Publications by authors named "Belinda De Simone"

62 Publications

Long splenic flexure carcinoma requiring laparoscopic extended left hemicolectomy with CME and transverse-rectal anastomosis: technique for a modified partial Deloyers in 5 steps to achieve enough reach and preserving middle colic vessels.

Langenbecks Arch Surg 2021 Jul 16. Epub 2021 Jul 16.

University Hospital 'Gregorio Marañón', Madrid, Spain.

Introduction: This How-I-Do-It article presents a modified Deloyers procedure by mean of the case of a 67-year-old female with adenocarcinoma extending for a long segment and involving the splenic flexure and proximal descending colon who underwent a laparoscopic left extended hemicolectomy (LELC) with derotation of the right colon and primary colorectal anastomosis.

Background: While laparoscopic extended right colectomy is a well-established procedure, LELC is rarely used (mainly for distal transverse or proximal descending colon carcinomas extending to the area of the splenic flexure). LELC presents several technical challenges which are demonstrated in this How-I-Do-It article.

Technique And Methods: Firstly, the steps needed to mobilize the left colon and procure a safe approach to the splenic flexure are described, especially when a tumor is closely related to it. This is achieved by mobilization and resection of the descending colon, while maintaining a complete mesocolic excision to the level of the duodenojejunal ligament for the inferior mesenteric vein and flush to the aorta for the inferior mesenteric artery. Subsequently, we depict the adjuvant steps required to enable a primary anastomosis by trying to mobilize the transverse colon and release as much of the mesocolic attachments at the splenic flexure area. Finally, we present the rare instance when a laparoscopic derotation of the ascending colon is required to provide a tension-free anastomosis. The resection is completed by delivery of the fully derotated ascending colon and hepatic flexure through a suprapubic mini-Pfannenstiel incision. The primary colorectal anastomosis is subsequently fashioned in a tension-free way and provides for a quick postoperative recovery of the patient.

Results: This modified Deloyers procedure preserves the middle colic since the fully mobilized mesocolon allows for a tension-free anastomosis while maintaining better blood supply to the mobilized stump. Also, by eliminating the need for a mesenteric window and the transposition of the caecum, we allow the small bowel to rest over the anastomosis and the mobilized transverse colon and reduce the possibility of an internal herniation of the small bowel into the mesentery.

Conclusions: Laparoscopic derotation of the right colon and a partial, modified Deloyers procedure preserving the middle colic vessels are feasible techniques in experienced hands to provide primary anastomosis after LELC with improved functional outcome. Nevertheless, it is important to consider anatomical aspects of the left hemicolectomy along with oncological considerations, to provide both a safe oncological resection along with good postoperative bowel function.
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http://dx.doi.org/10.1007/s00423-021-02240-7DOI Listing
July 2021

Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project.

World J Emerg Surg 2021 Jul 2;16(1):35. Epub 2021 Jul 2.

UOC Chirurgia Generale - AOU san Giovanni di Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy.

Background And Aims: Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts' consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients.

Methods: The discussion among the steering group of clinical experts and methodologists from the societies' expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020-January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations.

Conclusions: The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary management of elderly patients with rectal cancer aims to provide updated evidence-based statements and recommendations on each of the following topics: epidemiology, pre-intervention strategies, diagnosis and staging, neoadjuvant chemoradiation, surgery, watch and wait strategy, adjuvant chemotherapy, synchronous liver metastases, and emergency presentation of rectal cancer.
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http://dx.doi.org/10.1186/s13017-021-00378-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254305PMC
July 2021

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy.

World J Emerg Surg 2021 Jun 10;16(1):30. Epub 2021 Jun 10.

Rothschild Hospital, AP-HP, Paris, and Université de Paris, Paris, France.

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.
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http://dx.doi.org/10.1186/s13017-021-00369-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190978PMC
June 2021

WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting.

World J Emerg Surg 2021 May 11;16(1):23. Epub 2021 May 11.

Department of Surgical Sciences, Policlinico Sant'Orsola Malpighi, Bologna, Italy.

Background: Despite the current therapeutic options for the treatment of inflammatory bowel disease, surgery is still frequently required in the emergency setting, although the number of cases performed seems to have decreased in recent years. The World Society of Emergency Surgery decided to debate in a consensus conference of experts, the main pertinent issues around the management of inflammatory bowel disease in the emergent situation, with the need to provide focused guidelines for acute care and emergency surgeons.

Method: A group of experienced surgeons and gastroenterologists were nominated to develop the topics assigned and answer the questions addressed by the Steering Committee of the project. Each expert followed a precise analysis and grading of the studies selected for review. Statements and recommendations were discussed and voted at the Consensus Conference of the 6th World Society of Emergency Surgery held in Nijmegen (The Netherlands) in June 2019.

Conclusions: Complicated inflammatory bowel disease requires a multidisciplinary approach because of the complexity of this patient group and disease spectrum in the emergency setting, with the aim of obtaining safe surgery with good functional outcomes and a decreasing stoma rate where appropriate.
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http://dx.doi.org/10.1186/s13017-021-00362-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111988PMC
May 2021

COVID-19 pandemic: the second phase, are we ready now? An emergency surgeons' manifesto.

Minerva Surg 2021 06 14;76(3):289-290. Epub 2021 Apr 14.

Department of Trauma and Emergency Surgery, University Hospital of Parma, Parma, Italy.

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http://dx.doi.org/10.23736/S2724-5691.21.08699-5DOI Listing
June 2021

WSES-AAST Guidelines for Management of Clostridioides (Clostridium) difficile infection in Surgical Patients: an executive summary.

J Trauma Acute Care Surg 2021 Mar 27. Epub 2021 Mar 27.

Department of Surgery, Macerata Hospital, Macerata, Italy. General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy. Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA. General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy. Department of General and Metabolic Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France. Abdominal Center, Helsinki University Hospital Meilahti, Finland. Division of General Surgery, Rambam Health Care Campus, Haifa, Israel. Ernest E. Moore Shock Trauma Center at Denver Health, Colorado, USA. Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy.

Abstract: In the last three decades, the dramatic worldwide increase in incidence and severity of Clostridioides difficile infection (CDI) (formerly Clostridium difficile infection) has made CDI a global public health challenge. Surgery is a known risk factor for development of CDI yet surgery is also a treatment option in severe cases of CDI. The World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients were published in 2015(1). In 2019(2) the guidelines were revised and updated according to the GRADE methodology.This executive summary is intended to consolidate knowledge on the management of CDI focusing on aspects that a general and emergency surgeon should know about the prevention and the management of CDI, by providing a practical and concise version of the original guidelines.
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http://dx.doi.org/10.1097/TA.0000000000003196DOI Listing
March 2021

The management of surgical patients in the emergency setting during COVID-19 pandemic: the WSES position paper.

World J Emerg Surg 2021 03 22;16(1):14. Epub 2021 Mar 22.

Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy.

Background: Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers.

Method: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology.

Results: Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts' opinion.

Conclusions: The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.
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http://dx.doi.org/10.1186/s13017-021-00349-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983964PMC
March 2021

The WSES: what do we see in the future?

World J Emerg Surg 2021 03 20;16(1):13. Epub 2021 Mar 20.

Department of Emergency and Trauma Surgery, University Hospital of Parma, Parma, Italy.

We present the New Year letter from the WSES board to wish everyone a new year full of positive surprises and good news, despite COVID-19 pandemic.We confirm the WSES primary aim: to promote education in emergency surgery putting together all the world experts on emergency surgery without restrictions or boundaries, in inclusivity, equality, and equal opportunities. This will be the year of innovations and WSES will assess the application of artificial intelligence technologies in emergency and trauma surgery.Thank you All for trusting us with your collaboration.
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http://dx.doi.org/10.1186/s13017-021-00358-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980739PMC
March 2021

Do young patients with high clinical suspicion of appendicitis really need cross-sectional imaging? Proceedings from a highly controversial debate among the experts' panel of 2020 WSES Jerusalem guidelines.

J Trauma Acute Care Surg 2021 05;90(5):e101-e107

From the Department of Emergency Surgery (M.P., A.P.), Azienda Ospedaliero-Universitaria di Cagliari, University Hospital Policlinico Duilio Casula, Cagliari, Italy; Department of Surgery (R.A.), Linkoping University, Linkoping, Sweden; Department of Surgery (M.B.), University of Amsterdam, Amsterdam, The Netherlands; General, Emergency and Trauma Surgery (F.C.), Pisa University Hospital, Pisa, Italy; Department of Surgery (M.S.), Macerata Hospital, Macerata, Italy; Denver Health System-Denver Health Medical Center (E.E.M.), Denver, Colorado; Department of Surgery (M.S.), Letterkenny Hospital, Donegal, Ireland; Department of Surgery (F.A.-Z.), College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates; Department of Abdominal Surgery (M.T., A.L.), Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Department of Upper GI Surgery (D.D.), Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom; Division of General Surgery (Y.K.), Rambam Health Care Campus, Haifa, Israel; Department of Gastrointestinal Surgery (K.S.), Stavanger University Hospital, Stavanger, Norway; Department of Surgery (G.A.), University Hospital Centre of Zagreb, Zagreb, Croatia; Section of Acute Care Surgery, Westchester Medical Center, Department of Surgery (R.L.), New York Medical College, Valhalla, New York; Acute Surgical Unit (M.K.), Canberra Hospital, ACT, Canberra, Australia; Faculdade de Ciências Médicas (FCM)-Unicamp, Campinas (G.P.F.), SP, Brazil; Department of Surgery (R.T.B., E.T., H.V.G.), Radboud University Medical Center, Nijmegen, The Netherlands; Niguarda Hospital Trauma Center (O.C.), Milan, Italy; Department of Surgery (R.V.M.), University of Washington, Harborview Medical Center, Seattle, Washington; Department of Surgery (F.P.), Nicola Giannettasio Hospital, Corigliano-Rossano, and La Sapienza University o Rome, Rome, Italy; Department of Visceral Surgery (B.D.S.), Centre Hospitalier Intercommunal Poissy/Saint-Germain-en-Laye, Poissy, France; Division of Trauma and Acute Care Surgery, Department of General Surgery (C.A.O.), Fundación Valle del Lili, Cali, Colombia; Department of General Surgery and Trauma (L.A.), Bufalini Hospital, Cesena, Italy; Emergency and Trauma Surgery Department (F.C.), Maggiore Hospital of Parma, Parma, Italy; and Department of General Surgery (S.D.S.), University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Varese, Italy.

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http://dx.doi.org/10.1097/TA.0000000000003097DOI Listing
May 2021

American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of abdominal vascular injuries.

J Trauma Acute Care Surg 2020 12;89(6):1197-1211

From the Division of Trauma (L.K., J.S.), Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego, San Diego; Comparative Effectiveness and Clinical Outcomes Research Center (R.C.), Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, California; Vascular and Trauma Surgery (A.M.O.G. Jr.), Universidade Federal do Pará/Centro Universitário do Estado do Pará, Belém, PA, Brazil; Department of War Surgery (V.R.), Kirov Military Medical Academy, Saint Petersburg, Russia; Department of Surgery (E.E.M.), Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, Colorado; Division Chief Trauma and Acute Care Surgery (J.M.G.), Department of Surgery, University of California Davis, Sacramento, California; Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates; Division of Trauma and Acute Care Surgery, Department of Surgery (A.B.P.), University of Pittsburgh School of Medicine, Pittsburg, Pennsylvania; Division of Trauma and Acute Care Surgery, Department of Surgery (C.A.O.), Fundación Valle del Lili, Universidad del Valle, Cali, Colombia; Department of Surgery (R.V.M.), University of Washington, Seattle, Washington; Department of Surgery (S.D.S.), University Hospital of Varese, University of Insubria, Italy; Division of Acute Care Surgery, Department of Surgery (R.I.), Virginia Commonwealth University Richmond, Virginia; Unit of Digestive and HPB Surgery (N.D.A.), CARE Department, Henri Mondor University Hospital (AP-HP) and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France; R. Adams Cowley Shock Trauma Center (T.S.), University of Maryland, Baltimore, Maryland; Emergency Surgery Department (F.C.), Parma University Hospital, Parma, Italy; Department of Surgery and Critical Care Medicine (A.K.), University of Calgary, Calgary, Alberta, Canada; Department of Emergency Surgery (V.K.), City Hospital, Mozyr, Belarus; Departments of Surgery and Medicine (N.P.), Schulich School of Medicine and Dentistry, Western University London Health Sciences Centre, London, Ontario, Canada; Trauma Services (I.C.), Auckland City Hospital, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Abdominal Center, Department of Surgery (A.L., M.S.), University Hospital Meilahti, Helsinki, Finland; Department of Digestive Surgery (M. Chirica), Grenoble University Hospital, Grenoble, France; 3rd Department of Surgery (E.P.), Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece; Division of Trauma/Acute Care Surgery and Surgical Critical Care (G.P.F.), University of Campinas, Campinas, Brazil; General, Emergency Surgery, and Trauma Center (M. Chiarugi), University of Pisa, Pisa, Italy; Department of General and Upper GI Surgery (D.D.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Dipartimento di Scienze Clinico Chirurgiche (E.C.), Diagnostiche e Pediatriche, University of Pavia, Pavia; General and Emergency Surgery Department (M. Ceresoli), School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy; Service de Chirurgie Generale, Digestive, Metabolique Centre Hospitalier de Poissy (B.D.S.), St Germain en Laye, France; Departamento de Cirugía (F.V.-R.), Hospital Angeles Lomas, Curso Universitario Posgrado de Cirugía, Universidad Nacional Autónoma de México, Mexico, Mexico; Department of Surgery (M.S.), Macerata Hospital (ASUR Marche), Macerata, Italy; Trauma Surgery Department (W.B.), Scripps Memorial Hospital, La Jolla, California; General Surgery Department (L.A.), Bufalini Hospital, Cesena, Italy; and Trauma Service, Department of General Surgery (D.G.W.), Royal Perth Hospital, The University of Western Australia, Perth, Australia.

Abdominal vascular trauma accounts for a small percentage of military and a moderate percentage of civilian trauma, affecting all age ranges and impacting young adult men most frequently. Penetrating causes are more frequent than blunt in adults, while blunt mechanisms are more common among pediatric populations. High rates of associated injuries, bleeding, and hemorrhagic shock ensure that, despite advances in both diagnostic and therapeutic technologies, immediate open surgical repair remains the mainstay of treatment for traumatic abdominal vascular injuries. Because of their devastating nature, abdominal vascular injuries remain a significant source of morbidity and mortality among trauma patients. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seek to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of abdominal vascular injuries. LEVEL OF EVIDENCE: Review study, level IV.
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http://dx.doi.org/10.1097/TA.0000000000002968DOI Listing
December 2020

American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of peripheral vascular injuries.

J Trauma Acute Care Surg 2020 12;89(6):1183-1196

From the Division of Trauma (L.K., J.S.), Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego, San Diego, California; Comparative Effectiveness and Clinical Outcomes Research Center (R.C.), Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, California; Vascular and Trauma Surgery (A.M.O.G. Jr.), Universidade Federal do Pará/Centro Universitário do Estado do Pará, Belém, PA, Brazil; Department of War Surgery (V.R.), Kirov Military Medical Academy, Saint Petersburg, Russia; Department of Surgery (E.E.M.), Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, Colorado; Division Chief Trauma and Acute Care Surgery (J.G.), Department of Surgery. University of California Davis, Sacramento, California; Department of Surgery (F.A.-Z.), College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates; Division of Trauma and Acute Care Surgery, Department of Surgery (A.B.P.), University of Pittsburgh School of Medicine, Pittsburg, Pennsylvania; Division of Trauma and Acute Care Surgery, Department of Surgery (C.O.), Fundación Valle del Lili, Universidad del Valle, Cali, Colombia; Department of Surgery (R.V.M.), University of Washington, Seattle, Washington; Department of Surgery (S.D.S.), University Hospital of Varese, University of Insubria, Varese, Italy; Division of Acute Care Surgery, Department of Surgery (R.I.), Virginia Commonwealth University Richmond, Virginia; Unit of Digestive and HPB Surgery (N.D.A.), CARE Department, Henri Mondor University Hospital (AP-HP) and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France; R. Adams Cowley Shock Trauma Center (T.S.), University of Maryland, Baltimore, Maryland; Emergency Surgery Department (F.C.), Parma University Hospital, Parma, Italy; Department of Surgery and Critical Care Medicine (A.K.), University of Calgary, Calgary, Alberta, Canada; Department of Emergency Surgery (V.K.), City Hospital, Mozyr, Belarus; Departments of Surgery and Medicine (N.P.), Schulich School of Medicine and Dentistry, Western University London Health Sciences Centre, London, Ontario, Canada; Trauma Services (I.C.), Auckland City Hospital, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Abdominal Center, Department of Surgery (A.L.), University Hospital Meilahti, Helsinki, Finland; Department of Digestive Surgery (M. Chirica), Grenoble University Hospital, Grenoble, France; 3rd Department of Surgery (E.P.), Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece; Division of Trauma/Acute Care Surgery and Surgical Critical Care (G.P.F.), University of Campinas, Campinas, Brazil; General, Emergency Surgery, and Trauma Center (M. Chiarugi, F.C.), University of Pisa, Pisa, Italy; Department of General and Upper GI Surgery (D.D.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Dipartimento di Scienze Clinico Chirurgiche (E.C.), Diagnostiche e Pediatriche, University of Pavia, Pavia; General and Emergency Surgery Department (M. Ceresoli), School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy; Service de Chirurgie Generale, Digestive, Metabolique Centre Hospitalier de Poissy (B.D.S.), St Germain en Laye, France; Universidad Nacional Autónoma de México, Curso Universitario Posgrado de Cirugía, Departamento de Cirugía (F.V.-R.), Hospital Angeles Lomas, Mexico, Mexico; Department of Surgery (M.S.), Macerata Hospital (ASUR Marche), Macerata, Italy; Trauma Surgery Department (W.B.), Scripps Memorial Hospital, La Jolla, California; General Surgery Department (L.A.), Bufalini Hospital, Cesena, Italy; and Trauma Service, Department of General Surgery (D.G.W.), Royal Perth Hospital, The University of Western Australia, Perth, Australia.

The peripheral arteries and veins of the extremities are among the most commonly injured vessels in both civilian and military vascular trauma. Blunt causes are more frequent than penetrating except during military conflicts and in certain geographic areas. Physical examination and simple bedside investigations of pulse pressures are key in early identification of these injuries. In stable patients with equivocal physical examinations, computed tomography angiograms have become the mainstay of screening and diagnosis. Immediate open surgical repair remains the first-line therapy in most patients. However, advances in endovascular therapies and more widespread availability of this technology have resulted in an increase in the range of injuries and frequency of utilization of minimally invasive treatments for vascular injuries in stable patients. Prevention of and early detection and treatment of compartment syndrome remain essential in the recovery of patients with significant peripheral vascular injuries. The decision to perform amputation in patients with mangled extremities remains difficult with few clear indicators. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seeks to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of peripheral vascular injuries. LEVEL OF EVIDENCE: Review study, level IV.
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http://dx.doi.org/10.1097/TA.0000000000002967DOI Listing
December 2020

2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis.

World J Emerg Surg 2020 11 5;15(1):61. Epub 2020 Nov 5.

Department of Surgery, College of Medicine, UAE University, Al Ain, UAE.

Background: Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC.

Materials And Methods: The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see https://www.gradeworkinggroup.org/ ). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached.

Results: The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal.

Conclusions, Knowledge Gaps And Research Recommendations: ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.
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http://dx.doi.org/10.1186/s13017-020-00336-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643471PMC
November 2020

Current management of acute left colon diverticulitis: What have Italian surgeons learned after the IPOD study?

Updates Surg 2021 Feb 3;73(1):139-148. Epub 2020 Oct 3.

Emergency and Trauma Surgery Department, University Hospital of Parma, Parma, Italy.

The acute left diverticulitis is a common problem encountered by surgeons in the acute setting. Some years ago, the Italian Prospective Observational Diverticulitis (IPOD) study showed several disputes in managing acute left colon diverticulitis in Italian surgical department. The aim of this study is to check the compliance of Italian surgeons with clinical evidence-based guidelines in non-university hospitals. A 21 multiple-choice questions survey was sent to the Italian Society of Hospital Surgeons (ACOI) mailing list members, from the 1st April 2019 to 6th June 2019. One hundred and seventy-four Italian general surgeons (the ACOI collaborative diverticulitis group) joined the project and answered to the survey. The response rate was 7% (174/2500 ACOI members). Despite current international guidelines about the management of acute diverticulitis, several controversies have emerged from the analysis of this survey in the clinical practice of Italian surgeons, resulting from their low compliance with evidence-based recommendations.
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http://dx.doi.org/10.1007/s13304-020-00891-7DOI Listing
February 2021

Correction to: Weight Regain After Gastric Plication: Reoperative Sleeve Gastrectomy or Roux-en-Y Gastric Bypass?-Analysis of 116 Consecutive Cases.

Obes Surg 2020 Oct;30(10):3988

Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France.

In the original article the name of author Luigi Prisco was incorrect. It is correct here.
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http://dx.doi.org/10.1007/s11695-020-04810-yDOI Listing
October 2020

Weight Regain After Gastric Plication: Reoperative Sleeve Gastrectomy or Roux-en-Y Gastric Bypass?-Analysis of 116 Consecutive Cases.

Obes Surg 2020 Oct 17;30(10):3982-3987. Epub 2020 Jun 17.

Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France.

Purpose: In France, laparoscopic gastric plication (GP) has rarely been utilized as a weight loss procedure. Although relatively safe and efficient, its long-term results are still controversial. The goal of this study is to assess the indications and outcomes of revisional surgery post-GP.

Materials And Methods: Between February 2010 and September 2017, patient characteristics undergoing GP were prospectively collected from our database. Failure of conservative treatment or presence of anatomical anomaly explaining weight loss insufficiency was an indication for revisional surgery (RS).

Results: A total of 300 patients were included, 41 patients were lost to follow-up (13.7%), 124 patients (41.3%) had total weight loss (TWL) > 30%, and 116 patients (38.7%) underwent RS. Revisional procedures were laparoscopic Roux-en-Y gastric bypass (RYGB) in 72 patients (62.1%) and sleeve gastrectomy (SG) in 44 patients (37.9%). The median interval to RS was 29 months. The mean operative time was 60 min for the SG and 125 min for the RYGB (p < 0.0001). Mortality was nil. Significant morbidity occurred in eight patients (6.9%) including 4 non-abdominal complications, 1 gastric leak, 1 case of hemorrhage, 1 case of hematoma, and 1 intra-abdominal abscess. The mean length of hospital stay (LOS) was 2.9 days (range, 1-11) for the SG group vs 3.2 days (range, 2-8) for the RYGB group (p = 0.608).

Conclusion: GP is associated with a relatively high rate of weight regain or insufficient weight loss. When compared to SG, RYGB seems to be the safer revisional procedure with fewer surgical complications.
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http://dx.doi.org/10.1007/s11695-020-04767-yDOI Listing
October 2020

Acute cholecystitis during COVID-19 pandemic: a multisocietary position statement.

World J Emerg Surg 2020 06 8;15(1):38. Epub 2020 Jun 8.

Department of Mini-Invasive and General Surgery, Cristo Re Hospital, Rome, Italy.

Following the spread of the infection from the new SARS-CoV2 coronavirus in March 2020, several surgical societies have released their recommendations to manage the implications of the COVID-19 pandemic for the daily clinical practice. The recommendations on emergency surgery have fueled a debate among surgeons on an international level.We maintain that laparoscopic cholecystectomy remains the treatment of choice for acute cholecystitis, even in the COVID-19 era. Moreover, since laparoscopic cholecystectomy is not more likely to spread the COVID-19 infection than open cholecystectomy, it must be organized in such a way as to be carried out safely even in the present situation, to guarantee the patient with the best outcomes that minimally invasive surgery has shown to have.
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http://dx.doi.org/10.1186/s13017-020-00317-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278255PMC
June 2020

2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting.

World J Emerg Surg 2020 05 7;15(1):32. Epub 2020 May 7.

Trauma Service, Inkosi Albert Luthuli Central Hospital and Department of Surgery, Nelson R Mandela School of Clinical Medicine, Durban, South Africa.

Acute colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of acute left-sided colonic diverticulitis (ALCD) according to the most recent available literature. The update includes recent changes introduced in the management of ALCD. The new update has been further integrated with advances in acute right-sided colonic diverticulitis (ARCD) that is more common than ALCD in select regions of the world.
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http://dx.doi.org/10.1186/s13017-020-00313-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206757PMC
May 2020

Hey surgeons! It is time to lead and be a champion in preventing and managing surgical infections!

World J Emerg Surg 2020 04 19;15(1):28. Epub 2020 Apr 19.

Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy.

Appropriate measures of infection prevention and management are integral to optimal clinical practice and standards of care. Among surgeons, these measures are often over-looked. However, surgeons are at the forefront in preventing and managing infections. Surgeons are responsible for many of the processes of healthcare that impact the risk for surgical site infections and play a key role in their prevention. Surgeons are also at the forefront in managing patients with infections, who often need prompt source control and appropriate antibiotic therapy, and are directly responsible for their outcome. In this context, the direct leadership of surgeons in infection prevention and management is of utmost importance. In order to disseminate worldwide this message, the editorial has been translated into 9 different languages (Arabic, Chinese, French, German, Italian, Portuguese, Spanish, Russian, and Turkish).
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http://dx.doi.org/10.1186/s13017-020-00308-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168830PMC
April 2020

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines.

World J Emerg Surg 2020 04 15;15(1):27. Epub 2020 Apr 15.

UCSD Health System - Hillcrest Campus Department of Surgery Chief Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, San Diego, CA, USA.

Background And Aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy.

Methods: This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients.

Conclusions: The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.
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http://dx.doi.org/10.1186/s13017-020-00306-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386163PMC
April 2020

Laparoscopy at all costs? Not now during COVID-19 outbreak and not for acute care surgery and emergency colorectal surgery: A practical algorithm from a hub tertiary teaching hospital in Northern Lombardy, Italy.

J Trauma Acute Care Surg 2020 06;88(6):715-718

From the Department of General Surgery (S.D.S., G.I., E.Z., G.C.), University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Italy; Digestive Diseases Department (M.K.), Brighton and Sussex University Hospitals, Brighton, United Kingdom; General Surgery Unit (F.P.), Nicola Giannettasio Hospital, Corigliano-Rossano, Italy; and Département de Chirurgie Viscérale (Bariatrique & Métabolique, Oncologique, et d'Urgence)(B.D.S.), Centre Hospitalier Poissy/Saint-Germain, France.

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http://dx.doi.org/10.1097/TA.0000000000002727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473818PMC
June 2020

Laparoscopic versus open approach for diffuse peritonitis from appendicitis ethiology: a subgroup analysis from the Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) study.

Updates Surg 2020 Mar 19;72(1):185-191. Epub 2020 Feb 19.

Department of Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy.

Diffuse peritonitis represents a life-threatening complication of acute appendicitis (AA). Whether laparoscopy is a safe procedure and presents similar results compared with laparotomy in case of complicated AA is still a matter of debate. The objective of this study is to compare laparoscopic (LA) and open appendectomy (OA) for the management of diffuse peritonitis caused by AA. This is a prospective multicenter cohort study, including 223 patients with diffuse peritonitis from perforated AA, enrolled in the Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) study from February to May 2018. Two groups were created: LA = 78 patients, mean age 42.51 ± 22.14 years and OA = 145 patients, mean age 38.44 ± 20.95 years. LA was employed in 34.98% of cases. There was no statically significant difference between LA and OA groups in terms of intra-abdominal abscess, postoperative peritonitis, rate of reoperation, and mortality. The wound infection rate was higher in the OA group (OR 21.63; 95% CI 3.46-895.47; P = 0.00). The mean postoperative hospital stay in the LA group was shorter than in the OA group (6.40 ± 4.29 days versus 7.8 ± 5.30 days; P = 0.032). Although LA was only used in one-third of cases, it is a safe procedure and should be considered in the management of patients with diffuse peritonitis caused by AA, respecting its indications.
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http://dx.doi.org/10.1007/s13304-020-00711-yDOI Listing
March 2020

A proposal for a comprehensive approach to infections across the surgical pathway.

World J Emerg Surg 2020 02 18;15(1):13. Epub 2020 Feb 18.

Department of Surgery, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy.

Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should always focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.
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http://dx.doi.org/10.1186/s13017-020-00295-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029591PMC
February 2020

Emergency general surgeons: the special forces of general surgery (the "navy seals paradigm").

World J Emerg Surg 2020 02 12;15(1):11. Epub 2020 Feb 12.

General, Emergency and Trauma Surgery Dept, Pisa University Hospital, Pisa, Italy.

Emergency surgeons have a crucial role in bridging the gap of skills resulting from the well-known general surgery fragmentation. The multi-specialist general surgery approach is still necessary to define proper diagnosis and therapy priorities in an emergency. Governments have to find effective organizational solutions to maintain emergency general surgery standards of care and to improve them further.
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http://dx.doi.org/10.1186/s13017-020-0293-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017518PMC
February 2020

Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines.

World J Emerg Surg 2020 02 10;15(1):10. Epub 2020 Feb 10.

Department of Emergency and Trauma Surgery, University Hospital of Parma, 43100, Parma, Italy.

Background: Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections.

Methods: The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES.

Results: Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI.

Conclusions: The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.
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http://dx.doi.org/10.1186/s13017-020-0288-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158095PMC
February 2020

The Operative management in Bariatric Acute abdomen (OBA) Survey: long-term complications of bariatric surgery and the emergency surgeon's point of view.

World J Emerg Surg 2020 01 6;15(1). Epub 2020 Jan 6.

Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy.

Background: The number of bariatric procedures is increasing worldwide. No consensus or guidelines about the emergency management of long-term complications following bariatric surgery are currently available. The aim of this study is to investigate by a web survey how an emergency surgeon approaches this unique group of patients in an emergency medical scenario and to report their personal experience.

Method: An international web survey was sent to 197 emergency surgeons with the aim to collect data about emergency surgeons' experience in the management of patients admitted in the emergency department for acute abdominal pain after bariatric surgery. The survey was conceived as a questionnaire composed by 26 (multiple choice and open) questions and approved by a steering committee.

Results: One hundred seventeen international emergency surgeons decided to join the project and answered to the web survey with a response rate of 59.39%.

Conclusions: The aim of this WSES web survey was to highlight the current management of patients previously submitted to bariatric surgical procedures by ES. Emergency surgeons must be mindful of postoperative bariatric surgery complications. CT scan with oral intestinal opacification may be useful in making a diagnosis if carefully interpreted by the radiologist and the surgeon. In case of inconclusive clinical and radiological findings, when symptoms fail to improve, surgical exploration for bariatric patients presenting acute abdominal pain, by laparoscopy if expertise is available, is mandatory in the first 12-24 h, to have good outcomes and decrease morbidity rate.
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http://dx.doi.org/10.1186/s13017-019-0281-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6945511PMC
January 2020

Necrotizing Soft Tissue Infections: A Focused Review of Pathophysiology, Diagnosis, Operative Management, Antimicrobial Therapy, and Pediatrics.

Surg Infect (Larchmt) 2020 Mar 4;21(2):81-93. Epub 2019 Oct 4.

Envision Healthcare, Dallas, Texas.

Necrotizing fasciitis is a major health problem throughout the world. The purpose of this review is to assist providers with the care of these patients through a better understanding of the pathophysiology and management options. This is a collaborative review of the literature between members of the Surgical Infection Society of North America and World Society of Emergency Surgery. Necrotizing fasciitis continues to be difficult to manage with the mainstay being early diagnosis and surgical intervention. Recognition of at-risk populations assists with the initiation of treatment, thereby impacting outcomes. Although there are some additional treatment strategies available, surgical debridement and antimicrobial therapy are central to the successful eradication of the disease process.
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http://dx.doi.org/10.1089/sur.2019.219DOI Listing
March 2020

Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study.

World J Emerg Surg 2019 15;14:34. Epub 2019 Jul 15.

Department of Surgery, Lumbini Medical College and Teaching Hospital Ltd., Tansen, Palpa Nepal.

Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted.

Methods: This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018.

Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8.

Conclusions: The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.
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http://dx.doi.org/10.1186/s13017-019-0253-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631509PMC
September 2019

Bowel obstruction: a narrative review for all physicians.

World J Emerg Surg 2019 29;14:20. Epub 2019 Apr 29.

Emergency and Trauma Surgery Department, Cesena Hospital, Cesena, Italy.

Small and large bowel obstructions are responsible for approximately 15% of hospital admissions for acute abdominal pain in the USA and ~ 20% of cases needing acute surgical care. Starting from the analysis of a common clinical problem, we want to guide primary care physicians in the initial management of a patient presenting with acute abdominal pain associated with intestinal obstruction.
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http://dx.doi.org/10.1186/s13017-019-0240-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489175PMC
September 2019

2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections.

World J Emerg Surg 2018 14;13:58. Epub 2018 Dec 14.

11Infectious Diseases Division, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Intergrata di Udine, Udine, Italy.

Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections. SSTIs are a frequent clinical problem in surgical departments. In order to clarify key issues in the management of SSTIs, a task force of experts met in Bertinoro, Italy, on June 28, 2018, for a specialist multidisciplinary consensus conference under the auspices of the World Society of Emergency Surgery (WSES) and the Surgical Infection Society Europe (SIS-E). The multifaceted nature of these infections has led to a collaboration among general and emergency surgeons, intensivists, and infectious disease specialists, who have shared these clinical practice recommendations.
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http://dx.doi.org/10.1186/s13017-018-0219-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6295010PMC
May 2019
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