World Journal of Emergency Surgery最新文献

{"title":"Efficacy of a novel polyoxazoline-based hemostatic patch in liver and spleen surgery.","authors":"Edwin A Roozen,&nbsp;Roger M L M Lomme,&nbsp;Nicole U B Calon,&nbsp;Richard P G Ten Broek,&nbsp;Harry van Goor","doi":"10.1186/s13017-023-00483-x","DOIUrl":"https://doi.org/10.1186/s13017-023-00483-x","url":null,"abstract":"<p><strong>Background: </strong>A new hemostatic sealant based on a N-hydroxy-succinimide polyoxazoline (NHS-POx) polymer was evaluated to determine hemostatic efficacy and long-term wound healing and adverse effects in a large animal model of parenchymal organ surgical bleeds.</p><p><strong>Methods: </strong>Experiment 1 included 20 pigs that were treated with two NHS-POx patch prototypes [a gelatin fibrous carrier (GFC) with NHS-POx and an oxidized regenerated cellulose (ORC) with poly(lactic-co-glycolic acid)-NHS-POx:NU-POx (nucleophilically activated polyoxazoline)], a blank gelatin patch (GFC Blank), TachoSil^® and Veriset™ to stop moderate liver and spleen punch bleedings. After various survival periods (1-6 weeks), pigs were re-operated to evaluate patch degradation and parenchymal healing. During the re-operation, experiment 2 was performed: partial liver and spleen resections with severe bleeding, and hemostatic efficacy was evaluated under normal and heparinized conditions of the two previous prototypes and one additional NHS-POx patch. In the third experiment an improved NHS-POx patch (GATT-Patch; GFC-NHS-POx and added 20% as nucleophilically activated polyoxazoline; NU-POx) was compared with TachoSil^®, Veriset™ and GFC Blank on punch bleedings and partial liver and spleen resections for rapid (10s) hemostatic efficacy.</p><p><strong>Results: </strong>NHS-POx-based patches showed better (GFC-NHS-POx 83.1%, ORC-PLGA-NHS-POx: NU-POx 98.3%) hemostatic efficacy compared to TachoSil^® (25.0%) and GFC Blank (43.3%), and comparable efficacy with Veriset™ (96.7%) on moderate standardized punch bleedings on liver and spleen. All patches demonstrated gradual degradation over 6 weeks with a reduced local inflammation rate and an improved wound healing. For severe bleedings under non-heparinized conditions, hemostasis was achieved in 100% for Veriset™, 40% for TachoSil and 80-100% for the three NHS-POx prototypes; similar differences between patches remained for heparinized conditions. In experiment 3, GATT-Patch, Veriset™, TachoSil and GFC Blank reached hemostasis after 10s in 100%, 42.8%, 7.1% and 14.3%, respectively, and at 3 min in 100%, 100%, 14.3% and 35.7%, respectively, on all liver and spleen punctures and resections.</p><p><strong>Conclusions: </strong>NHS-POx-based patches, and particularly the GATT-Patch, are fast in achieving effective hemostatic sealing on standardized moderate and severe bleedings without apparent long-term adverse events.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"19"},"PeriodicalIF":8.0,"publicationDate":"2023-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9215943","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":"Science fiction or clinical reality: a review of the applications of artificial intelligence along the continuum of trauma care.","authors":"Olivia F Hunter,&nbsp;Frances Perry,&nbsp;Mina Salehi,&nbsp;Hubert Bandurski,&nbsp;Alan Hubbard,&nbsp;Chad G Ball,&nbsp;S Morad Hameed","doi":"10.1186/s13017-022-00469-1","DOIUrl":"https://doi.org/10.1186/s13017-022-00469-1","url":null,"abstract":"<p><p>Artificial intelligence (AI) and machine learning describe a broad range of algorithm types that can be trained based on datasets to make predictions. The increasing sophistication of AI has created new opportunities to apply these algorithms within within trauma care. Our paper overviews the current uses of AI along the continuum of trauma care, including injury prediction, triage, emergency department volume, assessment, and outcomes. Starting at the point of injury, algorithms are being used to predict severity of motor vehicle crashes, which can help inform emergency responses. Once on the scene, AI can be used to help emergency services triage patients remotely in order to inform transfer location and urgency. For the receiving hospital, these tools can be used to predict trauma volumes in the emergency department to help allocate appropriate staffing. After patient arrival to hospital, these algorithms not only can help to predict injury severity, which can inform decision-making, but also predict patient outcomes to help trauma teams anticipate patient trajectory. Overall, these tools have the capability to transform trauma care. AI is still nascent within the trauma surgery sphere, but this body of the literature shows that this technology has vast potential. AI-based predictive tools in trauma need to be explored further through prospective trials and clinical validation of algorithms.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"16"},"PeriodicalIF":8.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9987401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9215934","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":"A prospective multicentre study evaluating the outcomes of the abdominal wall dehiscence repair using posterior component separation with transversus abdominis muscle release reinforced by a retro-muscular mesh: filling a step.","authors":"Tamer A A M Habeeb,&nbsp;Abdulzahra Hussain,&nbsp;Vishal Shelat,&nbsp;Massimo Chiaretti,&nbsp;Jose Bueno-Lledó,&nbsp;Alfonso García Fadrique,&nbsp;Abd-Elfattah Kalmoush,&nbsp;Mohamed Elnemr,&nbsp;Khaled Safwat,&nbsp;Ahmed Raafat,&nbsp;Tamer Wasefy,&nbsp;Ibrahim A Heggy,&nbsp;Gamal Osman,&nbsp;Waleed A Abdelhady,&nbsp;Walid A Mawla,&nbsp;Alaa A Fiad,&nbsp;Mostafa M Elaidy,&nbsp;Wessam Amr,&nbsp;Mohamed I Abdelhamid,&nbsp;Ahmed Mahmoud Abdou,&nbsp;Abdelaziz I A Ibrahim,&nbsp;Muhammad Ali Baghdadi","doi":"10.1186/s13017-023-00485-9","DOIUrl":"https://doi.org/10.1186/s13017-023-00485-9","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the results of posterior component separation (CS) and transversus abdominis muscle release (TAR) with retro-muscular mesh reinforcement in patients with primary abdominal wall dehiscence (AWD). The secondary aims were to detect the incidence of postoperative surgical site occurrence and risk factors of incisional hernia (IH) development following AWD repair with posterior CS with TAR reinforced by retromuscular mesh.</p><p><strong>Methods: </strong>Between June 2014 and April 2018, 202 patients with grade IA primary AWD (Björck's first classification) following midline laparotomies were treated using posterior CS with TAR release reinforced by a retro-muscular mesh in a prospective multicenter cohort study.</p><p><strong>Results: </strong>The mean age was 42 ± 10 years, with female predominance (59.9%). The mean time from index surgery (midline laparotomy) to primary AWD was 7 ± 3 days. The mean vertical length of primary AWD was 16 ± 2 cm. The median time from primary AWD occurrence to posterior CS + TAR surgery was 3 ± 1 days. The mean operative time of posterior CS + TAR was 95 ± 12 min. No recurrent AWD occurred. Surgical site infections (SSI), seroma, hematoma, IH, and infected mesh occurred in 7.9%, 12.4%, 2%, 8.9%, and 3%, respectively. Mortality was reported in 2.5%. Old age, male gender, smoking, albumin level < 3.5 gm%, time from AWD to posterior CS + TAR surgery, SSI, ileus, and infected mesh were significantly higher in IH. IH rate was 0.5% and 8.9% at two and three years, respectively. In multivariate logistic regression analyses, the predictors of IH were time from AWD till posterior CS + TAR surgical intervention, ileus, SSI, and infected mesh.</p><p><strong>Conclusion: </strong>Posterior CS with TAR reinforced by retro-muscular mesh insertion resulted in no AWD recurrence, low IH rates, and low mortality of 2.5%. Trial registration Clinical trial: NCT05278117.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"15"},"PeriodicalIF":8.0,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9985288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9222271","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":"Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey.","authors":"Lorenzo Cobianchi,&nbsp;Francesca Dal Mas,&nbsp;Vanni Agnoletti,&nbsp;Luca Ansaloni,&nbsp;Walter Biffl,&nbsp;Giovanni Butturini,&nbsp;Stefano Campostrini,&nbsp;Fausto Catena,&nbsp;Stefano Denicolai,&nbsp;Paola Fugazzola,&nbsp;Jacopo Martellucci,&nbsp;Maurizio Massaro,&nbsp;Pietro Previtali,&nbsp;Federico Ruta,&nbsp;Alessandro Venturi,&nbsp;Sarah Woltz,&nbsp;Haytham M Kaafarani,&nbsp;Tyler J Loftus","doi":"10.1186/s13017-022-00464-6","DOIUrl":"https://doi.org/10.1186/s13017-022-00464-6","url":null,"abstract":"<p><strong>Background: </strong>Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons.</p><p><strong>Methods: </strong>Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society's website, and shared on the society's Twitter profile.</p><p><strong>Results: </strong>A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly.</p><p><strong>Discussion: </strong>Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"14"},"PeriodicalIF":8.0,"publicationDate":"2023-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9936681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9228979","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":"Surgical resident experience with common bile duct exploration and assessment of performance and autonomy with formative feedback.","authors":"Molly Q Nyren, Amanda C Filiberto, Patrick W Underwood, Kenneth L Abbott, Jeremy A Balch, Francesca Dal Mas, Lorenzo Cobianchi, Philip A Efron, Brian C George, Benjamin Shickel, Gilbert R Upchurch, George A Sarosi, Tyler J Loftus","doi":"10.1186/s13017-023-00480-0","DOIUrl":"10.1186/s13017-023-00480-0","url":null,"abstract":"<p><strong>Background: </strong>Common bile duct exploration (CBDE) is safe and effective for managing choledocholithiasis, but most US general surgeons have limited experience with CBDE and are uncomfortable performing this procedure in practice. Surgical trainee exposure to CBDE is limited, and their learning curve for achieving autonomous, practice-ready performance has not been previously described. This study tests the hypothesis that receipt of one or more prior CBDE operative performance assessments, combined with formative feedback, is associated with greater resident operative performance and autonomy.</p><p><strong>Methods: </strong>Resident and attending assessments of resident operative performance and autonomy were obtained for 189 laparoscopic or open CBDEs performed at 28 institutions. Performance and autonomy were graded along validated ordinal scales. Cases in which the resident had one or more prior CBDE case evaluations (n = 48) were compared with cases in which the resident had no prior evaluations (n = 141).</p><p><strong>Results: </strong>Compared with cases in which the resident had no prior CBDE case evaluations, cases with a prior evaluation had greater proportions of practice-ready or exceptional performance ratings according to both residents (27% vs. 11%, p = .009) and attendings (58% vs. 19%, p < .001) and had greater proportions of passive help or supervision only autonomy ratings according to both residents (17% vs. 4%, p = .009) and attendings (69% vs. 32%, p < .01).</p><p><strong>Conclusions: </strong>Residents with at least one prior CBDE evaluation and formative feedback demonstrated better operative performance and received greater autonomy than residents without prior evaluations, underscoring the propensity of feedback to help residents achieve autonomous, practice-ready performance for rare operations.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"13"},"PeriodicalIF":6.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9901129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10747928","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":"Abdominal emergency surgery in patients with hematological malignancies: a retrospective single-center analysis.","authors":"Philipp H von Kroge,&nbsp;Anna Duprée,&nbsp;Oliver Mann,&nbsp;Jakob R Izbicki,&nbsp;Jonas Wagner,&nbsp;Paymon Ahmadi,&nbsp;Sören Weidemann,&nbsp;Raissa Adjallé,&nbsp;Nicolaus Kröger,&nbsp;Carsten Bokemeyer,&nbsp;Walter Fiedler,&nbsp;Franziska Modemann,&nbsp;Susanne Ghandili","doi":"10.1186/s13017-023-00481-z","DOIUrl":"https://doi.org/10.1186/s13017-023-00481-z","url":null,"abstract":"<p><strong>Background: </strong>Hematologic patients requiring abdominal emergency surgery are considered to be a high-risk population based on disease- and treatment-related immunosuppression. However, the optimal surgical therapy and perioperative management of patients with abdominal emergency surgery in patients with coexisting hematological malignancies remain unclear.</p><p><strong>Methods: </strong>We here report a single-center retrospective analysis aimed to investigate the impact of abdominal emergency surgery due to clinically suspected gastrointestinal perforation (group A), intestinal obstruction (group B), or acute cholecystitis (group C) on mortality and morbidity of patients with coexisting hematological malignancies. All patients included in this retrospective single-center study were identified by screening for the ICD 10 diagnostic codes for gastrointestinal perforation, intestinal obstruction, and ischemia and acute cholecystitis. In addition, a keyword search was performed in the database of all pathology reports in the given time frame.</p><p><strong>Results: </strong>A total of 56 patients were included in this study. Gastrointestinal perforation and intestinal obstruction occurred in 26 and 13 patients, respectively. Of those, 21 patients received a primary gastrointestinal anastomosis, and anastomotic leakage (AL) occurred in 33.3% and resulted in an AL-related 30-day mortality rate of 80%. The only factor associated with higher rates of AL was sepsis before surgery. In patients with suspected acute cholecystitis, postoperative bleeding events requiring abdominal packing occurred in three patients and lead to overall perioperative morbidity of 17.6% and surgery-related 30-day mortality of 5.9%.</p><p><strong>Conclusion: </strong>In patients with known or suspected hematologic malignancies who require emergency abdominal surgery due to gastrointestinal perforation or intestinal obstruction, a temporary or permanent stoma might be preferred to a primary intestinal anastomosis.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"12"},"PeriodicalIF":8.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9900956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10747927","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":"Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper.","authors":"Nicola de'Angelis, Francesco Marchegiani, Carlo Alberto Schena, Jim Khan, Vanni Agnoletti, Luca Ansaloni, Ana Gabriela Barría Rodríguez, Paolo Pietro Bianchi, Walter Biffl, Francesca Bravi, Graziano Ceccarelli, Marco Ceresoli, Osvaldo Chiara, Mircea Chirica, Lorenzo Cobianchi, Federico Coccolini, Raul Coimbra, Christian Cotsoglou, Mathieu D'Hondt, Dimitris Damaskos, Belinda De Simone, Salomone Di Saverio, Michele Diana, Eloy Espin-Basany, Stefan Fichtner-Feigl, Paola Fugazzola, Paschalis Gavriilidis, Caroline Gronnier, Jeffry Kashuk, Andrew W Kirkpatrick, Michele Ammendola, Ewout A Kouwenhoven, Alexis Laurent, Ari Leppaniemi, Mickaël Lesurtel, Riccardo Memeo, Marco Milone, Ernest Moore, Nikolaos Pararas, Andrew Peitzmann, Patrick Pessaux, Edoardo Picetti, Manos Pikoulis, Michele Pisano, Frederic Ris, Tyler Robison, Massimo Sartelli, Vishal G Shelat, Giuseppe Spinoglio, Michael Sugrue, Edward Tan, Ellen Van Eetvelde, Yoram Kluger, Dieter Weber, Fausto Catena","doi":"10.1186/s13017-023-00476-w","DOIUrl":"10.1186/s13017-023-00476-w","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS.</p><p><strong>Methods: </strong>This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements.</p><p><strong>Results: </strong>Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20-107) depending on the initial surgeon's experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon's proficiency.</p><p><strong>Conclusions: </strong>Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"11"},"PeriodicalIF":6.0,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9883976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9305839","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":"Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variables.","authors":"Barza Afzal,&nbsp;Roberto Cirocchi,&nbsp;Aruna Dawani,&nbsp;Jacopo Desiderio,&nbsp;Antonio Di Cintio,&nbsp;Domenico Di Nardo,&nbsp;Federico Farinacci,&nbsp;James Fung,&nbsp;Alessandro Gemini,&nbsp;Lorenzo Guerci,&nbsp;Sen Yin Melina Kam,&nbsp;Svetlana Lakunina,&nbsp;Lee Madi,&nbsp;Stefano Mazzetti,&nbsp;Bakhtiar Nadyrshine,&nbsp;Ola Shams,&nbsp;Maria Chiara Ranucci,&nbsp;Francesco Ricci,&nbsp;Afroza Sharmin,&nbsp;Stefano Trastulli,&nbsp;Tanzela Yasin,&nbsp;Giles Bond-Smith,&nbsp;Giovanni D Tebala","doi":"10.1186/s13017-023-00478-8","DOIUrl":"https://doi.org/10.1186/s13017-023-00478-8","url":null,"abstract":"<p><strong>Introduction: </strong>Recent evidence confirms that the treatment of acute appendicitis is not necessarily surgical, and selected patients with uncomplicated appendicitis can benefit from a non-operative management. Unfortunately, no cost-effective test has been proven to be able to effectively predict the degree of appendicular inflammation as yet, therefore, patient selection is too often left to the personal choice of the emergency surgeon. Our paper aims to clarify if basic and readily available blood tests can give reliable prognostic information to build up predictive models to help the decision-making process.</p><p><strong>Methods: </strong>Clinical notes of 2275 patients who underwent an appendicectomy with a presumptive diagnosis of acute appendicitis were reviewed, taking into consideration basic preoperative blood tests and histology reports on the surgical specimens. Variables were compared with univariate and multivariate analysis, and predictive models were created.</p><p><strong>Results: </strong>18.2% of patients had a negative appendicectomy, 9.6% had mucosal only inflammation, 53% had transmural inflammation and 19.2% had gangrenous appendicitis. A strong correlation was found between degree of inflammation and lymphocytes count and CRP/Albumin ratio, both at univariate and multivariate analysis. A predictive model to identify cases of gangrenous appendicitis was developed.</p><p><strong>Conclusion: </strong>Low lymphocyte count and high CRP/Albumin ratio combined into a predictive model may have a role in the selection of patients who deserve appendicectomy instead of non-operative management of acute appendicitis.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"10"},"PeriodicalIF":8.0,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9882741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10741783","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":"The optimal timing and intervention to reduce mortality for necrotizing pancreatitis: a systematic review and network meta-analysis.","authors":"Yang Yang,&nbsp;Yu Zhang,&nbsp;Shuaiyong Wen,&nbsp;Yunfeng Cui","doi":"10.1186/s13017-023-00479-7","DOIUrl":"https://doi.org/10.1186/s13017-023-00479-7","url":null,"abstract":"<p><strong>Background: </strong>A series of randomized controlled trials have investigated the efficacy and safety of different timings of interventions and methods of intervention. However, the optimal treatment strategy is not yet clear.</p><p><strong>Methods: </strong>We searched PubMed, EMBASE, ClinicalTrials.gov and the Cochrane Library until November 30, 2022. A systematic review and Bayesian network meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Trials comparing different treatment strategies for necrotizing pancreatitis were included. This study was registered in the Prospective Register of Systematic Reviews (CRD42022364409) to ensure transparency.</p><p><strong>Results: </strong>We analyzed a total of 10 studies involving 570 patients and 8 treatment strategies. Although no statistically significant differences were identified comparing odds ratios, trends were confirmed by the surface under the cumulative ranking (SUCRA) scores. The interventions with a low rate of mortality were delayed surgery (DS), delayed surgical step-up approach (DSU) and delayed endoscopic step-up approach (DEU), while the interventions with a low rate of major complications were DSU, DEU and DS. According to the clustered ranking plot, DSU performed the best overall in reducing mortality and major complications, while DD performed the worst. Analysis of the secondary endpoints confirmed the superiority of DEU and DSU in terms of individual components of major complications (organ failure, pancreatic fistula, bleeding, and visceral organ or enterocutaneous fistula), exocrine insufficiency, endocrine insufficiency and length of stay. Overall, DSU was superior to other interventions.</p><p><strong>Conclusion: </strong>DSU was the optimal treatment strategy for necrotizing pancreatitis. Drainage alone should be avoided in clinical practice. Any interventions should be postponed for at least 4 weeks if possible. The step-up approach was preferred.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"9"},"PeriodicalIF":8.0,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9883927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9305838","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":"Elective adhesiolysis for chronic abdominal pain reduces long-term risk of adhesive small bowel obstruction.","authors":"Barend A W van den Beukel, Masja K Toneman, Fleur van Veelen, Marjolein Blusse van Oud-Alblas, Koen van Dongen, Martijn W J Stommel, Harry van Goor, Richard P G Ten Broek","doi":"10.1186/s13017-023-00477-9","DOIUrl":"10.1186/s13017-023-00477-9","url":null,"abstract":"<p><strong>Background: </strong>Selected patients with adhesion-related chronic abdominal pain can be treated effectively by adhesiolysis with the application of adhesion barriers. These patients might also have an increased risk to develop adhesive small bowel obstruction (ASBO). It is unknown how frequently these patients develop ASBO, and how elective adhesiolysis for pain impacts the risk of ASBO.</p><p><strong>Methods: </strong>Patients with adhesion-related chronic pain were included in this cohort study with long-term follow-up. The diagnosis of adhesions was confirmed using CineMRI. The decision for operative treatment of adhesions was made by shared agreement based on the correlation of complaints with CineMRI findings. The primary outcome was the 5-years incidence of readmission for ASBO. Incidence was compared between patients with elective adhesiolysis and those treated non-operatively and between patients with and without previous ASBO. Univariable and multivariable Cox regression analysis was performed to identify predictive factors for ASBO. Secondary outcomes included reoperation for ASBO and self-reported pain and other abdominal symptoms.</p><p><strong>Results: </strong>A total of 122 patients were included, 69 patients underwent elective adhesiolysis. Thirty patients in both groups had previous episodes of ASBO in history. During 5-year follow-up, the readmission rate for ASBO was 6.5% after elective adhesiolysis compared to 26.9% after non-operative treatment (p = 0.012). These percentages were 13.3% compared to 40% in the subgroup of patients with previous episodes of ASBO (p = 0.039). In multivariable analysis, elective adhesiolysis was associated with a decreased risk of readmission for ASBO with an odds ratio of 0.21 (95% CI 0.07-0.65), the risk was increased in patients with previous episodes with a odds ratio of 19.2 (95% CI 2.5-144.4). There was no difference between the groups in the prevalence of self-reported abdominal pain. However, in surgically treated patients the impact of pain on daily activities was lower, and the incidence of other symptoms was lower.</p><p><strong>Conclusion: </strong>More than one in four patients with chronic adhesion-related pain develop episodes of ASBO when treated non-operatively. Elective adhesiolysis reduces the incidence of ASBO in patients with chronic adhesion-related symptoms, both in patients with and without previous episodes of ASBO in history. Trial registration The study was registered at Clinicaltrials.gov under NCT01236625.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"8"},"PeriodicalIF":8.0,"publicationDate":"2023-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9872389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9187235","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}