Publications by authors named "Massimo Chiarugi"

85 Publications

Answer to letter: The decrease of non-complicated acute appendicitis and the negative appendectomy rate during pandemic.

Eur J Trauma Emerg Surg 2021 Jun 26. Epub 2021 Jun 26.

General and Emergency Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Via Pergolesi 33, 20900, Monza, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-021-01731-yDOI Listing
June 2021

Surgical site infection prevention and management in immunocompromised patients: a systematic review of the literature.

World J Emerg Surg 2021 Jun 10;16(1):33. Epub 2021 Jun 10.

General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa 1, 56100, Pisa, Italy.

Background: Immunocompromised patients are at higher risk of surgical site infection and wound complications. However, optimal management in the perioperative period is not well established. Present systematic review aims to analyse existing strategies and interventions to prevent and manage surgical site infections and other wound complications in immunocompromised patients.

Methods: A systematic review of the literature was conducted.

Results: Literature review shows that partial skin closure is effective to reduce SSI in this population. There is not sufficient evidence to definitively suggest in favour of prophylactic negative pressure wound therapy. The use of mammalian target of rapamycin (mTOR) and calcineurin inhibitors (CNI) in transplanted patient needing ad emergent or undeferrable abdominal surgical procedure must be carefully and multidisciplinary evaluated. The role of antibiotic prophylaxis in transplanted patients needs to be assessed.

Conclusion: Strict adherence to SSI infection preventing bundles must be implemented worldwide especially in immunocompromised patients. Lastly, it is necessary to elaborate a more widely approved definition of immunocompromised state. Without such shared definition, it will be hard to elaborate the needed methodologically correct studies for this fragile population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13017-021-00375-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8194010PMC
June 2021

Correction to: The decrease of non-complicated acute appendicitis and the negative appendectomy rate during pandemic.

Eur J Trauma Emerg Surg 2021 May 31. Epub 2021 May 31.

General and Emergency Surgery Dept, School of Medicine and Surgery, Milano-Bicocca University, Via Pergolesi 33, 20900, Monza, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-021-01683-3DOI Listing
May 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13017-021-00362-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111988PMC
May 2021

Intraperitoneal chemotherapy for ovarian cancer with peritoneal metastases, systematic review of the literature and focused personal experience.

J Gastrointest Oncol 2021 Apr;12(Suppl 1):S144-S181

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

Epithelial ovarian cancer (EOC) causes 60% of ovarian cancer cases and is the fourth most common cause of death from cancer in women. The standard of care for EOC includes a combination of surgery followed by intravenous chemotherapy. Intraperitoneal (IP) chemotherapy (CT) has been introduced into the therapeutic algorithm of EOC with positive results. To explore existing results regarding intraperitoneal chemotherapy a systematic review of the literature and an analysis of our own institutional prospective database of patients treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) for EOC at different stages were conducted. The focused report concerning our personal experience with advanced EOC treated with cytoreductive surgery and HIPEC produced the following results: In 57 patients cisplatin + paclitaxel as HIPEC was the only significant factor improving overall survival (OS) at multivariate analysis (OR 6.54, 95% CI: 1.24-34.47, P=0.027). Patients treated with HIPEC cisplatin + paclitaxel showed a median OS of 46 months (SD 6.4, 95% CI: 33.4-58.6), while patients treated with other HIPEC regimens showed a median OS of 12 months (SD 3.1, 95% CI: 6.0-18.0). The 2y-OS was 72% and 3y-OS was 68% for cisplatin + paclitaxel as HIPEC, while the 2y- and 3y-OS was 0% for other HIPEC regimens. Patients treated with HIPEC cisplatin + paclitaxel showed a median disease-free survival (DFS) of 13 months (SD 1.6, 95% CI: 9.9-16.1), while patients treated with other HIPEC regimens showed a median DFS of 8 months (SD 3.1, 95% CI: 1.9-14.1). In conclusion, HIPEC cisplatin + paclitaxel in ovarian cancer showed positive results that may be considered semi-definitive according to the level of evidence and should be considered a starting point for further investigations. At present HIPEC cisplatin + paclitaxel should be proposed to patients with advanced ovarian cancer as standard treatment at almost all stages of disease. Platinum + taxane-based intraperitoneal regimens demonstrated superior results compared to other regimens.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jgo-2020-06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100719PMC
April 2021

Raw veganism severe complication.

ANZ J Surg 2021 Apr 22. Epub 2021 Apr 22.

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

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ans.16877DOI Listing
April 2021

The decrease of non-complicated acute appendicitis and the negative appendectomy rate during pandemic.

Eur J Trauma Emerg Surg 2021 Apr 12. Epub 2021 Apr 12.

General and Emergency Surgery Dept, School of Medicine and Surgery, Milano-Bicocca University, Via Pergolesi 33, 20900, Monza, Italy.

Background: During pandemic, admissions for surgical emergencies dropped down dramatically. Also acute appendicitis decreased. The aim of the present study was to evaluate the change in volume and clinical presentation of patients with acute appendicitis during pandemic and the variation in treatment.

Methods: This is a retrospective study of patients admitted in 11 Italian hospital for acute appendicitis during the lockdown period (March-April 2020) compared with the same period of the previous 2 years (2018-2019). The number and the rate of complicated and non-complicated acute appendicitis were recorded and compared between the two study periods; non-operative vs operative treatment and negative appendectomy rate were also recorded.

Results: The study included 532 patients, 112 in the study period and 420 in the control period; Hospital admission for acute appendicitis dropped by 46% (OR 0.516 95% CI 0.411-0.648 p < 0.001) during the 2020 lockdown. The number of complicated acute appendicitis did not change (- 18%, OR 0.763 95% CI 0.517-1.124 p = 0.1719), whereas the number of non-complicated acute appendicitis significantly decreased (- 56%, OR 0.424 95% CI 0.319-0.564 p < 0.001). Non-operative treatment rate remained similar (12.1% vs. 11.6% p = 0.434). The negative appendectomy rate also significantly decreased (6.1% vs. 17.3%, p = 0.006).

Conclusions: The present study found a significant reduction of both admissions for non-complicated acute appendicitis and negative appendectomy rate during the pandemic period. Conversely, admissions for complicated acute appendicitis did not change.

Trial Registration: NCT04649996.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-021-01663-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040760PMC
April 2021

SARS-CoV-2 Is Present in Peritoneal Fluid in COVID-19 Patients.

Ann Surg 2020 09;272(3):e240-e242

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

Background: The excretion pathomechanisms of SARS-CoV-2 are actually unknown. No certain data exist about viral load in the different body compartments and fluids during the different disease phases.

Material And Methods: Specific real-time reverse transcriptase-polymerase chain reaction targeting 3 SARS-CoV-e genes were used to detect the presence of the virus.

Results: SARS-CoV-2 was detected in peritoneal fluid at a higher concentration than in respiratory tract.

Conclusion: Detection of SARS-CoV-2 in peritoneal fluid has never been reported. The present article represents the very first positive result describing the presence of the virus in peritoneal fluid during an emergency surgical procedure in a COVID-19 sick patient. This article thus represents a warning for increasing the level of awareness and protection for surgeon especially in emergency surgical setting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SLA.0000000000004030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467036PMC
September 2020

Predictive factors of mortality in open abdomen for abdominal sepsis: a retrospective cohort study on 113 patients.

Updates Surg 2021 Mar 8. Epub 2021 Mar 8.

Emergency Surgery Department and Trauma Center, University of Pisa, New Santa Chiara Hospital, Via Paradisa 2, 56124, Pisa, Italy.

Over the past few years, the open abdomen (OA) as a part of Damage Control Surgery (DCS) has been introduced as a surgical strategy with the intent to reduce the mortality of patients with severe abdominal sepsis. Aims of our study were to analyze the OA effects on patients with abdominal sepsis and identify predictive factors of mortality. Patients admitted to our institution with abdominal sepsis requiring OA from 2010 to 2019 were retrospectively analyzed. Primary outcomes were mortality, morbidity and definitive fascial closure (DFC). Comparison between groups was made via univariate and multivariate analyses. On 1474 patients operated for abdominal sepsis, 113 (7.6%) underwent OA. Male gender accounted for 52.2% of cases. Mean age was 68.1 ± 14.3 years. ASA score was > 2 in 87.9%. Mean BMI, APACHE II score and Mannheim Peritonitis Index were 26.4 ± 4.9, 15.3 ± 6.3, and 22.6 ± 7.3, respectively. A negative pressure wound system technique was used in 47% of the cases. Overall, mortality was 43.4%, morbidity 76.6%, and DFC rate was 97.8%. Entero-atmospheric fistula rate was 2.2%. At multivariate analysis, APACHE II score (OR 1.18; 95% CI 1.05-1.32; p = 0.005), Frailty Clinical Scale (OR 4.66; 95% CI 3.19-6.12; p < 0.0001) and ASA grade IV (OR 7.86; 95% CI 2.18-28.27; p = 0.002) were significantly associated with mortality. OA seems to be a safe and reliable treatment for critically ill patients with severe abdominal sepsis. Nonetheless, in these patients, co-morbidity and organ failure remain the major obstacles to a better prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13304-021-01012-8DOI Listing
March 2021

Trauma quality indicators: internationally approved core factors for trauma management quality evaluation.

World J Emerg Surg 2021 Feb 23;16(1). Epub 2021 Feb 23.

General Surgery, Brescia University Hospital, Brescia, Italy.

Introduction: Quality in medical care must be measured in order to be improved. Trauma management is part of health care, and by definition, it must be checked constantly. The only way to measure quality and outcomes is to systematically accrue data and analyze them.

Material And Methods: A systematic revision of the literature about quality indicators in trauma associated to an international consensus conference RESULTS: An internationally approved base core set of 82 trauma quality indicators was obtained: Indicators were divided into 6 fields: prevention, structure, process, outcome, post-traumatic management, and society integrational effects.

Conclusion: Present trauma quality indicator core set represents the result of an international effort aiming to provide a useful tool in quality evaluation and improvement. Further improvement may only be possible through international trauma registry development. This will allow for huge international data accrual permitting to evaluate results and compare outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13017-021-00350-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901006PMC
February 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/TA.0000000000002967DOI Listing
December 2020

The role of damage control surgery in the treatment of perforated colonic diverticulitis: a systematic review and meta-analysis.

Int J Colorectal Dis 2021 May 22;36(5):867-879. Epub 2020 Oct 22.

North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK.

Introduction: Damage control surgery (DCS) is the classic approach to manage severe trauma and has recently also been considered an appropriate approach to the treatment of critically ill patients with severe intra-abdominal sepsis. The purpose of the present review is to evaluate the outcomes following DCS for Hinchey II-IV complicated acute diverticulitis (CAD).

Methods: A comprehensive systematic search was undertaken to identify all randomized clinical trials (RCTs) and observational studies, irrespectively of their size, publication status, and language. Adults who have undergone DCS for CAD Hinchey II, III, or IV were included in this review. DCS is compared with the immediate and definitive surgical treatment in the form of HP, colonic resection, and primary anastomosis (RPA) with or without covering stoma or laparoscopic lavage. We searched the following electronic databases: PubMed MEDLINE, Scopus, and ISI Web of Knowledge. The protocol of this systematic review and meta-analysis was published on Prospero (CRD42020144953).

Results: Nine studies with 318 patients, undergoing DCS, were included. The presence of septic shock at the presentation in the emergency department was heterogeneous, and the weighted mean rate of septic shock across the studies was shown to be 35.1% [95% CI 8.4 to 78.6%]. The majority of the patients had Hinchey III (68.3%) disease. The remainder had either Hinchey IV (28.9%) or Hinchey II (2.8%). Phase I is similarly described in most of the studies as lavage, limited resection with closed blind colonic ends. In a few studies, resection and anastomosis (9.1%) or suture of the perforation site (0.9%) were performed in phase I of DCS. In those patients who underwent DCS, the most common method of temporary abdominal closure (TAC) was the negative pressure wound therapy (NPWT) (97.8%). The RPA was performed in 62.1% [95% CI 40.8 to 83.3%] and the 22.7% [95% CI 15.1 to 30.3%]: 12.8% during phase I and 87.2% during phase III. A covering ileostomy was performed in 6.9% [95% CI 1.5 to 12.2%]. In patients with RPA, the overall leak was 7.3% [95% CI 4.3 to 10.4%] and the major anastomotic leaks were 4.7% [95% CI 2.0 to 7.4%]; the rate of postoperative mortality was estimated to be 9.2% [95% CI 6.0 to 12.4%].

Conclusions: The present meta-analysis revealed an approximately 62.1% weighted rate of achieving GI continuity with the DCS approach to generalized peritonitis in Hinchey III and IV with major leaks of 4.7% and overall mortality of 9.2%. Despite the promising results, we are aware of the limitations related to the significant heterogeneity of inclusion criteria. Importantly, the low rate of reported septic shock may point toward selection bias. Further studies are needed to evaluate the clinical advantages and cost-effectiveness of the DCS approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00384-020-03784-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026449PMC
May 2021

Timing of surgical intervention for compartment syndrome in different body region: systematic review of the literature.

World J Emerg Surg 2020 10 21;15(1):60. Epub 2020 Oct 21.

General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100, Pisa, Italy.

Compartment syndrome can occur in many body regions and may range from homeostasis asymptomatic alterations to severe, life-threatening conditions. Surgical intervention to decompress affected organs or area of the body is often the only effective treatment, although evidences to assess the best timing of intervention are lacking. Present paper systematically reviewed the literature stratifying timings according to the compartmental syndromes which may beneficiate from immediate, early, delayed, or prophylactic surgical decompression. Timing of decompression have been stratified into four categories: (1) immediate decompression for those compartmental syndromes whose missed therapy would rapidly lead to patient death or extreme disability, (2) early decompression with the time burden of 3-12 h and in any case before clinical signs of irreversible deterioration, (3) delayed decompression identified with decompression performed after 12 h or after signs of clinical deterioration has occurred, and (4) prophylactic decompression in those situations where high incidence of compartment syndrome is expected after a specific causative event.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13017-020-00339-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579897PMC
October 2020

Comment on: SARS-Cov-2 in peritoneal fluid: an important finding in the Covid-19 pandemic.

Br J Surg 2020 12 13;107(13):e667. Epub 2020 Oct 13.

Emergency Surgery Unit and Trauma Center, University of Pisa, Pisa, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/bjs.12049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675518PMC
December 2020

Open abdomen management for severe peritonitis in elderly. Results from the prospective International Register of Open Abdomen (IROA): Cohort study.

Int J Surg 2020 Oct 4;82:240-244. Epub 2020 Sep 4.

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

Background: Analyzing the data of the International Register of Open Abdomen (IROA), the feasibility of open abdomen treatment has been demonstrated at every age. This new analysis on the IROA database investigates the risk factors for mortality in elderly patients treated with open abdomen for intra-abdominal infection.

Methods: Data were derived from the IROA, a prospective observational international cohort study that enrolled patients treated with open abdomen worldwide. A univariate analysis of potential risk factors was performed. Inclusion criteria were patients older than 65 years and treated with open abdomen for intra-abdominal infection. End point was overall mortality, calculated within 30 days after open abdomen management, after 1-month and 1-year follow-up.

Results: A total of 116 patients was analyzed with mean age of 76 ± 7 years. Definitive closure was achieved in 93 patients (93/116, 80.2%) for a mean open abdomen duration of 5.0 ± 5.0 days. Complicated patients were 101 (101/116, 87.1%) for a total of 201 complications. Overall, 62 out of 116 patients (53.4%) died: 23 patients (23/62, 37.1%) during open abdomen management, 29 patients (46.8%) within 30 days after abdominal closure, 9 patients (14.5%) after 1-month follow-up, and 1 patient (1.6%) after 1-year follow-up. Age did not affect mortality (75 ± 6 years in alive patients versus 77 ± 7 years in dead patients, p = 0.773). Definitive abdominal closure was the most important factor to prevent mortality.

Conclusions: This study confirmed that age alone cannot be considered a determinant for death, even in elderly patients managed with open abdomen for severe intra-abdominal infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijsu.2020.08.030DOI Listing
October 2020

Open Abdomen and Fluid Instillation in the Septic Abdomen: Results from the IROA Study.

World J Surg 2020 Dec 24;44(12):4032-4040. Epub 2020 Aug 24.

General Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia, 1, 56124, Pisa, Italy.

Background: Open abdomen (OA) is a surgical option that can be used in patients with severe peritonitis. Few evidences exist to recommend the use of intraperitoneal fluid instillation associated with OA in managing septic abdomen.

Materials And Methods: A prospective analysis of adult patients enrolled in the International Register of Open Abdomen (trial registration: NCT02382770) was performed.

Results: A total of 387 patients were enrolled in two groups: 84 with peritoneal fluid instillation (FI) and 303 without (NFI). The groups were homogeneous for baseline characteristics. Overall complications were 92.9% in FI and 86.3% in NFI (p = 0.106). Complications during OA were 72.6% in FI and 59.9% in NFI (p = 0.034). Complications after definitive closure were 70.8% in FI and 61.1% in NFI (p = 0.133). Entero-atmospheric fistula was 13.1% in FI and 12% in NFI (p = 0.828). Fascial closure was 78.6% in FI and 63.7% in NFI (p = 0.02). Analysis of FI in negative pressure wound therapy (NPWT) showed: Overall morbidity in NPWT was 94% and in non-NPWT 91.2% (p = 0.622) and morbidity during OA was 68% and 79.4% (p = 0.25), respectively. Definitive fascial closure in NPWT was 87.8% and 96.8% in non-NPWT (p = 0.173). Overall mortality was 40% in NPWT and 29.4% in non-NPWT (p = 0.32) and morality during OA period was 18% and 8.8% (p = 0.238), respectively.

Conclusion: We found intraperitoneal fluid instillation during open abdomen in peritonitic patients to increase the complication rate during the open abdomen period, with no impact on mortality, entero-atmospheric fistula rate and opening time. Fascial closure rate is increased by instillation. Fluid instillation is feasible even when associated with nonnegative pressure temporary abdominal closure techniques.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00268-020-05728-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599169PMC
December 2020

Incidentally discovered Meckel's diverticulum: should I stay or should I go?

ANZ J Surg 2020 09 11;90(9):1694-1699. Epub 2020 Aug 11.

Emergency Surgery Unit and Trauma Center, The University of Pisa, Pisa, Italy.

Background: The aim of this study was to assess the indication for surgical treatment of incidentally discovered Meckel's diverticulum (MD) on the basis of clinical and histological features.

Methods: The charts of patients undergoing surgery for MD were analysed. Two groups were identified: (1) patients who had incidentally discovered MD resected (incidental MD, IMD) and (2) patients who received first-line surgery for a complicated MD (CMD). Demographics and intraoperative and post-operative outcomes were compared. Histological findings were also analysed and compared.

Results: Sixty-five patients were included in the study. IMD was observed in 39 patients (60%), while CMD was observed in 26 (40%). Male gender was significantly more frequent in CMD (P = 0.020), and mean age was significantly higher in IMD (P = 0.025). Body mass index and the American Society of Anesthesiologists score >2 were similar in both groups. Laparoscopy was carried out in 36% of IMD and in 50% of CMD patients (P = 0.309). A tangential resection was performed in 92% of IMD and 73% of CMD patients (P = 0.07). No complications related to diverticular resection were found in IMD, while they occurred in 8% of CMD patients (P = 0.931). Meanly, diverticula were longer when complicated (P = 0.001). CMD showed significant histological differences and more frequent gastric ectopic mucosa (P = 0.039). A malignant tumour was incidentally found in IMD.

Conclusion: As surgery is mandatory in CMD, the optimal management of IMD remains uncertain. Mucosal abnormalities may favour complications, but these cannot be identified before excision. Stapled diverticulectomy is safe and effective. A surgical approach to IMD may prevent complications at a very low cost.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ans.16189DOI Listing
September 2020

Routine drain or no drain after laparoscopic cholecystectomy for acute cholecystitis.

Surgeon 2021 Jun 24;19(3):167-174. Epub 2020 Jul 24.

Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; University of Insubria, Surgery I unit, University Hospital of Varese, Italy. Electronic address:

Background: Laparoscopic cholecystectomy (LC) is considered to be the gold standard in the early management of acute cholecystitis however, recommendations for routine drain insertion in the acute setting are unavailable.

Study Design: A systematic review of literature review and metanalysis was conducted. All studies comparing drain versus no drain after LC for acute cholecystitis were included.

Results: Seven studies, with 1274 patients, were included. Postoperative wound infection rates (relative risk (RR) 0.30, 95% confidence interval (CI) 0.10 to 0.88; I2 = 0%) and postoperative abdominal collection requiring drainage (RR 1.20, 95% CI 0.35 to 4.12; I 2 = 0%) were lower in the no-drain group, but this was only significant for wounded infections on subgroup analysis of RCTs. Length of stay hospital (mean difference (MD) -0.49, 95% CI -0.89 to -0.09; I 2 = 69%) and operative time (MD -8.13, 95% CI -13.87 to -2.38; I 2 = 92%) were significantly shorter in the no drain group however this was in the context of significant heterogeneity.

Conclusion: The available data suggests that acute cholecystitis is not an indication for routine drain placement after LC. However, these results must be interpreted with caution due to the limitations of the included studies. In effect, the main issue of this meta-analysis lies on the limitations of the included studies themselves, because of a considerable heterogeneity among the included works, particularly for the inclusion criteria of patients and reported severity of acute cholecystitis. Further work is required to produce evidence which will definitively alter clinical practice.

Level Of Evidence: Level 2a (systematic review of cohort studies). Oxford CEBM levels of evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.surge.2020.04.011DOI Listing
June 2021

Abdominal compartment syndrome as unusual presentation of a fast-growing solid tumor.

J Trauma Acute Care Surg 2020 10;89(4):e125-e127

From the Emergency Surgery Unit and Trauma Center, Cisanello Hospital, University of Pisa, Pisa, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/TA.0000000000002883DOI Listing
October 2020

Jejunoileal diverticula: a broad spectrum of complications.

ANZ J Surg 2020 07 5;90(7-8):1454-1458. Epub 2020 Jul 5.

Department of General Surgery, Cattinara Hospital, Trieste, Italy.

Background: Small bowel diverticula are a rare condition occurring mainly in the elderly. They can be isolated or multiple and can involve the duodenum, jejunum and ileum. Acute complications are extremely rare, with an aspecific pattern of symptoms. The aim of the study is to report the different patterns of presentation of patients with complicated jejunoileal diverticula.

Methods: This is a retrospective descriptive study on a consecutive series of patients admitted for complicated jejunoileal diverticula in four Italian surgical departments between 2012 and 2019. Complications included acute diverticulitis, bleeding, perforation and intestinal obstruction. Patients presenting with complicated duodenal or Meckel's diverticula were not included.

Results: Twenty-six patients were enrolled. The median age was 77 (46-94) years. Abdominal pain, fever and nausea/vomiting were the most frequent symptoms at presentation. Abdominal computed tomography (CT) was diagnostic in 35% of patients. Ten (38%) patients had bowel perforation, nine (35%) acute diverticulitis, five (19%) bowel obstruction and two (8%) had intestinal bleeding. Twenty-one (81%) patients underwent surgery, two (8%) were managed by CT-guided drainage of collections and three (11%) were treated with antibiotics. One patient died post-operatively. The median hospital stay was 9 (5-62) days.

Conclusion: Acutely complicated jejunoileal diverticula are infrequent, but a strong suspect should be raised whenever elderly patients are admitted for unspecific abdominal pain with a non-diagnostic CT scan. Conservative management may be offered in very selected cases if a diagnosis is obtained, but in most instances, surgery is both diagnostic and therapeutic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ans.16128DOI Listing
July 2020

Enhancing safety of laparoscopic surgery in COVID-19 era: clinical experience with low-cost filtration devices.

Eur J Trauma Emerg Surg 2020 Aug 1;46(4):731-735. Epub 2020 Jun 1.

Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.

Background: Surgery in the era of the current COVID-19 pandemic has been curtailed and restricted to emergency and certain oncological indications, and requires special attention concerning the safety of patients and health care personnel. Desufflation during or after laparoscopic surgery has been reported to entail a potential risk of contamination from 2019-nCoV through the aerosol generated during dissection and/or use of energy-driven devices. In order to protect the operating room staff, it is vital to filter the released aerosol.

Methods: The assemblage of two easily available and low-cost filter systems to prevent potential dissemination of Coronavirus via the aerosol is described.

Results: Forty-nine patients underwent laparoscopic surgeries with the use of one of the two described tools, both of which proved to be effective in smoke evacuation, without affecting laparoscopic visualization.

Conclusion: The proposed systems are cost-effective, easily assembled and reproducible, and provide complete viral filtration during intra- and postoperative release of CO
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-020-01413-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266121PMC
August 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13017-020-00313-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206757PMC
May 2020

Detect to protect: pneumoperitoneum gas samples for SARS-CoV-2 and biohazard testing.

Surg Endosc 2020 07 4;34(7):2863-2865. Epub 2020 May 4.

Dipartimento di Scienze Clinico Chirurgiche, Diagnostiche e Pediatriche, Università Degli Studi Di Pavia, Pavia, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-020-07611-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197360PMC
July 2020

Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2076 patients.

Updates Surg 2020 Dec 27;72(4):1175-1180. Epub 2020 Apr 27.

Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.

Background: Intra-abdominal abscesses (IAA) may develop after laparoscopic appendectomies (LA) for acute appendicitis. The identification of risk factors for postoperative IAA could lead to a decrease in the readmission rate and surgery redoes after LA for acute appendicitis.

Materials And Methods: The present study retrospectively analyzed patients undergone LA for acute appendicitis during the period 2001-2017. Clinical, intraoperative, and postoperative outcomes were described. Comparison between groups was made via univariate and multivariate analyses.

Results: The charts of 2076 patients undergone LA were reviewed. Thirty-seven patients (1.8%) developed a postoperative IAA. Male gender (p < 0.05), ASA score ≥ 2 (p < 0.05), a gangrenous or perforated appendicitis (p < 0.0001), abscess or pelvic peritonitis (p < 0.0001), clipping the mesoappendix (p < 0.0001), appendix division by mechanical stapler (p < 0.05), prolonged antibiotic therapy (p < 0.05), and piperacillin/tazocin regimen (p < 0.0001) were significantly more frequent in the group of patients with IAA. In terms of multivariate analysis, only pelvic peritonitis (p = 0.010), perforated appendicitis (p = 0.0002), and clipping the mesoappendix (p = 0.0002) were independent predictive factors for postoperative IAA.

Conclusion: Patients with peritonitis or a perforated appendicitis, and those who had their mesoappendix clipped showed a higher likelihood of developing an IAA. At risk patients should be provided with careful follow-up for the early detection and management of this complication.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13304-020-00749-yDOI Listing
December 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13017-020-00306-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386163PMC
April 2020

COVID-19 the showdown for mass casualty preparedness and management: the Cassandra Syndrome.

World J Emerg Surg 2020 04 9;15(1):26. Epub 2020 Apr 9.

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

Since December 2019, the world is potentially facing one of the most difficult infectious situations of the last decades. COVID-19 epidemic warrants consideration as a mass casualty incident (MCI) of the highest nature. An optimal MCI/disaster management should consider all four phases of the so-called disaster cycle: mitigation, planning, response, and recovery. COVID-19 outbreak has demonstrated the worldwide unpreparedness to face a global MCI.This present paper thus represents a call for action to solicitate governments and the Global Community to actively start effective plans to promote and improve MCI management preparedness in general, and with an obvious current focus on COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13017-020-00304-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145275PMC
April 2020

Surgery in COVID-19 patients: operational directives.

World J Emerg Surg 2020 04 7;15(1):25. Epub 2020 Apr 7.

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

The current COVID-19 pandemic underlines the importance of a mindful utilization of financial and human resources. Preserving resources and manpower is paramount in healthcare. It is important to ensure the ability of surgeons and specialized professionals to function through the pandemic. A conscious effort should be made to minimize infection in this sector. A high mortality rate within this group would be detrimental.This manuscript is the result of a collaboration between the major Italian surgical and anesthesiologic societies: ACOI, SIC, SICUT, SICO, SICG, SIFIPAC, SICE, and SIAARTI. We aim to describe recommended clinical pathways for COVID-19-positive patients requiring acute non-deferrable surgical care. All hospitals should organize dedicated protocols and workforce training as part of the effort to face the current pandemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13017-020-00307-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137852PMC
April 2020