage and transmural necrosis, and between different types of AMI. Additionally, studies on combinations of biomarkers are warranted. PROSPERO registration: CRD42022379341.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"44"},"PeriodicalIF":8.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10474684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10153685","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 complicated diaphragmatic hernia in the acute setting: a WSES position paper.","authors":"Mario Giuffrida,&nbsp;Gennaro Perrone,&nbsp;Fikri Abu-Zidan,&nbsp;Vanni Agnoletti,&nbsp;Luca Ansaloni,&nbsp;Gian Luca Baiocchi,&nbsp;Cino Bendinelli,&nbsp;Walter L Biffl,&nbsp;Luigi Bonavina,&nbsp;Francesca Bravi,&nbsp;Paolo Carcoforo,&nbsp;Marco Ceresoli,&nbsp;Alain Chichom-Mefire,&nbsp;Federico Coccolini,&nbsp;Raul Coimbra,&nbsp;Nicola de'Angelis,&nbsp;Marc de Moya,&nbsp;Belinda De Simone,&nbsp;Salomone Di Saverio,&nbsp;Gustavo Pereira Fraga,&nbsp;Joseph Galante,&nbsp;Rao Ivatury,&nbsp;Jeffry Kashuk,&nbsp;Michael Denis Kelly,&nbsp;Andrew W Kirkpatrick,&nbsp;Yoram Kluger,&nbsp;Kaoru Koike,&nbsp;Ari Leppaniemi,&nbsp;Ronald V Maier,&nbsp;Ernest Eugene Moore,&nbsp;Andrew Peitzmann,&nbsp;Boris Sakakushev,&nbsp;Massimo Sartelli,&nbsp;Michael Sugrue,&nbsp;Brian W C A Tian,&nbsp;Richard Ten Broek,&nbsp;Carlo Vallicelli,&nbsp;Imtaz Wani,&nbsp;Dieter G Weber,&nbsp;Giovanni Docimo,&nbsp;Fausto Catena","doi":"10.1186/s13017-023-00510-x","DOIUrl":"https://doi.org/10.1186/s13017-023-00510-x","url":null,"abstract":"<p><strong>Background: </strong>Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable.</p><p><strong>Methods: </strong>A bibliographic search using major databases was performed using the terms \"emergency surgery\" \"diaphragmatic hernia,\" \"traumatic diaphragmatic rupture\" and \"congenital diaphragmatic hernia.\" GRADE methodology was used to evaluate the evidence and give recommendations.</p><p><strong>Results: </strong>CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients.</p><p><strong>Conclusions: </strong>Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"43"},"PeriodicalIF":8.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10373334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947636","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":"ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings.","authors":"Simone Frassini, Lorenzo Cobianchi, Paola Fugazzola, Walter L Biffl, Federico Coccolini, Dimitrios Damaskos, Ernest E Moore, Yoram Kluger, Marco Ceresoli, Raul Coimbra, Justin Davies, Andrew Kirkpatrick, Isidoro Di Carlo, Timothy C Hardcastle, Arda Isik, Massimo Chiarugi, Kurinchi Gurusamy, Ronald V Maier, Helmut A Segovia Lohse, Hans Jeekel, Marja A Boermeester, Fikri Abu-Zidan, Kenji Inaba, Dieter G Weber, Goran Augustin, Luigi Bonavina, George Velmahos, Massimo Sartelli, Salomone Di Saverio, Richard P G Ten Broek, Stefano Granieri, Francesca Dal Mas, Camilla Nikita Farè, Jacopo Peverada, Simone Zanghì, Jacopo Viganò, Matteo Tomasoni, Tommaso Dominioni, Enrico Cicuttin, Andreas Hecker, Giovanni D Tebala, Joseph M Galante, Imtiaz Wani, Vladimir Khokha, Michael Sugrue, Thomas M Scalea, Edward Tan, Mark A Malangoni, Nikolaos Pararas, Mauro Podda, Belinda De Simone, Rao Ivatury, Yunfeng Cui, Jeffry Kashuk, Andrew Peitzman, Fernando Kim, Emmanouil Pikoulis, Gabriele Sganga, Osvaldo Chiara, Michael D Kelly, Ingo Marzi, Edoardo Picetti, Vanni Agnoletti, Nicola De'Angelis, Giampiero Campanelli, Marc de Moya, Andrey Litvin, Aleix Martínez-Pérez, Ibrahima Sall, Sandro Rizoli, Gia Tomadze, Boris Sakakushev, Philip F Stahel, Ian Civil, Vishal Shelat, David Costa, Alain Chichom-Mefire, Rifat Latifi, Mircea Chirica, Francesco Amico, Amyn Pardhan, Vidya Seenarain, Nikitha Boyapati, Basil Hatz, Travis Ackermann, Sandun Abeyasundara, Linda Fenton, Frank Plani, Rohit Sarvepalli, Omid Rouhbakhshfar, Pamela Caleo, Victor Ho-Ching Yau, Kristenne Clement, Erasmia Christou, Ana María González Castillo, Preet K S Gosal, Sunder Balasubramaniam, Jeremy Hsu, Kamon Banphawatanarak, Michele Pisano, Toro Adriana, Altomare Michele, Stefano P B Cioffi, Andrea Spota, Fausto Catena, Luca Ansaloni","doi":"10.1186/s13017-023-00511-w","DOIUrl":"10.1186/s13017-023-00511-w","url":null,"abstract":"<p><p>Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"42"},"PeriodicalIF":6.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10373269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947634","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":"Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines.","authors":"Federico Coccolini,&nbsp;Massimo Sartelli,&nbsp;Robert Sawyer,&nbsp;Kemal Rasa,&nbsp;Bruno Viaggi,&nbsp;Fikri Abu-Zidan,&nbsp;Kjetil Soreide,&nbsp;Timothy Hardcastle,&nbsp;Deepak Gupta,&nbsp;Cino Bendinelli,&nbsp;Marco Ceresoli,&nbsp;Vishal G Shelat,&nbsp;Richard Ten Broek,&nbsp;Gian Luca Baiocchi,&nbsp;Ernest E Moore,&nbsp;Ibrahima Sall,&nbsp;Mauro Podda,&nbsp;Luigi Bonavina,&nbsp;Igor A Kryvoruchko,&nbsp;Philip Stahel,&nbsp;Kenji Inaba,&nbsp;Philippe Montravers,&nbsp;Boris Sakakushev,&nbsp;Gabriele Sganga,&nbsp;Paolo Ballestracci,&nbsp;Manu L N G Malbrain,&nbsp;Jean-Louis Vincent,&nbsp;Manos Pikoulis,&nbsp;Solomon Gurmu Beka,&nbsp;Krstina Doklestic,&nbsp;Massimo Chiarugi,&nbsp;Marco Falcone,&nbsp;Elena Bignami,&nbsp;Viktor Reva,&nbsp;Zaza Demetrashvili,&nbsp;Salomone Di Saverio,&nbsp;Matti Tolonen,&nbsp;Pradeep Navsaria,&nbsp;Miklosh Bala,&nbsp;Zsolt Balogh,&nbsp;Andrey Litvin,&nbsp;Andreas Hecker,&nbsp;Imtiaz Wani,&nbsp;Andreas Fette,&nbsp;Belinda De Simone,&nbsp;Rao Ivatury,&nbsp;Edoardo Picetti,&nbsp;Vladimir Khokha,&nbsp;Edward Tan,&nbsp;Chad Ball,&nbsp;Carlo Tascini,&nbsp;Yunfeng Cui,&nbsp;Raul Coimbra,&nbsp;Michael Kelly,&nbsp;Costanza Martino,&nbsp;Vanni Agnoletti,&nbsp;Marja A Boermeester,&nbsp;Nicola De'Angelis,&nbsp;Mircea Chirica,&nbsp;Walt L Biffl,&nbsp;Luca Ansaloni,&nbsp;Yoram Kluger,&nbsp;Fausto Catena,&nbsp;Andrew W Kirkpatrick","doi":"10.1186/s13017-023-00509-4","DOIUrl":"https://doi.org/10.1186/s13017-023-00509-4","url":null,"abstract":"<p><p>Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"41"},"PeriodicalIF":8.0,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10362628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9869589","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":"Guided blood transfusion of trauma patients with rotational thromboelastometry: a single-center cohort study.","authors":"Mina Salehi, Rajan Bola, Nenke de Jong, Andrew W Shih, Naisan Garraway, Philip Dawe","doi":"10.1186/s13017-023-00508-5","DOIUrl":"10.1186/s13017-023-00508-5","url":null,"abstract":"<p><strong>Background: </strong>Rotational thromboelastometry (ROTEM) is a blood test used to measure in vitro clot strength as a surrogate for a patient's ability to form clots in vivo. This provides information about induction, formation, and clot lysis, allowing goal-directed transfusion therapy for specific hemostatic needs. We sought to evaluate the effect of ROTEM-guided transfusion on blood product usage and in-hospital mortality among patients with a traumatic injury.</p><p><strong>Methods: </strong>This was a single-center observational cohort analysis of emergency department patients in a Level 1 trauma center. We compared blood usage in trauma patients in whom ratio-based massive hemorrhage protocols were activated in the twelve months before the introduction of ROTEM (pre-ROTEM group) to the twelve months following the introduction of ROTEM (ROTEM-period group). ROTEM was implemented in this center in November 2016. The ROTEM device allowed clinicians to make real-time decisions about blood product therapy in resuscitation for trauma.</p><p><strong>Results: </strong>The pre-ROTEM group contained 21 patients. Forty-three patients were included from the ROTEM-period, of whom 35 patients received ROTEM-guided resuscitation (81% compliance). The use of fibrinogen concentrate was significantly higher in the ROTEM-period group (pre-ROTEM mean 0.2 vs. ROTEM-period mean 0.8; p = 0.006). There was no significant difference in the number of units of red blood cells, platelets, cryoprecipitate, or fresh frozen plasma transfused between these groups. There was no significant difference in the mortality rate between the pre-ROTEM and ROTEM-period groups (33% vs. 19%; p = 0.22).</p><p><strong>Conclusions: </strong>The introduction of ROTEM-guided transfusion at this institution was associated with increased fibrinogen usage, but this did not impact mortality rates. There was no difference in the administration of red blood cell, fresh frozen plasma, platelet, and cryoprecipitate. Future research should focus on increased ROTEM compliance and optimizing ROTEM-guided transfusion to prevent blood product overuse among trauma patients.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"40"},"PeriodicalIF":8.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9799832","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":"Advantages of using a polymeric clip versus an endoloop during laparoscopic appendectomy in uncomplicated appendicitis: a randomized controlled study.","authors":"Kil-Yong Lee, Jaeim Lee, Youn Young Park, Seong Taek Oh","doi":"10.1186/s13017-023-00507-6","DOIUrl":"10.1186/s13017-023-00507-6","url":null,"abstract":"<p><strong>Background: </strong>Polymeric clips are easy to apply, but whether they present more advantages than endoloops is unclear. This single-center, open-label, randomized controlled trial study was conducted to compare the advantages of using a polymeric clip versus an endoloop in terms of the surgical time.</p><p><strong>Methods: </strong>Adult patients who were diagnosed with acute appendicitis without perforation on preoperative abdominal computed tomography and underwent laparoscopic appendectomy between August 6, 2019, and December 26, 2022, were included. Single-blinded randomization was performed in a 1:1 ratio between the endoloop and polymeric clip groups. The primary endpoint was the difference in surgery time between the polymeric clip and endoloop groups. The secondary endpoints were the difference in the application time of each instrument, difference in operation and anesthesia fees, as well as the frequency of complications.</p><p><strong>Results: </strong>The completed trial included 104 and 103 patients in the polymeric clip and endoloop groups, respectively. The median surgery time with a polymeric clip was shorter than that with an endoloop; however, the difference was not significant (18 min 56 s vs 19 min 49 s, p = 0.426). Interestingly, the median time from applying the instrument to appendiceal cutting in the polymeric clip group was significantly shorter than that in the endoloop group (49.0 s vs 84.5 s, p < 0.001). No significant difference was observed between the two groups in terms of surgical (p = 0.120) and anesthetic (p = 0.719) costs, as well as the total number of postoperative complications (p > 0.999).</p><p><strong>Conclusion: </strong>A polymeric clip is a safe instrument that can reduce the time from applying the instrument to appendiceal cutting, although it does not affect the overall surgical time and operation fee when performing laparoscopic appendectomy for uncomplicated appendicitis.</p><p><strong>Trial registration: </strong>KCT0004154.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"39"},"PeriodicalIF":8.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10311724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9793007","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}