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1. Sustaining a Multidisciplinary, Single-Institution, Postoperative Mobilization Clinical Practice Improvement Program Following Hepatopancreatobiliary Surgery During the COVID-19 Pandemic: Prospective Cohort Study

Author

Kai Siang Chan, Bei Wang, Yen Pin Tan, Jaclyn Jie Ling Chow, Ee Ling Ong, Sameer P Junnarkar, Jee Keem Low, Cheong Wei Terence Huey, and Vishal G Shelat

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Surgery, RD1-811
Abstract

BackgroundThe Enhanced Recovery After Surgery (ERAS) protocol has been recently extended to hepatopancreatobiliary (HPB) surgery, with excellent outcomes reported. Early mobilization is an essential facet of the ERAS protocol, but compliance has been reported to be poor. We recently reported our success in a 6-month clinical practice improvement program (CPIP) for early postoperative mobilization. During the COVID-19 pandemic, we experienced reduced staffing and resource availability, which can make CPIP sustainability difficult. ObjectiveWe report outcomes at 1 year following the implementation of our CPIP to improve postoperative mobilization in patients undergoing major HPB surgery during the COVID-19 pandemic. MethodsWe divided our study into 4 phases—phase 1: before CPIP implementation (January to April 2019); phase 2: CPIP implementation (May to September 2019); phase 3: post–CPIP implementation but prior to the COVID-19 pandemic (October 2019 to March 2020); and phase 4: post–CPIP implementation and during the pandemic (April 2020 to September 2020). Major HPB surgery was defined as any surgery on the liver, pancreas, and biliary system with a duration of >2 hours and with an anticipated blood loss of ≥500 ml. Study variables included length of hospital stay, distance ambulated on postoperative day (POD) 2, morbidity, balance measures (incidence of fall and accidental dislodgement of drains), and reasons for failure to achieve targets. Successful mobilization was defined as the ability to sit out of bed for >6 hours on POD 1 and ambulate ≥30 m on POD 2. The target mobilization rate was ≥75%. ResultsA total of 114 patients underwent major HPB surgery from phases 2 to 4 of our study, with 33 (29.0%), 45 (39.5%), and 36 (31.6%) patients in phases 2, 3, and 4, respectively. No baseline patient demographic data were collected for phase 1 (pre–CPIP implementation). The majority of the patients were male (n=79, 69.3%) and underwent hepatic surgery (n=92, 80.7%). A total of 76 (66.7%) patients underwent ON-Q PainBuster insertion intraoperatively. The median mobilization rate was 22% for phase 1, 78% for phases 2 and 3 combined, and 79% for phase 4. The mean pain score was 2.7 (SD 1.0) on POD 1 and 1.8 (SD 1.5) on POD 2. The median length of hospitalization was 6 days (IQR 5-11.8). There were no falls or accidental dislodgement of drains. Six patients (5.3%) had pneumonia, and 21 (18.4%) patients failed to ambulate ≥30 m on POD 2 from phases 2 to 4. The most common reason for failure to achieve the ambulation target was pain (6/21, 28.6%) and lethargy or giddiness (5/21, 23.8%). ConclusionsThis follow-up study demonstrates the sustainability of our CPIP in improving early postoperative mobilization rates following major HPB surgery 1 year after implementation, even during the COVID-19 pandemic. Further large-scale, multi-institutional prospective studies should be conducted to assess compliance and determine its sustainability.

Published
2021
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2. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery

Author

Miklosh Bala, Fausto Catena, Jeffry Kashuk, Belinda De Simone, Carlos Augusto Gomes, Dieter Weber, Massimo Sartelli, Federico Coccolini, Yoram Kluger, Fikri M. Abu-Zidan, Edoardo Picetti, Luca Ansaloni, Goran Augustin, Walter L. Biffl, Marco Ceresoli, Osvaldo Chiara, Massimo Chiarugi, Raul Coimbra, Yunfeng Cui, Dimitris Damaskos, Salomone Di Saverio, Joseph M. Galante, Vladimir Khokha, Andrew W. Kirkpatrick, Kenji Inaba, Ari Leppäniemi, Andrey Litvin, Andrew B. Peitzman, Vishal G. Shelat, Michael Sugrue, Matti Tolonen, Sandro Rizoli, Ibrahima Sall, Solomon G. Beka, Isidoro Di Carlo, Richard Ten Broek, Chirika Mircea, Giovanni Tebala, Michele Pisano, Harry van Goor, Ronald V. Maier, Hans Jeekel, Ian Civil, Andreas Hecker, Edward Tan, Kjetil Soreide, Matthew J. Lee, Imtiaz Wani, Luigi Bonavina, Mark A. Malangoni, Kaoru Koike, George C. Velmahos, Gustavo P. Fraga, Andreas Fette, Nicola de’Angelis, Zsolt J. Balogh, Thomas M. Scalea, Gabriele Sganga, Michael D. Kelly, Jim Khan, Philip F. Stahel, and Ernest E. Moore

Subjects
Mesenteric ischemia, Mesenteric arterial occlusion, Mesenteric artery stenting, Bowel ischemia, Guidelines, Recommendations, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.

Published
2022
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3. Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

Author

Belinda De Simone, Elie Chouillard, Almino C. Ramos, Gianfranco Donatelli, Tadeja Pintar, Rahul Gupta, Federica Renzi, Kamal Mahawar, Brijesh Madhok, Stefano Maccatrozzo, Fikri M. Abu-Zidan, Ernest E. Moore, Dieter G. Weber, Federico Coccolini, Salomone Di Saverio, Andrew Kirkpatrick, Vishal G. Shelat, Francesco Amico, Emmanouil Pikoulis, Marco Ceresoli, Joseph M. Galante, Imtiaz Wani, Nicola De’ Angelis, Andreas Hecker, Gabriele Sganga, Edward Tan, Zsolt J. Balogh, Miklosh Bala, Raul Coimbra, Dimitrios Damaskos, Luca Ansaloni, Massimo Sartelli, Nikolaos Parasas, Yoram Kluger, Elias Chahine, Vanni Agnoletti, Gustavo Fraga, Walter L. Biffl, and Fausto Catena

Subjects
Abdominal pain, Bariatric surgery, Acute abdomen, Long-term complication, Emergency surgery, Sleeve gastrectomy, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Method A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Conclusions The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting.

Published
2022
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4. The acute phase management of spinal cord injury affecting polytrauma patients: the ASAP study

Author

Edoardo Picetti, Corrado Iaccarino, Raul Coimbra, Fikri Abu-Zidan, Giovanni D. Tebala, Zsolt J. Balogh, Walter L. Biffl, Federico Coccolini, Deepak Gupta, Ronald V. Maier, Ingo Marzi, Chiara Robba, Massimo Sartelli, Franco Servadei, Philip F. Stahel, Fabio S. Taccone, Andreas W. Unterberg, Marta Velia Antonini, Joseph M. Galante, Luca Ansaloni, Andrew W. Kirkpatrick, Sandro Rizoli, Ari Leppaniemi, Osvaldo Chiara, Belinda De Simone, Mircea Chirica, Vishal G. Shelat, Gustavo P. Fraga, Marco Ceresoli, Luca Cattani, Francesco Minardi, Edward Tan, Imtiaz Wani, Massimo Petranca, Francesco Domenichelli, Yunfeng Cui, Laura Malchiodi, Emanuele Sani, Andrey Litvin, Andreas Hecker, Vito Montanaro, Solomon Gurmu Beka, Salomone Di Saverio, Sandra Rossi, and Fausto Catena

Subjects
Polytrauma, Traumatic spinal cord injury, Management, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Few data on the management of acute phase of traumatic spinal cord injury (tSCI) in patients suffering polytrauma are available. As the therapeutic choices in the first hours may have a deep impact on outcome of tSCI patients, we conducted an international survey investigating this topic. Methods The survey was composed of 29 items. The main endpoints of the survey were to examine: (1) the hemodynamic and respiratory management, (2) the coagulation management, (3) the timing of magnetic resonance imaging (MRI) and spinal surgery, (4) the use of corticosteroid therapy, (5) the role of intraspinal pressure (ISP)/spinal cord perfusion pressure (SCPP) monitoring and (6) the utilization of therapeutic hypothermia. Results There were 171 respondents from 139 centers worldwide. A target mean arterial pressure (MAP) target of 80–90 mmHg was chosen in almost half of the cases [n = 84 (49.1%)]. A temporary reduction in the target MAP, for the time strictly necessary to achieve bleeding control in polytrauma, was accepted by most respondents [n = 100 (58.5%)]. Sixty-one respondents (35.7%) considered acceptable a hemoglobin (Hb) level of 7 g/dl in tSCI polytraumatized patients. An arterial partial pressure of oxygen (PaO2) of 80–100 mmHg [n = 94 (55%)] and an arterial partial pressure of carbon dioxide (PaCO2) of 35–40 mmHg [n = 130 (76%)] were chosen in most cases. A little more than half of respondents considered safe a platelet (PLT) count > 100.000/mm3 [n = 99 (57.9%)] and prothrombin time (PT)/activated partial thromboplastin time (aPTT)

Published
2022
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5. Predictors of mortality within the first year post-hepatectomy for hepatocellular carcinoma

Author

Sanaa Sheriff, Sudharsan Madhavan, Geraldine Yanlei Lei, Yiong Huak Chan, Sameer P. Junnarkar, Cheong Wei Huey, Jee Keem Low, and Vishal G. Shelat

Subjects
Liver, Surgery, Hepatectomy, Hepatocellular carcinoma, Mortality, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background Hepatic resection (HR) for hepatocellular carcinoma (HCC) is safe with good perioperative and long-term oncologic outcomes. There is a paucity of data with regards to intermediate-term outcomes (i.e., beyond 90-day and within 1-year mortality). This paper studies the risk factors for within 1-year mortality after elective HR with curative intent in patients with HCC. Methods An audit of patients who underwent curative HR for HCC from January 2007 to April 2016 was conducted. Univariate and multivariate analysis were sequentially performed on perioperative variables using Cox-regression analysis to identify factors predicting intermediate-term outcomes defined as within 1-year mortality. Kaplan–Meier survival curves and hazard ratios were obtained. Results Three hundred forty-eight patients underwent HR during the study period and 163 patients had curative hepatectomy for HCC. Fifteen patients (9.2%) died within 1-year after HR. Multivariate analysis identified Child-Pugh class B/C (HR 5.5, p = 0.035), multinodularity (HR 7.1, p = 0.001), macrovascular invasion (HR 4.2, p = 0.04) postoperative acute renal failure (HR 5.8, p = 0.049) and posthepatic liver failure (HR 9.6, p = 0.009) as significant predictors of 1-year mortality. Conclusion One-year mortality following HR for HCC remains high and can be predicted preoperatively by multinodularity, Child-Pugh class, and macrovascular invasion. Postoperative acute renal failure and liver failure are associated with 1-year mortality.

Published
2022
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6. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment

Author

Luke Smyth, Cino Bendinelli, Nicholas Lee, Matthew G. Reeds, Eu Jhin Loh, Francesco Amico, Zsolt J. Balogh, Salomone Di Saverio, Dieter Weber, Richard Peter ten Broek, Fikri M. Abu-Zidan, Giampiero Campanelli, Solomon Gurmu Beka, Massimo Chiarugi, Vishal G. Shelat, Edward Tan, Ernest Moore, Luigi Bonavina, Rifat Latifi, Andreas Hecker, Jim Khan, Raul Coimbra, Giovanni D. Tebala, Kjetil Søreide, Imtiaz Wani, Kenji Inaba, Andrew W. Kirkpatrick, Kaoru Koike, Gabriele Sganga, Walter L. Biffl, Osvaldo Chiara, Thomas M. Scalea, Gustavo P. Fraga, Andrew B. Peitzman, and Fausto Catena

Subjects
Penetrating trauma, Blunt trauma, Bowel injury, Bowel trauma, Bowel injury diagnosis, CT signs bowel injury, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract The aim of this paper was to review the recent literature to create recommendations for the day-to-day diagnosis and surgical management of small bowel and colon injuries. Where knowledge gaps were identified, expert consensus was pursued during the 8th International Congress of the World Society of Emergency Surgery Annual (September 2021, Edinburgh). This process also aimed to guide future research.

Published
2022
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7. It’s time for a minimum synoptic operation template in patients undergoing laparoscopic cholecystectomy: a systematic review

Author

Niall O’Connor, Michael Sugrue, Conor Melly, Gearoid McGeehan, Magda Bucholc, Aileen Crawford, Paul O’Connor, Fikri Abu-Zidan, Imtiaz Wani, Zsolt J. Balogh, Vishal G. Shelat, Giovanni D. Tebala, Belinda De Simone, Hani O. Eid, Mircea Chirica, Gustavo P. Fraga, Salomone Di Saverio, Edoardo Picetti, Luigi Bonavina, Marco Ceresoli, Andreas Fette, Boris Sakakushe, Emmanouil Pikoulis, Raul Coimbra, Richard ten Broek, Andreas Hecker, Ari Leppäniemi, Andrey Litvin, Philip Stahel, Edward Tan, Kaoru Koike, Fausto Catena, Michele Pisano, Federico Coccolini, and Alison Johnston

Subjects
Laparoscopic cholecystectomy, Synoptic reporting, Operation notes, Patient safety, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Despite the call to enhance accuracy and value of operation records few international recommended minimal standards for operative notes documentation have been described. This study undertook a systematic review of existing operative reporting systems for laparoscopic cholecystectomy (LC) to fashion a comprehensive, synoptic operative reporting template for the future. Methods A search for all relevant articles was conducted using PubMed version of Medline, Scopus and Web of Science databases in June 2021, for publications from January 1st 2011 to October 25th 2021, using the keywords: laparoscopic cholecystectomy AND operation notes OR operative notes OR proforma OR documentation OR report OR narrative OR audio-visual OR synoptic OR digital. Two reviewers (NOC, GMC) independently assessed each published study using a MINORS score of ≥ 16 for comparative and ≥ 10 for non-comparative for inclusion. This systematic review followed PRISMA guidelines and was registered with PROSPERO. Synoptic operative templates from published data were assimilated into one “ideal” laparoscopic operative report template following international input from the World Society of Emergency Surgery board. Results A total of 3567 articles were reviewed. Following MINORS grading 25 studies were selected spanning 14 countries and 4 continents. Twenty-two studies were prospective. A holistic overview of the operative procedure documentation was reported in 6/25 studies and a further 19 papers dealt with selective surgical aspects of LC. A unique synoptic LC operative reporting template was developed and translated into Chinese/Mandarin, French and Arabic. Conclusion This systematic review identified a paucity of publications dealing with operative reporting of LC. The proposed new template may be integrated digitally with hospitals’ medical systems and include additional narrative text and audio-visual data. The template may help define new OR (operating room) recording standards and impact on care for patients undergoing LC.

Published
2022
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8. It is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey

Author

Massimo Sartelli, Francesco M. Labricciosa, Federico Coccolini, Raul Coimbra, Fikri M. Abu-Zidan, Luca Ansaloni, Majdi N. Al-Hasan, Shamshul Ansari, Philip S. Barie, Miguel Angel Caínzos, Marco Ceresoli, Massimo Chiarugi, Jeffrey A. Claridge, Enrico Cicuttin, Evan Patchen Dellinger, Donald E. Fry, Xavier Guirao, Timothy Craig Hardcastle, Andreas Hecker, Ari K. Leppäniemi, Andrey Litvin, Sanjay Marwah, Emilio Maseda, John E. Mazuski, Ziad Ahmed Memish, Andrew W. Kirkpatrick, Leonardo Pagani, Mauro Podda, Huseyin Kemal Rasa, Boris E. Sakakushev, Robert G. Sawyer, Fabio Tumietto, Yonghong Xiao, Wedad Faraj Aboubreeg, Harissou Adamou, Lali Akhmeteli, Emrah Akin, Maria Grazia Alberio, Felipe Alconchel, Ibrahim Amadou Magagi, Ana Belén Araúz, Giulio Argenio, Boyko C. Atanasov, Semra Demirli Atici, Selmy Sabry Awad, Efstratia Baili, Lovenish Bains, Miklosh Bala, Oussama Baraket, Suman Baral, Vladislav A. Belskii, Moussa Benboubker, Offir Ben-Ishay, Pierpaolo Bordoni, Abdalia Boumédiène, Giuseppe Brisinda, Laura Cavazzuti, Sujith J. Chandy, Maria Michela Chiarello, Nicola Cillara, Guglielmo Clarizia, Maria-Elena Cocuz, Iuliu Gabriel Cocuz, Luigi Conti, Raffaella Coppola, Yunfeng Cui, Jacek Czepiel, Fabrizio D’Acapito, Dimitrios Damaskos, Koray Das, Belinda De Simone, Samir Delibegovic, Zaza Demetrashvili, Dzemail S. Detanac, Sameer Dhingra, Stefano Di Bella, Evgeni N. Dimitrov, Agron Dogjani, Mario D’Oria, Irina Magdalena Dumitru, Mutasim M. Elmangory, Octavian Enciu, Massimo Fantoni, Daniela Filipescu, Francesco Fleres, Domitilla Foghetti, Pietro Fransvea, Mahir Gachabayov, Rita Galeiras, Gianni Gattuso, Wagih M. Ghannam, Valeria Ghisetti, Giorgio Giraudo, Kebebe Bekele Gonfa, Emre Gonullu, Yousif Tag Elsir Y. Hamad, Matthias Hecker, Arda Isik, Nizar Ismail, Azzain Ismail, Sumita Agarwal Jain, Souha S. Kanj, Garima Kapoor, Ilias Karaiskos, Alfie J. Kavalakat, Jakub Kenig, Faryal Khamis, Vladimir Khokha, Ronald Kiguba, Jae Il Kim, Yoshiro Kobe, Kenneth Yuh Yen Kok, Bojan M. Kovacevic, Igor Andreevich Kryvoruchko, Akira Kuriyama, Aitor Landaluce-Olavarria, Konstantinos Lasithiotakis, Varut Lohsiriwat, Eftychios Lostoridis, Davide Luppi, Gustavo Miguel Machain Vega, Marc Maegele, Athanasios Marinis, Gennaro Martines, Aleix Martínez-Pérez, Damien Massalou, Cristian Mesina, Gökhan Metan, María Guadalupe Miranda-Novales, Shyam Kumar Mishra, Mohaned Ibrahim Hussein Mohamed, Ali Yasen Y. Mohamedahmed, Ismael Mora-Guzmán, Francesk Mulita, Ana-Maria Musina, Pradeep H. Navsaria, Ionut Negoi, Gabriela Elisa Nita, Donal B. O’Connor, Carlos Alberto Ordoñez, Desiré Pantalone, Arpád Panyko, Aristeidis Papadopoulos, Nikolaos Pararas, Francesco Pata, Tapan Patel, Gianluca Pellino, Teresa Perra, Gennaro Perrone, Antonio Pesce, Tadeja Pintar, Georgi Ivanov Popivanov, Alberto Porcu, Martha Alexa Quiodettis, Razrim Rahim, Ashrarur Rahman Mitul, Martin Reichert, Miran Rems, Glendee Yolande Reynolds Campbell, Nuno Rocha-Pereira, Gabriel Rodrigues, Gustavo Eduardo Roncancio Villamil, Stefano Rossi, Ibrahima Sall, Hossein Samadi Kafil, Diego Sasia, Jeremiah Seni, Charalampos Seretis, Mario Serradilla-Martín, Vishal G. Shelat, Boonying Siribumrungwong, Mihail Slavchev, Leonardo Solaini, Boun Kim Tan, Antonio Tarasconi, Dario Tartaglia, Elena Adelina Toma, Gia Tomadze, Adriana Toro, Marcos Roberto Tovani-Palone, Harry van Goor, Alin Vasilescu, Andras Vereczkei, Massimiliano Veroux, Sergio Alberto Weckmann, Lukas Werner Widmer, AliIbrahim Yahya, Sanoop K. Zachariah, Andee Dzulkarnaen Zakaria, Nadezhda Zubareva, Wietse P. Zuidema, Isidoro Di Carlo, Francesco Cortese, Gian Luca Baiocchi, Ronald V. Maier, and Fausto Catena

Subjects
Cross-sectional survey, Antimicrobial stewardship, Antibiotic prescribing, Antibiotic resistance, Infection prevention and control, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants’ perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.

Published
2022
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9. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections

Author

Massimo Sartelli, Federico Coccolini, Yoram Kluger, Ervis Agastra, Fikri M. Abu-Zidan, Ashraf El Sayed Abbas, Luca Ansaloni, Abdulrashid Kayode Adesunkanmi, Goran Augustin, Miklosh Bala, Oussama Baraket, Walter L. Biffl, Marco Ceresoli, Elisabetta Cerutti, Osvaldo Chiara, Enrico Cicuttin, Massimo Chiarugi, Raul Coimbra, Daniela Corsi, Francesco Cortese, Yunfeng Cui, Dimitris Damaskos, Nicola de’Angelis, Samir Delibegovic, Zaza Demetrashvili, Belinda De Simone, Stijn W. de Jonge, Stefano Di Bella, Salomone Di Saverio, Therese M. Duane, Paola Fugazzola, Joseph M. Galante, Wagih Ghnnam, George Gkiokas, Carlos Augusto Gomes, Ewen A. Griffiths, Timothy C. Hardcastle, Andreas Hecker, Torsten Herzog, Aleksandar Karamarkovic, Vladimir Khokha, Peter K. Kim, Jae Il Kim, Andrew W. Kirkpatrick, Victor Kong, Renol M. Koshy, Kenji Inaba, Arda Isik, Rao Ivatury, Francesco M. Labricciosa, Yeong Yeh Lee, Ari Leppäniemi, Andrey Litvin, Davide Luppi, Ronald V. Maier, Athanasios Marinis, Sanjay Marwah, Cristian Mesina, Ernest E. Moore, Frederick A. Moore, Ionut Negoi, Iyiade Olaoye, Carlos A. Ordoñez, Mouaqit Ouadii, Andrew B. Peitzman, Gennaro Perrone, Tadeja Pintar, Giuseppe Pipitone, Mauro Podda, Kemal Raşa, Julival Ribeiro, Gabriel Rodrigues, Ines Rubio-Perez, Ibrahima Sall, Norio Sato, Robert G. Sawyer, Vishal G. Shelat, Michael Sugrue, Antonio Tarasconi, Matti Tolonen, Bruno Viaggi, Andrea Celotti, Claudio Casella, Leonardo Pagani, Sameer Dhingra, Gian Luca Baiocchi, and Fausto Catena

Subjects
Skin and soft-tissue infections, Necrotizing soft-tissue infections, Necrotizing infections, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract 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. Together, the World Society of Emergency Surgery, the Global Alliance for Infections in Surgery, the Surgical Infection Society-Europe, The World Surgical Infection Society, and the American Association for the Surgery of Trauma have jointly completed an international multi-society document to promote global standards of care in SSTIs guiding clinicians by describing reasonable approaches to the management of SSTIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting evidence was shared by an international task force with different clinical backgrounds.

Published
2022
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10. The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly

Author

Paola Fugazzola, Marco Ceresoli, Federico Coccolini, Francesco Gabrielli, Alessandro Puzziello, Fabio Monzani, Bruno Amato, Gabriele Sganga, Massimo Sartelli, Francesco Menichetti, Gabriele Adolfo Puglisi, Dario Tartaglia, Paolo Carcoforo, Nicola Avenia, Yoram Kluger, Ciro Paolillo, Mauro Zago, Ari Leppäniemi, Matteo Tomasoni, Lorenzo Cobianchi, Francesca Dal Mas, Mario Improta, Ernest E. Moore, Andrew B. Peitzman, Michael Sugrue, Vanni Agnoletti, Gustavo P. Fraga, Dieter G. Weber, Dimitrios Damaskos, Fikri M. Abu-Zidan, Imtiaz Wani, Andrew W. Kirkpatrick, Manos Pikoulis, Nikolaos Pararas, Edward Tan, Richard Ten Broek, Ronald V. Maier, R. Justin Davies, Jeffry Kashuk, Vishal G. Shelat, Alain Chicom Mefire, Goran Augustin, Stefano Magnone, Elia Poiasina, Belinda De Simone, Massimo Chiarugi, Walt Biffl, Gian Luca Baiocchi, Fausto Catena, and Luca Ansaloni

Subjects
Acute diverticulitis, Elderly, Surgery in elderly, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Acute left colonic diverticulitis (ALCD) in the elderly presents with unique epidemiological features when compared with younger patients. The clinical presentation is more nuanced in the elderly population, having higher in-hospital and postoperative mortality. Furthermore, geriatric comorbidities are a risk factor for complicated diverticulitis. Finally, elderly patients have a lower risk of recurrent episodes and, in case of recurrence, a lower probability of requiring urgent surgery than younger patients. The aim of the present work is to study age-related factors that may support a unique approach to the diagnosis and treatment of this problem in the elderly when compared with the WSES guidelines for the management of acute left-sided colonic diverticulitis. During the 1° Pisa Workshop of Acute Care & Trauma Surgery held in Pisa (Italy) in September 2019, with the collaboration of the World Society of Emergency Surgery (WSES), the Italian Society of Geriatric Surgery (SICG), the Italian Hospital Surgeons Association (ACOI), the Italian Emergency Surgery and Trauma Association (SICUT), the Academy of Emergency Medicine and Care (AcEMC) and the Italian Society of Surgical Pathophysiology (SIFIPAC), three panel members presented a number of statements developed for each of the four themes regarding the diagnosis and management of ALCD in older patients, formulated according to the GRADE approach, at a Consensus Conference where a panel of experts participated. The statements were subsequently debated, revised, and finally approved by the Consensus Conference attendees. The current paper is a summary report of the definitive guidelines statements on each of the following topics: diagnosis, management, surgical technique and antibiotic therapy.

Published
2022
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11. A pandemic recap: lessons we have learned

Author

Federico Coccolini, Enrico Cicuttin, Camilla Cremonini, Dario Tartaglia, Bruno Viaggi, Akira Kuriyama, Edoardo Picetti, Chad Ball, Fikri Abu-Zidan, Marco Ceresoli, Bruno Turri, Sumita Jain, Carlo Palombo, Xavier Guirao, Gabriel Rodrigues, Mahir Gachabayov, Fernando Machado, Lostoridis Eftychios, Souha S. Kanj, Isidoro Di Carlo, Salomone Di Saverio, Vladimir Khokha, Andrew Kirkpatrick, Damien Massalou, Francesco Forfori, Francesco Corradi, Samir Delibegovic, Gustavo M. Machain Vega, Massimo Fantoni, Demetrios Demetriades, Garima Kapoor, Yoram Kluger, Shamshul Ansari, Ron Maier, Ari Leppaniemi, Timothy Hardcastle, Andras Vereczkei, Evika Karamagioli, Emmanouil Pikoulis, Mauro Pistello, Boris E. Sakakushev, Pradeep H. Navsaria, Rita Galeiras, Ali I. Yahya, Aleksei V. Osipov, Evgeni Dimitrov, Krstina Doklestić, Michele Pisano, Paolo Malacarne, Paolo Carcoforo, Maria Grazia Sibilla, Igor A. Kryvoruchko, Luigi Bonavina, Jae Il Kim, Vishal G. Shelat, Jacek Czepiel, Emilio Maseda, Sanjay Marwah, Mircea Chirica, Giandomenico Biancofiore, Mauro Podda, Lorenzo Cobianchi, Luca Ansaloni, Paola Fugazzola, Charalampos Seretis, Carlos Augusto Gomez, Fabio Tumietto, Manu Malbrain, Martin Reichert, Goran Augustin, Bruno Amato, Alessandro Puzziello, Andreas Hecker, Angelo Gemignani, Arda Isik, Alessandro Cucchetti, Mirco Nacoti, Doron Kopelman, Cristian Mesina, Wagih Ghannam, Offir Ben-Ishay, Sameer Dhingra, Raul Coimbra, Ernest E. Moore, Yunfeng Cui, Martha A. Quiodettis, Miklosh Bala, Mario Testini, Jose Diaz, Massimo Girardis, Walter L. Biffl, Matthias Hecker, Ibrahima Sall, Ugo Boggi, Gabriele Materazzi, Lorenzo Ghiadoni, Junichi Matsumoto, Wietse P. Zuidema, Rao Ivatury, Mushira A. Enani, Andrey Litvin, Majdi N. Al-Hasan, Zaza Demetrashvili, Oussama Baraket, Carlos A. Ordoñez, Ionut Negoi, Ronald Kiguba, Ziad A. Memish, Mutasim M. Elmangory, Matti Tolonen, Korey Das, Julival Ribeiro, Donal B. O’Connor, Boun Kim Tan, Harry Van Goor, Suman Baral, Belinda De Simone, Davide Corbella, Pietro Brambillasca, Michelangelo Scaglione, Fulvio Basolo, Nicola De’Angelis, Cino Bendinelli, Dieter Weber, Leonardo Pagani, Cinzia Monti, Gianluca Baiocchi, Massimo Chiarugi, Fausto Catena, and Massimo Sartelli

Subjects
Pandemia, International, Thoughts, Reflection, Ethics, Biology, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.

Published
2021
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12. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections

Author

Massimo Sartelli, Federico Coccolini, Yoram Kluger, Ervis Agastra, Fikri M. Abu-Zidan, Ashraf El Sayed Abbas, Luca Ansaloni, Abdulrashid Kayode Adesunkanmi, Boyko Atanasov, Goran Augustin, Miklosh Bala, Oussama Baraket, Suman Baral, Walter L. Biffl, Marja A. Boermeester, Marco Ceresoli, Elisabetta Cerutti, Osvaldo Chiara, Enrico Cicuttin, Massimo Chiarugi, Raul Coimbra, Elif Colak, Daniela Corsi, Francesco Cortese, Yunfeng Cui, Dimitris Damaskos, Nicola de’ Angelis, Samir Delibegovic, Zaza Demetrashvili, Belinda De Simone, Stijn W. de Jonge, Sameer Dhingra, Stefano Di Bella, Francesco Di Marzo, Salomone Di Saverio, Agron Dogjani, Therese M. Duane, Mushira Abdulaziz Enani, Paola Fugazzola, Joseph M. Galante, Mahir Gachabayov, Wagih Ghnnam, George Gkiokas, Carlos Augusto Gomes, Ewen A. Griffiths, Timothy C. Hardcastle, Andreas Hecker, Torsten Herzog, Syed Mohammad Umar Kabir, Aleksandar Karamarkovic, Vladimir Khokha, Peter K. Kim, Jae Il Kim, Andrew W. Kirkpatrick, Victor Kong, Renol M. Koshy, Igor A. Kryvoruchko, Kenji Inaba, Arda Isik, Katia Iskandar, Rao Ivatury, Francesco M. Labricciosa, Yeong Yeh Lee, Ari Leppäniemi, Andrey Litvin, Davide Luppi, Gustavo M. Machain, Ronald V. Maier, Athanasios Marinis, Cristina Marmorale, Sanjay Marwah, Cristian Mesina, Ernest E. Moore, Frederick A. Moore, Ionut Negoi, Iyiade Olaoye, Carlos A. Ordoñez, Mouaqit Ouadii, Andrew B. Peitzman, Gennaro Perrone, Manos Pikoulis, Tadeja Pintar, Giuseppe Pipitone, Mauro Podda, Kemal Raşa, Julival Ribeiro, Gabriel Rodrigues, Ines Rubio-Perez, Ibrahima Sall, Norio Sato, Robert G. Sawyer, Helmut Segovia Lohse, Gabriele Sganga, Vishal G. Shelat, Ian Stephens, Michael Sugrue, Antonio Tarasconi, Joel Noutakdie Tochie, Matti Tolonen, Gia Tomadze, Jan Ulrych, Andras Vereczkei, Bruno Viaggi, Chiara Gurioli, Claudio Casella, Leonardo Pagani, Gian Luca Baiocchi, and Fausto Catena

Subjects
Intra-abdominal infections, Peritonitis, Sepsis, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The cornerstones of effective treatment of IAIs include early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using a critical care environment, combined with an optimal surgical approach. Together, the World Society of Emergency Surgery (WSES), the Global Alliance for Infections in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) have jointly completed an international multi-society document in order to facilitate clinical management of patients with IAIs worldwide building evidence-based clinical pathways for the most common IAIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting information was shared by an international task force from 46 countries with different clinical backgrounds. The aim of the document is to promote global standards of care in IAIs providing guidance to clinicians by describing reasonable approaches to the management of IAIs.

Published
2021
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13. Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

Author

Federico Coccolini, Mario Improta, Massimo Sartelli, Kemal Rasa, Robert Sawyer, Raul Coimbra, Massimo Chiarugi, Andrey Litvin, Timothy Hardcastle, Francesco Forfori, Jean-Louis Vincent, Andreas Hecker, Richard Ten Broek, Luigi Bonavina, Mircea Chirica, Ugo Boggi, Emmanuil Pikoulis, Salomone Di Saverio, Philippe Montravers, Goran Augustin, Dario Tartaglia, Enrico Cicuttin, Camilla Cremonini, Bruno Viaggi, Belinda De Simone, Manu Malbrain, Vishal G. Shelat, Paola Fugazzola, Luca Ansaloni, Arda Isik, Ines Rubio, Itani Kamal, Francesco Corradi, Antonio Tarasconi, Stefano Gitto, Mauro Podda, Anastasia Pikoulis, Ari Leppaniemi, Marco Ceresoli, Oreste Romeo, Ernest E. Moore, Zaza Demetrashvili, Walter L. Biffl, Imitiaz Wani, Matti Tolonen, Therese Duane, Sameer Dhingra, Nicola DeAngelis, Edward Tan, Fikri Abu-Zidan, Carlos Ordonez, Yunfeng Cui, Francesco Labricciosa, Gennaro Perrone, Francesco Di Marzo, Andrew Peitzman, Boris Sakakushev, Michael Sugrue, Marja Boermeester, Ramiro Manzano Nunez, Carlos Augusto Gomes, Miklosh Bala, Yoram Kluger, and Fausto Catena

Subjects
Infections, Intra-abdominal, Peritonitis, Cholecystitis, Appendicitis, Diverticulitis, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Immunocompromised patients are a heterogeneous and diffuse category frequently presenting to the emergency department with acute surgical diseases. Diagnosis and treatment in immunocompromised patients are often complex and must be multidisciplinary. Misdiagnosis of an acute surgical disease may be followed by increased morbidity and mortality. Delayed diagnosis and treatment of surgical disease occur; these patients may seek medical assistance late because their symptoms are often ambiguous. Also, they develop unique surgical problems that do not affect the general population. Management of this population must be multidisciplinary. This paper presents the World Society of Emergency Surgery (WSES), Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), and Global Alliance for Infection in Surgery (GAIS) joined guidelines about the management of acute abdomen in immunocompromised patients.

Published
2021
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14. Diverticular Disease of the Appendix Is Associated with Complicated Appendicitis

Author

Ming Li Chia, Shaun Wen Yang Chan, and Vishal G. Shelat

Subjects
diverticular disease of appendix, appendicitis, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Introduction: Diverticular disease of the vermiform appendix (DDA) has an incidence of 0.004 to 2.1% in appendicectomy specimens. DDA is variably associated with perforation and malignancy. We report a single-center experience of DDA. The primary aim is to validate the association of DDA with complicated appendicitis or malignancy, and the secondary aim is to validate systemic inflammatory response syndrome (SIRS) criteria and quick Sepsis-related Organ Failure Assessment (qSOFA) scores. Methods: The histopathology reports of 2,305 appendicectomy specimens from January 2011 to December 2015 were reviewed. Acute appendicitis was found in 2,164 (93.9%) specimens. Histology of the remaining 141 (6.1%) patients revealed: normal appendix (n = 110), DDA (n = 22), endometriosis of appendix (n = 6), and an absent appendix (n = 3). Patient demographics, clinical profile, operative data, and perioperative outcomes of DDA patients are studied. Modified Alvarado score, Andersson score, SIRS criteria, and qSOFA scores were retrospectively calculated. Results: The incidence of DDA was 0.95%. Ten patients (45.5%) had diverticulitis. The mean age of DDA patients was 39.5 years (range 23–87), with male preponderance (n = 12, 54.5%). The median Modified Alvarado score was 8 (range 4–9), and the median Andersson score was 5 (range 2–8). Fourteen patients (63.6%) had SIRS, and none had a high qSOFA score. Eight patients (36.4%) had complicated appendicitis (perforation [n = 2] or abscess [n = 6]). Eleven (50%) patients underwent laparoscopic appendicectomy. There were three 30-day readmissions and no mortality. Conclusion: DDA is a distinct clinical pathology associated with complicated appendicitis.

Published
2020
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15. Demographics, Radiological Findings, and Clinical Outcomes of Klebsiella pneumonia vs. Non-Klebsiella pneumoniae Pyogenic Liver Abscess: A Systematic Review and Meta-Analysis with Trial Sequential Analysis

Author

Kai Siang Chan, Christopher Tze Wei Chia, and Vishal G. Shelat

Subjects
Escherichia coli, hepatic abscess, liver abscess, Klebsiella pneumoniae, percutaneous drainage, surgical drainage, Medicine
Abstract

Pyogenic liver abscess (PLA) is a common cause of hepatobiliary sepsis. Klebsiella pneumoniae (KP) is the most common organism causing PLA. Evidence is scarce on the demographics, radiological findings, and outcomes of KPPLA versus non-KPPLA (N-KPPLA). PubMed, Embase, The Cochrane Library, and Scopus were systematically searched until 14 May 2022 for studies comparing KPPLA and N-KPPLA. Exclusion criteria were single-arm studies. Primary outcomes were mortality (30-day/in-hospital) and metastatic complications. There were 16 studies, including 5127 patients (KPPLA n = 3305, N-KPPLA n = 1822). Patients with KPPLA were younger (mean difference: −2.04 years, p = 0.02). History of hepatobiliary disease (Odds ratio (OR) 0.30, 95% CI: 0.20, 0.46) and malignancy (OR 0.26, 95% CI: 0.16, 0.42) were less common in KPPLA. KPPLA was associated with lower incidence of multiple abscesses (OR 0.52, 95% CI: 0.35, 0.76, p < 0.001) and bilobar abscesses (OR 0.60, 95% CI: 0.49, 0.74, p < 0.001). KPPLA has higher overall metastatic complications (KPPLA 9.7% vs. N-KPPLA 4.8%, OR 3.16, 95% CI: 2.00, 4.99, p < 0.001), but lower mortality (KPPLA 3.9% vs. N-KPPLA 7.6%, OR 0.51, 95% CI: 0.34, 0.78, p < 0.001). Trial sequential analysis showed conclusive evidence that KPPLA has lower mortality than N-KPPLA. In conclusion, KPPLA has lower mortality than N-KPPLA.

Published
2022
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16. 2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

Author

Massimo Sartelli, Stefano Di Bella, Lynne V. McFarland, Sahil Khanna, Luis Furuya-Kanamori, Nadir Abuzeid, Fikri M. Abu-Zidan, Luca Ansaloni, Goran Augustin, Miklosh Bala, Offir Ben-Ishay, Walter L. Biffl, Stephen M. Brecher, Adrián Camacho-Ortiz, Miguel A. Caínzos, Shirley Chan, Jill R. Cherry-Bukowiec, Jesse Clanton, Federico Coccolini, Maria E. Cocuz, Raul Coimbra, Francesco Cortese, Yunfeng Cui, Jacek Czepiel, Zaza Demetrashvili, Isidoro Di Carlo, Salomone Di Saverio, Irina M. Dumitru, Christian Eckmann, Edward H. Eiland, Joseph D. Forrester, Gustavo P. Fraga, Jean L. Frossard, Donald E. Fry, Rita Galeiras, Wagih Ghnnam, Carlos A. Gomes, Ewen A. Griffiths, Xavier Guirao, Mohamed H. Ahmed, Torsten Herzog, Jae Il Kim, Tariq Iqbal, Arda Isik, Kamal M. F. Itani, Francesco M. Labricciosa, Yeong Y. Lee, Paul Juang, Aleksandar Karamarkovic, Peter K. Kim, Yoram Kluger, Ari Leppaniemi, Varut Lohsiriwat, Gustavo M. Machain, Sanjay Marwah, John E. Mazuski, Gokhan Metan, Ernest E. Moore, Frederick A. Moore, Carlos A. Ordoñez, Leonardo Pagani, Nicola Petrosillo, Francisco Portela, Kemal Rasa, Miran Rems, Boris E. Sakakushev, Helmut Segovia-Lohse, Gabriele Sganga, Vishal G. Shelat, Patrizia Spigaglia, Pierre Tattevin, Cristian Tranà, Libor Urbánek, Jan Ulrych, Pierluigi Viale, Gian L. Baiocchi, and Fausto Catena

Subjects
Clostridioides difficile infection, Clostridium difficile infection, Pseudomembranous colitis, Antimicrobial treatment, Fecal microbiota transplantation, Infection control, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.

Published
2019
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17. Six Long-Standing Questions about Antibiotic Prophylaxis in Surgery

Author

Massimo Sartelli, Marja A. Boermeester, Miguel Cainzos, Federico Coccolini, Stijn W. de Jonge, Kemal Rasa, E. Patchen Dellinger, Deborah A. McNamara, Donald E. Fry, Yunfeng Cui, Samir Delibegovic, Zaza Demetrashvili, Belinda De Simone, George Gkiokas, Timothy C. Hardcastle, Kamal M. F. Itani, Arda Isik, Francesco Maria Labricciosa, Varut Lohsiriwat, Sanjay Marwah, Tadeja Pintar, Jennifer Rickard, Vishal G. Shelat, Fausto Catena, and Philip S. Barie

Subjects
Microbiology (medical), Infectious Diseases, healthcare-associated infections, surgical antibiotic prophylaxis, Pharmacology (medical), surgical site infections, General Pharmacology, Toxicology and Pharmaceutics, Biochemistry, Microbiology
Abstract

Surgical site infections (SSIs) are the most common adverse event occurring in surgical patients. Optimal prevention of SSIs requires the bundled integration of a variety of measures before, during, and after surgery. Surgical antibiotic prophylaxis (SAP) is an effective measure for preventing SSIs. It aims to counteract the inevitable introduction of bacteria that colonize skin or mucosa into the surgical site during the intervention. This document aims to guide surgeons in appropriate administration of SAP by addressing six key questions. The expert panel identifies a list of principles in response to these questions that every surgeon around the world should always respect in administering SAP.

Published
2023

18. Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Author

Reichert, Martin, Sartelli, Massimo, Weigand, Markus A, Hecker, Matthias, Oppelt, Philip U, Noll, Julia, Askevold, Ingolf H, Liese, Juliane, Padberg, Winfried, Coccolini, Federico, Catena, Fausto, Hecker, Andreas, Adam Peckham-Cooper, Adrian Camacho-Ortiz, Aikaterini T. Mastoraki, Aitor Landaluce-Olavarria, Ajay Kumar Pal, Akira Kuriyama, Alain Chichom-Mefire, Alberto Porcu, Aleix Martínez-Pérez, Aleksandar R. Karamarkovic, Aleksei V. Osipov, Alessandro Coppola, Alessandro Cucchetti, Alessandro Spolini, Alessio Giordano, Alexander Reinisch-Liese, Alfie J. Kavalakat, Alin Vasilescu, Amin Alamin, Amit Gupta, Ana Maria Dascalu, Ana-Maria Musina, Anargyros Bakopoulos, Andee Dzulkarnaen Zakaria, Andras Vereczkei, Andrea Balla, Andrea Bottari, Andreas Baumann, Andreas Fette, Andrey Litvin, Aniella Katharina Reichert, Anna Guariniello, Anna Paspala, Anne-Sophie Schneck, Antonio Brillantino, Antonio Pesce, Arda Isik, Ari Kalevi Leppäniemi, Aristeidis Papadopoulos, Aristotelis Kechagias, Ashraf Yehya Abdalla Mohamed, Ashrarur Rahman Mitul, Athanasios Marinis, Athanasios Syllaios, Baris Mantoglu, Belinda De Simone, Benjamin Stefan Weiss, Bernd Pösentrup, Biagio Picardi, Biagio Zampogna, Boris Eugeniev Sakakushev, Boyko Chavdarov Atanasov, Bruno Nardo, Bulent Calik, Camilla Cremonini, Carlos A. Ordoñez, Charalampos Seretis, Chiara Cascone, Christos Chouliaras, Cino Bendinelli, Claudia Lopes, Claudio Guerci, Clemens Weber, Constantinos Nastos, Cristian Mesina, Damiano Caputo, Damien Massalou, Davide Cavaliere, Deborah A. McNamara, Demetrios Demetriades, Desirè Pantalone, Diego Coletta, Diego Sasia, Diego Visconti, Dieter G. Weber, Diletta Corallino, Dimitrios Chatzipetris, Dimitrios K. Manatakis, Dimitrios Ntourakis, Dimitrios Papaconstantinou, Dimitrios Schizas, Dimosthenis Chrysikos, Dmitry Mikhailovich Adamovich, Doaa Elkafrawy, Dragos Seban, Edgar Fernando Hernandez García, Edoardo Baldini, Edoardo Picetti, Edward C. T. H. Tan, Efstratia Baili, Eftychios Lostoridis, Elena Adelina Toma, Elif Colak, Elisabetta Cerutti, Elmin Steyn, Elmuiz A. Hsabo, Emmanouil Ioannis Kapetanakis, Emmanouil Kaouras, Emmanuel Schneck, Emrah Akin, Emre Gonullu, Enes çelik, Enrico Cicuttin, Enrico Pinotti, Erik Johnsson, Ernest E. Moore, Ervis Agastra, Evgeni Nikolaev Dimitrov, Ewen A. Griffiths, Fabrizio D’Acapito, Federica Saraceno, Felipe Alconchel, Felix Alexander Zeppernick, Fernando Machado Rodríguez, Fikri Abu-Zidan, Francesca Pecchini, Francesco Favi, Francesco Ferrara, Francesco Fleres, Francesco Pata, Francesco Pietro Maria Roscio, Francesk Mulita, Frank J. M. F. Dor, Fredrik Linder, Gabriel Dimofte, Gabriel Rodrigues, Gabriela Nita, Gabriele Sganga, Gennaro Martines, Gennaro Mazzarella, Gennaro Perrone, George Velmahos, Georgios D. Lianos, Gia Tomadze, Gian Luca Baiocchi, Giancarlo D’Ambrosio, Gianluca Pellino, Gianmaria Casoni Pattacini, Giorgio Giraudo, Giorgio Lisi, Giovanni Domenico Tebala, Giovanni Pirozzolo, Giulia Montori, Giulio Argenio, Giuseppe Brisinda, Giuseppe Currò, Giuseppe Giuliani, Giuseppe Palomba, Giuseppe Roscitano, Gökhan Avşar, Goran Augustin, Guglielmo Clarizia, Gustavo M. Machain Vega, Gustavo P. Fraga, Harsheet Sethi, Hazim Abdulnassir Eltyeb, Helmut A. Segovia Lohse, Herald René Segovia Lohse, Hüseyin Bayhan, Hytham K. S. Hamid, Igor A. Kryvoruchko, Immacolata Iannone, Imtiaz Wani, Ioannis I. Lazaridis, Ioannis Katsaros, Ioannis Nikolopoulos, Ionut Negoi, Isabella Reccia, Isidoro Di Carlo, Iyiade Olatunde Olaoye, Jacek Czepiel, Jae Il Kim, Jeremy Meyer, Jesus Manuel Saenz Terrazas, Joel Noutakdie Tochie, Joseph M. Galante, Justin Davies, Kapil Sugand, Kebebe Bekele Gonfa, Kemal Rasa, Kenneth Y. Y. Kok, Konstantinos G. Apostolou, Konstantinos Lasithiotakis, Konstantinos Tsekouras, Kumar Angamuthu, Lali Akhmeteli, Larysa Sydorchuk, Laura Fortuna, Leandro Siragusa, Leonardo Pagani, Leonardo Solaini, Lisa A. Miller, Lovenish Bains, Luca Ansaloni, Luca Ferrario, Luigi Bonavina, Luigi Conti, Luis Antonio Buonomo, Luis Tallon-Aguilar, Lukas Tomczyk, Lukas Werner Widmer, Maciej Walędziak, Mahir Gachabayov, Maloni M. Bulanauca, Manu L. N. G. Malbrain, Marc Maegele, Marco Catarci, Marco Ceresoli, Maria Chiara Ranucci, Maria Ioanna Antonopoulou, Maria Papadoliopoulou, Maria Rosaria Valenti, Maria Sotiropoulou, Mario D’Oria, Mario Serradilla Martín, Markus Hirschburger, Massimiliano Veroux, Massimo Fantoni, Matteo Nardi, Matti Tolonen, Mauro Montuori, Mauro Podda, Maximilian Scheiterle, Maximos Frountzas, Mehmet Sarıkaya, Mehmet Yildirim, Michael Bender, Michail Vailas, Michel Teuben, Michela Campanelli, Michele Ammendola, Michele Malerba, Michele Pisano, Mihaela Pertea, Mihail Slavchev, Mika Ukkonen, Miklosh Bala, Mircea Chirica, Mirko Barone, Mohamed Maher Shaat, Mohammed Jibreel Suliman Mohammed, Mona Awad Akasha Abuelgasim, Monika Gureh, Mouaqit Ouadii, Mujdat Balkan, Mumin Mohamed, Musluh Hakseven, Natalia Velenciuc, Nicola Cillara, Nicola de’Angelis, Nicolò Tamini, Nikolaos J. Zavras, Nikolaos Machairas, Nikolaos Michalopoulos, Nikolaos N. Koliakos, Nikolaos Pararas, Noel E. Donlon, Noushif Medappil, Offir Ben-Ishay, Olmi Stefano, Omar Islam, Ömer Tammo, Orestis Ioannidis, Oscar Aparicio, Oussama Baraket, Pankaj Kumar, Pasquale Cianci, Per Örtenwall, Petar Angelov Uchikov, Philip de Reuver, Philip F. Stahel, Philip S. Barie, Micaela Piccoli, Piotr Major, Pradeep H. Navsaria, Prakash Kumar Sasmal, Raul Coimbra, Razrim Rahim, Recayi Çapoğlu, Renol M. Koshy, Ricardo Alessandro Teixeira Gonsaga, Riccardo Pertile, Rifat Ramadan Mussa Mohamed, Rıza Deryol, Robert G. Sawyer, Roberta Angelico, Roberta Ragozzino, Roberto Bini, Roberto Cammarata, Rosa Scaramuzzo, Rossella Gioco, Ruslan Sydorchuk, Salma Ahmed, Salomone Di Saverio, Sameh Hany Emile, Samir Delibegovic, Sanjay Marwah, Savvas Symeonidis, Scott G. Thomas, Sebahattin Demir, Selmy S. Awad, Semra Demirli Atici, Serge Chooklin, Serhat Meric, Sevcan Sarıkaya, Sharfuddin Chowdhury, Shaza Faycal Mirghani, Sherry M. Wren, Simone Gargarella, Simone Rossi Del Monte, Sofia Esposito, Sofia Xenaki, Soliman Fayez Ghedan Mohamed, Solomon Gurmu Beka, Sorinel Lunca, Spiros G. Delis, Spyridon Dritsas, Stefan Morarasu, Stefano Magnone, Stefano Rossi, Stefanos Bitsianis, Stylianos Kykalos, Suman Baral, Sumita A. Jain, Syed Muhammad Ali, Tadeja Pintar, Tania Triantafyllou, Tarik Delko, Teresa Perra, Theodoros A. Sidiropoulos, Thomas M. Scalea, Tim Oliver Vilz, Timothy Craig Hardcastle, Tongporn Wannatoop, Torsten Herzog, Tushar Subhadarshan Mishra, Ugo Boggi, Valentin Calu, Valentina Tomajer, Vanni Agnoletti, Varut Lohsiriwat, Victor Kong, Virginia Durán Muñoz-Cruzado, Vishal G. Shelat, Vladimir Khokha, Wagih Mommtaz Ghannam, Walter L. Biffl, Wietse Zuidema, Yasin Kara, Yoshiro Kobe, Zaza Demetrashvili, Ziad A. Memish, Zoilo Madrazo, Zsolt J. Balogh, Zulfu Bayhan, Surgery, AMS - Musculoskeletal Health, Other Research, APH - Quality of Care, Reichert, Martin, Sartelli, Massimo, Weigand, Markus A, Hecker, Matthia, Oppelt, Philip U, Noll, Julia, Askevold, Ingolf H, Liese, Juliane, Padberg, Winfried, Coccolini, Federico, Catena, Fausto, Hecker, Andrea, Adam Peckham-Cooper, Adrian Camacho-Ortiz, Aikaterini T. Mastoraki, Aitor Landaluce-Olavarria, Ajay Kumar Pal, Akira Kuriyama, Alain Chichom-Mefire, Alberto Porcu, Aleix Martínez-Pérez, Aleksandar R. Karamarkovic, Aleksei V. Osipov, Alessandro Coppola, Alessandro Cucchetti, Alessandro Spolini, Alessio Giordano, Alexander Reinisch-Liese, Alfie J. Kavalakat, Alin Vasilescu, Amin Alamin, Amit Gupta, Ana Maria Dascalu, Ana-Maria Musina, Anargyros Bakopoulos, Andee Dzulkarnaen Zakaria, Andras Vereczkei, Andrea Balla, Andrea Bottari, Andreas Baumann, Andreas Fette, Andrey Litvin, Aniella Katharina Reichert, Anna Guariniello, Anna Paspala, Anne-Sophie Schneck, Antonio Brillantino, Antonio Pesce, Arda Isik, Ari Kalevi Leppäniemi, Aristeidis Papadopoulos, Aristotelis Kechagias, Ashraf Yehya Abdalla Mohamed, Ashrarur Rahman Mitul, Athanasios Marinis, Athanasios Syllaios, Baris Mantoglu, Belinda De Simone, Benjamin Stefan Weiss, Bernd Pösentrup, Biagio Picardi, Biagio Zampogna, Boris Eugeniev Sakakushev, Boyko Chavdarov Atanasov, Bruno Nardo, Bulent Calik, Camilla Cremonini, Carlos A. Ordoñez, Charalampos Seretis, Chiara Cascone, Christos Chouliaras, Cino Bendinelli, Claudia Lopes, Claudio Guerci, Clemens Weber, Constantinos Nastos, Cristian Mesina, Damiano Caputo, Damien Massalou, Davide Cavaliere, Deborah A. McNamara, Demetrios Demetriades, Desirè Pantalone, Diego Coletta, Diego Sasia, Diego Visconti, Dieter G. Weber, Diletta Corallino, Dimitrios Chatzipetris, Dimitrios K. Manatakis, Dimitrios Ntourakis, Dimitrios Papaconstantinou, Dimitrios Schizas, Dimosthenis Chrysikos, Dmitry Mikhailovich Adamovich, Doaa Elkafrawy, Dragos Seban, Edgar Fernando Hernandez García, Edoardo Baldini, Edoardo Picetti, Edward C. T. H. Tan, Efstratia Baili, Eftychios Lostoridis, Elena Adelina Toma, Elif Colak, Elisabetta Cerutti, Elmin Steyn, Elmuiz A. Hsabo, Emmanouil Ioannis Kapetanakis, Emmanouil Kaouras, Emmanuel Schneck, Emrah Akin, Emre Gonullu, Enes çelik, Enrico Cicuttin, Enrico Pinotti, Erik Johnsson, Ernest E. Moore, Ervis Agastra, Evgeni Nikolaev Dimitrov, Ewen A. Griffiths, Fabrizio D’Acapito, Federica Saraceno, Felipe Alconchel, Felix Alexander Zeppernick, Fernando Machado Rodríguez, Fikri Abu-Zidan, Francesca Pecchini, Francesco Favi, Francesco Ferrara, Francesco Fleres, Francesco Pata, Francesco Pietro Maria Roscio, Francesk Mulita, Frank J. M. F. Dor, Fredrik Linder, Gabriel Dimofte, Gabriel Rodrigues, Gabriela Nita, Gabriele Sganga, Gennaro Martines, Gennaro Mazzarella, Gennaro Perrone, George Velmahos, Georgios D. Lianos, Gia Tomadze, Gian Luca Baiocchi, Giancarlo D’Ambrosio, Gianluca Pellino, Gianmaria Casoni Pattacini, Giorgio Giraudo, Giorgio Lisi, Giovanni Domenico Tebala, Giovanni Pirozzolo, Giulia Montori, Giulio Argenio, Giuseppe Brisinda, Giuseppe Currò, Giuseppe Giuliani, Giuseppe Palomba, Giuseppe Roscitano, Gökhan Avşar, Goran Augustin, Guglielmo Clarizia, Gustavo M. Machain Vega, Gustavo P. Fraga, Harsheet Sethi, Hazim Abdulnassir Eltyeb, Helmut A. Segovia Lohse, Herald René Segovia Lohse, Hüseyin Bayhan, Hytham K. S. Hamid, Igor A. Kryvoruchko, Immacolata Iannone, Imtiaz Wani, Ioannis I. Lazaridis, Ioannis Katsaros, Ioannis Nikolopoulos, Ionut Negoi, Isabella Reccia, Isidoro Di Carlo, Iyiade Olatunde Olaoye, Jacek Czepiel, Jae Il Kim, Jeremy Meyer, Jesus Manuel Saenz Terrazas, Joel Noutakdie Tochie, Joseph M. Galante, Justin Davies, Kapil Sugand, Kebebe Bekele Gonfa, Kemal Rasa, Kenneth Y. Y. Kok, Konstantinos G. Apostolou, Konstantinos Lasithiotakis, Konstantinos Tsekouras, Kumar Angamuthu, Lali Akhmeteli, Larysa Sydorchuk, Laura Fortuna, Leandro Siragusa, Leonardo Pagani, Leonardo Solaini, Lisa A. Miller, Lovenish Bains, Luca Ansaloni, Luca Ferrario, Luigi Bonavina, Luigi Conti, Luis Antonio Buonomo, Luis Tallon-Aguilar, Lukas Tomczyk, Lukas Werner Widmer, Maciej Walędziak, Mahir Gachabayov, Maloni M. Bulanauca, Manu L. N. G. Malbrain, Marc Maegele, Marco Catarci, Marco Ceresoli, Maria Chiara Ranucci, Maria Ioanna Antonopoulou, Maria Papadoliopoulou, Maria Rosaria Valenti, Maria Sotiropoulou, Mario D’Oria, Mario Serradilla Martín, Markus Hirschburger, Massimiliano Veroux, Massimo Fantoni, Matteo Nardi, Matti Tolonen, Mauro Montuori, Mauro Podda, Maximilian Scheiterle, Maximos Frountzas, Mehmet Sarıkaya, Mehmet Yildirim, Michael Bender, Michail Vailas, Michel Teuben, Michela Campanelli, Michele Ammendola, Michele Malerba, Michele Pisano, Mihaela Pertea, Mihail Slavchev, Mika Ukkonen, Miklosh Bala, Mircea Chirica, Mirko Barone, Mohamed Maher Shaat, Mohammed Jibreel Suliman Mohammed, Mona Awad Akasha Abuelgasim, Monika Gureh, Mouaqit Ouadii, Mujdat Balkan, Mumin Mohamed, Musluh Hakseven, Natalia Velenciuc, Nicola Cillara, Nicola de’Angelis, Nicolò Tamini, Nikolaos J. Zavras, Nikolaos Machairas, Nikolaos Michalopoulos, Nikolaos N. Koliakos, Nikolaos Pararas, Noel E. Donlon, Noushif Medappil, Offir Ben-Ishay, Olmi Stefano, Omar Islam, Ömer Tammo, Orestis Ioannidis, Oscar Aparicio, Oussama Baraket, Pankaj Kumar, Pasquale Cianci, Per Örtenwall, Petar Angelov Uchikov, Philip de Reuver, Philip F. Stahel, Philip S. Barie, Micaela Piccoli, Piotr Major, Pradeep H. Navsaria, Prakash Kumar Sasmal, Raul Coimbra, Razrim Rahim, Recayi Çapoğlu, Renol M. Koshy, Ricardo Alessandro Teixeira Gonsaga, Riccardo Pertile, Rifat Ramadan Mussa Mohamed, Rıza Deryol, Robert G. Sawyer, Roberta Angelico, Roberta Ragozzino, Roberto Bini, Roberto Cammarata, Rosa Scaramuzzo, Rossella Gioco, Ruslan Sydorchuk, Salma Ahmed, Salomone Di Saverio, Sameh Hany Emile, Samir Delibegovic, Sanjay Marwah, Savvas Symeonidis, Scott G. Thomas, Sebahattin Demir, Selmy S. Awad, Semra Demirli Atici, Serge Chooklin, Serhat Meric, Sevcan Sarıkaya, Sharfuddin Chowdhury, Shaza Faycal Mirghani, Sherry M. Wren, Simone Gargarella, Simone Rossi Del Monte, Sofia Esposito, Sofia Xenaki, Soliman Fayez Ghedan Mohamed, Solomon Gurmu Beka, Sorinel Lunca, Spiros G. Delis, Spyridon Dritsas, Stefan Morarasu, Stefano Magnone, Stefano Rossi, Stefanos Bitsianis, Stylianos Kykalos, Suman Baral, Sumita A. Jain, Syed Muhammad Ali, Tadeja Pintar, Tania Triantafyllou, Tarik Delko, Teresa Perra, Theodoros A. Sidiropoulos, Thomas M. Scalea, Tim Oliver Vilz, Timothy Craig Hardcastle, Tongporn Wannatoop, Torsten Herzog, Tushar Subhadarshan Mishra, Ugo Boggi, Valentin Calu, Valentina Tomajer, Vanni Agnoletti, Varut Lohsiriwat, Victor Kong, Virginia Durán Muñoz-Cruzado, Vishal G. Shelat, Vladimir Khokha, Wagih Mommtaz Ghannam, Walter L. Biffl, Wietse Zuidema, Yasin Kara, Yoshiro Kobe, Zaza Demetrashvili, Ziad A. Memish, Zoilo Madrazo, Zsolt J. Balogh, Zulfu Bayhan, Reichert, M, Sartelli, M, Weigand, M, Hecker, M, Oppelt, P, Noll, J, Askevold, I, Liese, J, Padberg, W, Coccolini, F, Catena, F, Hecker, A, Peckham-Cooper, A, Camacho-Ortiz, A, Mastoraki, A, Landaluce-Olavarria, A, Pal, A, Kuriyama, A, Chichom-Mefire, A, Porcu, A, Martinez-Perez, A, Karamarkovic, A, Osipov, A, Coppola, A, Cucchetti, A, Spolini, A, Giordano, A, Reinisch-Liese, A, Kavalakat, A, Vasilescu, A, Alamin, A, Gupta, A, Dascalu, A, Musina, A, Bakopoulos, A, Zakaria, A, Vereczkei, A, Balla, A, Bottari, A, Baumann, A, Fette, A, Litvin, A, Reichert, A, Guariniello, A, Paspala, A, Schneck, A, Brillantino, A, Pesce, A, Isik, A, Leppaniemi, A, Papadopoulos, A, Kechagias, A, Mohamed, A, Mitul, A, Marinis, A, Syllaios, A, Mantoglu, B, De Simone, B, Weiss, B, Posentrup, B, Picardi, B, Zampogna, B, Sakakushev, B, Atanasov, B, Nardo, B, Calik, B, Cremonini, C, Ordonez, C, Seretis, C, Cascone, C, Chouliaras, C, Bendinelli, C, Lopes, C, Guerci, C, Weber, C, Nastos, C, Mesina, C, Caputo, D, Massalou, D, Cavaliere, D, Mcnamara, D, Demetriades, D, Pantalone, D, Coletta, D, Sasia, D, Visconti, D, Weber, D, Corallino, D, Chatzipetris, D, Manatakis, D, Ntourakis, D, Papaconstantinou, D, Schizas, D, Chrysikos, D, Adamovich, D, Elkafrawy, D, Seban, D, Garcia, E, Baldini, E, Picetti, E, Tan, E, Baili, E, Lostoridis, E, Toma, E, Colak, E, Cerutti, E, Steyn, E, Hsabo, E, Kapetanakis, E, Kaouras, E, Schneck, E, Akin, E, Gonullu, E, Celik, E, Cicuttin, E, Pinotti, E, Johnsson, E, Moore, E, Agastra, E, Dimitrov, E, Griffiths, E, D'Acapito, F, Saraceno, F, Alconchel, F, Zeppernick, F, Rodriguez, F, Abu-Zidan, F, Pecchini, F, Favi, F, Ferrara, F, Fleres, F, Pata, F, Roscio, F, Mulita, F, Dor, F, Linder, F, Dimofte, G, Rodrigues, G, Nita, G, Sganga, G, Martines, G, Mazzarella, G, Perrone, G, Velmahos, G, Lianos, G, Tomadze, G, Baiocchi, G, D'Ambrosio, G, Pellino, G, Pattacini, G, Giraudo, G, Lisi, G, Tebala, G, Pirozzolo, G, Montori, G, Argenio, G, Brisinda, G, Curro, G, Giuliani, G, Palomba, G, Roscitano, G, Avsar, G, Augustin, G, Clarizia, G, Vega, G, Fraga, G, Sethi, H, Eltyeb, H, Lohse, H, Bayhan, H, Hamid, H, Kryvoruchko, I, Iannone, I, Wani, I, Lazaridis, I, Katsaros, I, Nikolopoulos, I, Negoi, I, Reccia, I, Di Carlo, I, Olaoye, I, Czepiel, J, Kim, J, Meyer, J, Terrazas, J, Tochie, J, Galante, J, Davies, J, Sugand, K, Gonfa, K, Rasa, K, Kok, K, Apostolou, K, Lasithiotakis, K, Tsekouras, K, Angamuthu, K, Akhmeteli, L, Sydorchuk, L, Fortuna, L, Siragusa, L, Pagani, L, Solaini, L, Miller, L, Bains, L, Ansaloni, L, Ferrario, L, Bonavina, L, Conti, L, Buonomo, L, Tallon-Aguilar, L, Tomczyk, L, Widmer, L, Waledziak, M, Gachabayov, M, Bulanauca, M, Malbrain, M, Maegele, M, Catarci, M, Ceresoli, M, Ranucci, M, Antonopoulou, M, Papadoliopoulou, M, Valenti, M, Sotiropoulou, M, D'Oria, M, Martin, M, Hirschburger, M, Veroux, M, Fantoni, M, Nardi, M, Tolonen, M, Montuori, M, Podda, M, Scheiterle, M, Frountzas, M, Sarikaya, M, Yildirim, M, Bender, M, Vailas, M, Teuben, M, Campanelli, M, Ammendola, M, Malerba, M, Pisano, M, Pertea, M, Slavchev, M, Ukkonen, M, Bala, M, Chirica, M, Barone, M, Shaat, M, Mohammed, M, Abuelgasim, M, Gureh, M, Ouadii, M, Balkan, M, Mohamed, M, Hakseven, M, Velenciuc, N, Cillara, N, De'Angelis, N, Tamini, N, Zavras, N, Machairas, N, Michalopoulos, N, Koliakos, N, Pararas, N, Donlon, N, Medappil, N, Ben-Ishay, O, Stefano, O, Islam, O, Tammo, O, Ioannidis, O, Aparicio, O, Baraket, O, Kumar, P, Cianci, P, Ortenwall, P, Uchikov, P, de Reuver, P, Stahel, P, Barie, P, Piccoli, M, Major, P, Navsaria, P, Sasmal, P, Coimbra, R, Rahim, R, Capoglu, R, Koshy, R, Gonsaga, R, Pertile, R, Mohamed, R, Deryol, R, Sawyer, R, Angelico, R, Ragozzino, R, Bini, R, Cammarata, R, Scaramuzzo, R, Gioco, R, Sydorchuk, R, Ahmed, S, Di Saverio, S, Emile, S, Delibegovic, S, Marwah, S, Symeonidis, S, Thomas, S, Demir, S, Awad, S, Atici, S, Chooklin, S, Meric, S, Sarikaya, S, Chowdhury, S, Mirghani, S, Wren, S, Gargarella, S, Del Monte, S, Esposito, S, Xenaki, S, Mohamed, S, Beka, S, Lunca, S, Delis, S, Dritsas, S, Morarasu, S, Magnone, S, Rossi, S, Bitsianis, S, Kykalos, S, Baral, S, Jain, S, Ali, S, Pintar, T, Triantafyllou, T, Delko, T, Perra, T, Sidiropoulos, T, Scalea, T, Vilz, T, Hardcastle, T, Wannatoop, T, Herzog, T, Mishra, T, Boggi, U, Calu, V, Tomajer, V, Agnoletti, V, Lohsiriwat, V, Kong, V, Munoz-Cruzado, V, Shelat, V, Khokha, V, Ghannam, W, Biffl, W, Zuidema, W, Kara, Y, Kobe, Y, Demetrashvili, Z, Memish, Z, Madrazo, Z, Balogh, Z, and Bayhan, Z

Subjects
Cross-Sectional Studie, ddc:610, Capacity, Pandemic, SARS-CoV-2, COVID-19, WSES, Time to intervention, Appendicitis, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Cross-Sectional Studies, Emergency, Quarantine, Emergency Medicine, Emergency surgery, Humans, Surgery, Appendiciti, COVID-19, SARS-CoV-2, Pandemic, Emergency surgery, Emergency, Appendicitis, WSES, Time to intervention, Capacity, Quarantine, Pandemics, Diverticulitis, Human
Abstract

Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years.

Published
2022

19. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

Author

Massimo Sartelli, Alain Chichom-Mefire, Francesco M. Labricciosa, Timothy Hardcastle, Fikri M. Abu-Zidan, Abdulrashid K. Adesunkanmi, Luca Ansaloni, Miklosh Bala, Zsolt J. Balogh, Marcelo A. Beltrán, Offir Ben-Ishay, Walter L. Biffl, Arianna Birindelli, Miguel A. Cainzos, Gianbattista Catalini, Marco Ceresoli, Asri Che Jusoh, Osvaldo Chiara, Federico Coccolini, Raul Coimbra, Francesco Cortese, Zaza Demetrashvili, Salomone Di Saverio, Jose J. Diaz, Valery N. Egiev, Paula Ferrada, Gustavo P. Fraga, Wagih M. Ghnnam, Jae Gil Lee, Carlos A. Gomes, Andreas Hecker, Torsten Herzog, Jae Il Kim, Kenji Inaba, Arda Isik, Aleksandar Karamarkovic, Jeffry Kashuk, Vladimir Khokha, Andrew W. Kirkpatrick, Yoram Kluger, Kaoru Koike, Victor Y. Kong, Ari Leppaniemi, Gustavo M. Machain, Ronald V. Maier, Sanjay Marwah, Michael E. McFarlane, Giulia Montori, Ernest E. Moore, Ionut Negoi, Iyiade Olaoye, Abdelkarim H. Omari, Carlos A. Ordonez, Bruno M. Pereira, Gerson A. Pereira Júnior, Guntars Pupelis, Tarcisio Reis, Boris Sakakushev, Norio Sato, Helmut A. Segovia Lohse, Vishal G. Shelat, Kjetil Søreide, Waldemar Uhl, Jan Ulrych, Harry Van Goor, George C. Velmahos, Kuo-Ching Yuan, Imtiaz Wani, Dieter G. Weber, Sanoop K. Zachariah, and Fausto Catena

Subjects
Intra-abdominal infections, Sepsis, Peritonitis, Antibiotics, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.

Published
2017
Full Text
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20. Surgeons' perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

Author

Cobianchi, Lorenzo, Piccolo, Daniele, Dal Mas, Francesca, Agnoletti, Vanni, Ansaloni, Luca, Balch, Jeremy, Biffl, Walter, Butturini, Giovanni, Catena, Fausto, Coccolini, Federico, Denicolai, Stefano, De Simone, Belinda, Frigerio, Isabella, Fugazzola, Paola, Marseglia, Gianluigi, Marseglia, Giuseppe Roberto, Martellucci, Jacopo, Modenese, Mirko, Previtali, Pietro, Ruta, Federico, Venturi, Alessandro, Kaafarani, Haytham M, Loftus, Tyler J, Kenneth Lyle Abbott, Abubaker Abdelmalik, Nebyou Seyoum Abebe, Fikri Abu-Zidan, Yousif Abdallah Yousif Adam, Harissou Adamou, Dmitry Mikhailovich Adamovich, Ferdinando Agresta, Antonino Agrusa, Emrah Akin, Mario Alessiani, Henrique Alexandrino, Syed Muhammad Ali, Vasilescu Alin Mihai, Pedro Miguel Almeida, Mohammed Mohammed Al-Shehari, Michele Altomare, Francesco Amico, Michele Ammendola, Jacopo Andreuccetti, Elissavet Anestiadou, Peter Angelos, Alfredo Annicchiarico, Amedeo Antonelli, Daniel Aparicio-Sanchez, Antonella Ardito, Giulio Argenio, Catherine Claude Arvieux, Ingolf Harald Askevold, Boyko Tchavdarov Atanasov, Goran Augustin, Selmy Sabry Awad, Giulia Bacchiocchi, Carlo Bagnoli, Hany Bahouth, Efstratia Baili, Lovenish Bains, Gian Luca Baiocchi, Miklosh Bala, Carmen Balagué, Dimitrios Balalis, Edoardo Baldini, Oussama Baraket, Suman Baral, Mirko Barone, Alberto Gonzãlez Barranquero, Jorge Arturo Barreras, Gary Alan Bass, Zulfu Bayhan, Giovanni Bellanova, Offir Ben-Ishay, Fabrizio Bert, Valentina Bianchi, Helena Biancuzzi, Chiara Bidoli, Raluca Bievel Radulescu, Mark Brian Bignell, Alan Biloslavo, Daniele Bissacco, Roberto Bini, Paolo Boati, Guillaume Boddaert, Branko Bogdanic, Cristina Bombardini, Luigi Bonavina, Luca Bonomo, Andrea Bottari, Konstantinos Bouliaris, Gioia Brachini, Antonio Brillantino, Giuseppe Brisinda, Maloni Mamada Bulanauca, Luis Antonio Buonomo, Jakob Burcharth, Salvatore Buscemi, Francesca Calabretto, Giacomo Calini, Valentin Calu, Fabio Cesare Campanile, Riccardo Campo Dall Orto, Andrea Campos-Serra, Stefano Campostrini, Recayi Capoglu, Joao Miguel Carvas, Marco Cascella, Gianmaria Casoni Pattacini, Valerio Celentano, Danilo Corrado Centonze, Marco Ceresoli, Dimitrios Chatzipetris, Antonella Chessa, Maria Michela Chiarello, Mircea Chirica, Serge Chooklin, Christos Chouliaras, Sharfuddin Chowdhury, Pasquale Cianci, Nicola Cillara, Stefania Cimbanassi, Stefano Piero Bernardo Cioffi, Elif Colak, Enrique Colás Ruiz, Luigi Conti, Alessandro Coppola, Tiago Correia De Sa, Silvia Dantas Costa, Valerio Cozza, Giuseppe Curro', Kirsten Felicia Ann-Sophie Aimee Dabekaussen, Fabrizio D'Acapito, Dimitrios Damaskos, Giancarlo D'Ambrosio, Koray Das, Richard Justin Davies, Andrew Charles De Beaux, Sara Patricia De Lebrusant Fernandez, Alessandro De Luca, Francesca De Stefano, Luca Degrate, Zaza Demetrashvili, Andreas Kyriacou Demetriades, Dzemail Smail Detanac, Agnese Dezi, Giuseppe Di Buono, Isidoro Di Carlo, Pierpaolo Di Lascio, Marcello Di Martino, Salomone Di Saverio, Bogdan Diaconescu, Jose J Diaz, Rigers Dibra, Evgeni Nikolaev Dimitrov, Vincenza Paola Dinuzzi, Sandra Dios-Barbeito, Jehangir Farman Ali Diyani, Agron Dogjani, Maurizio Domanin, Mario D'Oria, Virginia Duran Munoz-Cruzado, Barbora East, Mikael Ekelund, Gerald Takem Ekwen, Adel Hamed Elbaih, Muhammed Elhadi, Natalie Enninghorst, Mairam Ernisova, Juan Pablo Escalera-Antezana, Sofia Esposito, Giuseppe Esposito, Mercedes Estaire, Camilla Nikita Farè, Roser Farre, Francesco Favi, Luca Ferrario, Antonjacopo Ferrario di Tor Vajana, Claudia Filisetti, Francesco Fleres, Vinicius Cordeiro Fonseca, Alexander Forero-Torres, Francesco Forfori, Laura Fortuna, Evangelos Fradelos, Gustavo P Fraga, Pietro Fransvea, Simone Frassini, Giuseppe Frazzetta, Erica Pizzocaro, Maximos Frountzas, Mahir Gachabayov, Rita Galeiras, Alain A Garcia Vazquez, Simone Gargarella, Ibrahim Umar Garzali, Wagih Mommtaz Ghannam, Faiz Najmuddin Ghazi, Lawrence Marshall Gillman, Rossella Gioco, Alessio Giordano, Luca Giordano, Carlo Giove, Giorgio Giraudo, Mario Giuffrida, Michela Giulii Capponi, Emanuel Gois Jr, Carlos Augusto Gomes, Felipe Couto Gomes, Ricardo Alessandro Teixeira Gonsaga, Emre Gonullu, Jacques Goosen, Tatjana Goranovic, Raquel Gracia-Roman, Giorgio Maria Paolo Graziano, Ewen Alexander Griffiths, Tommaso Guagni, Dimitar Bozhidarov Hadzhiev, Muad Gamil Haidar, Hytham K S Hamid, Timothy Craig Hardcastle, Firdaus Hayati, Andrew James Healey, Andreas Hecker, Matthias Hecker, Edgar Fernando Hernandez Garcia, Adrien Montcho Hodonou, Eduardo Cancio Huaman, Martin Huerta, Aini Fahriza Ibrahim, Basil Mohamed Salabeldin Ibrahim, Giuseppe Ietto, Marco Inama, Orestis Ioannidis, Arda Isik, Nizar Ismail, Azzain Mahadi Hamid Ismail, Ruhi Fadzlyana Jailani, Ji Young Jang, Christos Kalfountzos, Sujala Niatarika Rajsain Kalipershad, Emmanouil Kaouras, Lewis Jay Kaplan, Yasin Kara, Evika Karamagioli, Aleksandar Karamarkovia, Ioannis Katsaros, Alfie J Kavalakat, Aristotelis Kechagias, Jakub Kenig, Boris Juli Kessel, Jim S Khan, Vladimir Khokha, Jae Il Kim, Andrew Wallace Kirkpatrick, Roberto Klappenbach, Yoram Kluger, Yoshiro Kobe, Efstratios Kofopoulos Lymperis, Kenneth Yuh Yen Kok, Victor Kong, Dimitris P Korkolis, Georgios Koukoulis, Bojan Kovacevic, Vitor Favali Kruger, Igor A Kryvoruchko, Hayato Kurihara, Akira Kuriyama, Aitor Landaluce-Olavarria, Pierfrancesco Lapolla, Ari Leppäniemi, Leo Licari, Giorgio Lisi, Andrey Litvin, Aintzane Lizarazu, Heura Llaquet Bayo, Varut Lohsiriwat, Claudia Cristina Lopes Moreira, Eftychios Lostoridis, Agustãn Tovar Luna, Davide Luppi, Gustavo Miguel Machain V, Marc Maegele, Daniele Maggiore, Stefano Magnone, Ronald V Maier, Piotr Major, Mallikarjuna Manangi, Andrea Manetti, Baris Mantoglu, Chiara Marafante, Federico Mariani, Athanasios Marinis, Evandro Antonio Sbalcheiro Mariot, Gennaro Martines, Aleix Martinez Perez, Costanza Martino, Pietro Mascagni, Damien Massalou, Maurizio Massaro, Belen Matías-García, Gennaro Mazzarella, Giorgio Mazzarolo, Renato Bessa Melo, Fernando Mendoza-Moreno, Serhat Meric, Jeremy Meyer, Luca Miceli, Nikolaos V Michalopoulos, Flavio Milana, Andrea Mingoli, Tushar S Mishra, Muyed Mohamed, Musab Isam Eldin Abbas Mohamed, Ali Yasen Mohamedahmed, Mohammed Jibreel Suliman Mohammed, Rajashekar Mohan, Ernest E Moore, Dieter Morales-Garcia, Mã Ns Muhrbeck, Francesk Mulita, Sami Mohamed Siddig Mustafa, Edoardo Maria Muttillo, Mukhammad David Naimzada, Pradeep H Navsaria, Ionut Negoi, Luca Nespoli, Christine Nguyen, Melkamu Kibret Nidaw, Giuseppe Nigri, Ioannis Nikolopoulos, Donal Brendan O'Connor, Habeeb Damilola Ogundipe, Cristina Oliveri, Stefano Olmi, Ernest Cun Wang Ong, Luca Orecchia, Aleksei V Osipov, Muhammad Faeid Othman, Marco Pace, Mario Pacilli, Leonardo Pagani, Giuseppe Palomba, Desire' Pantalone, Arpad Panyko, Ciro Paolillo, Mario Virgilio Papa, Dimitrios Papaconstantinou, Maria Papadoliopoulou, Aristeidis Papadopoulos, Davide Papis, Nikolaos Pararas, Jose Gustavo Parreira, Neil Geordie Parry, Francesco Pata, Tapan Patel, Simon Paterson-Brown, Giovanna Pavone, Francesca Pecchini, Veronica Pegoraro, Gianluca Pellino, Maria Pelloni, Andrea Peloso, Eduardo Perea Del Pozo, Rita Goncalves Pereira, Bruno Monteiro Pereira, Aintzane Lizarazu Perez, Silvia Pérez, Teresa Perra, Gennaro Perrone, Antonio Pesce, Lorenzo Petagna, Giovanni Petracca, Vorapong Phupong, Biagio Picardi, Arcangelo Picciariello, Micaela Piccoli, Edoardo Picetti, Emmanouil Pikoulis Pikoulis, Tadeja Pintar, Giovanni Pirozzolo, Francesco Piscioneri, Mauro Podda, Alberto Porcu, Francesca Privitera, Clelia Punzo, Silvia Quaresima, Martha Alexa Quiodettis, Niels Qvist, Razrim Rahim, Filipe Ramalho de Almeida, Rosnelifaizur Bin Ramely, Huseyin Kemal Rasa, Martin Reichert, Alexander Reinisch-Liese, Angela Renne, Camilla Riccetti, Maria Rita Rodriguez-Luna, Daniel Roizblatt, Andrea Romanzi, Luigi Romeo, Francesco Pietro Maria Roscio, Ramely Bin Rosnelifaizur, Stefano Rossi, Andres M Rubiano, Elena Ruiz-Ucar, Boris Evgeniev Sakakushev, Juan Carlos Salamea, Ibrahima Sall, Lasitha Bhagya Samarakoon, Fabrizio Sammartano, Alejandro Sanchez Arteaga, Sergi Sanchez-Cordero, Domenico Pietro Maria Santoanastaso, Massimo Sartelli, Diego Sasia, Norio Sato, Artem Savchuk, Robert Grant Sawyer, Giacomo Scaioli, Dimitrios Schizas, Simone Sebastiani, Barbara Seeliger, Helmut Alfredo Segovia Lohse, Charalampos Seretis, Giacomo Sermonesi, Mario Serradilla-Martin, Vishal G Shelat, Sergei Shlyapnikov, Theodoros Sidiropoulos, Romeo Lages Simoes, Leandro Siragusa, Boonying Siribumrungwong, Mihail Slavchev, Leonardo Solaini, Gabriele Soldini, Andrey Sopuev, Kjetil Soreide, Apostolos Sovatzidis, Philip Frank Stahel, Matt Strickland, Mohamed Arif Hameed Sultan, Ruslan Sydorchuk, Larysa Sydorchuk, Syed Muhammad Ali Muhammad Syed, Luis Tallon-Aguilar, Andrea Marco Tamburini, Nicolò Tamini, Edward C T H Tan, Jih Huei Tan, Antonio Tarasconi, Nicola Tartaglia, Giuseppe Tartaglia, Dario Tartaglia, John Vincent Taylor, Giovanni Domenico Tebala, Michel Teuben, Alexis Theodorou, Matti Tolonen, Giovanni Tomasicchio, Adriana Toro, Beatrice Torre, Tania Triantafyllou, Giuseppe Trigiante Trigiante, Marzia Tripepi, Julio Trostchansky, Konstantinos Tsekouras, Victor Turrado-Rodriguez, Roberta Tutino, Matteo Uccelli, Petar Angelov Uchikov, Bakarne Ugarte-Sierra, Mika Tapani Ukkonen, Michail Vailas, Panteleimon G Vassiliu, Alain Garcia Vazquez, Rita Galeiras Vazquez, George Velmahos, Juan Ezequiel Verde, Juan Manuel Verde, Massimiliano Veroux, Jacopo Viganò, Ramon Vilallonga, Diego Visconti, Alessandro Vittori, Maciej Waledziak, Tongporn Wannatoop, Lukas Werner Widmer, Michael Samuel James Wilson, Sarah Woltz, Ting Hway Wong, Sofia Xenaki, Byungchul Yu, Steven Yule, Sanoop Koshy Zachariah, Georgios Zacharis, Claudia Zaghi, Andee Dzulkarnaen Zakaria, Diego A Zambrano, Nikolaos Zampitis, Biagio Zampogna, Simone Zanghì, Maristella Zantedeschi, Konstantinos Zapsalis, Fabio Zattoni, Monica Zese, Lorenzo, Cobianchi, Daniele, Piccolo, Francesca, Dal Ma, Vanni, Agnoletti, Luca, Ansaloni, Jeremy, Balch, Walter, Biffl, Giovanni, Butturini, Fausto, Catena, Federico, Coccolini, Stefano, Denicolai, Belinda, De Simone, Isabella, Frigerio, Paola, Fugazzola, Gianluigi, Marseglia, Giuseppe Roberto, Marseglia, Jacopo, Martellucci, Mirko, Modenese, Pietro, Previtali, Federico, Ruta, Alessandro, Venturi, Haytham M, Kaafarani, Tyler J, Loftu, Lyle Abbott, Kenneth, Abdelmalik, Abubaker, Seyoum Abebe, Nebyou, Abu-Zidan, Fikri, Abdallah Yousif Adam, Yousif, Adamou, Harissou, Mikhailovich Adamovich, Dmitry, Agresta, Ferdinando, Agrusa, Antonino, Akin, Emrah, Alessiani, Mario, Alexandrino, Henrique, Muhammad Ali, Syed, Alin Mihai, Vasilescu, Miguel Almeida, Pedro, Mohammed Al-Shehari, Mohammed, Altomare, Michele, Amico, Francesco, Ammendola, Michele, Andreuccetti, Jacopo, Anestiadou, Elissavet, Angelos, Peter, Annicchiarico, Alfredo, Antonelli, Amedeo, Aparicio-Sanchez, Daniel, Ardito, Antonella, Argenio, Giulio, Claude Arvieux, Catherine, Harald Askevold, Ingolf, Tchavdarov Atanasov, Boyko, Augustin, Goran, Sabry Awad, Selmy, Bacchiocchi, Giulia, Bagnoli, Carlo, Bahouth, Hany, Baili, Efstratia, Bains, Lovenish, Luca Baiocchi, Gian, Bala, Miklosh, Balagué, Carmen, Balalis, Dimitrio, Baldini, Edoardo, Baraket, Oussama, Baral, Suman, Barone, Mirko, Gonzãlez Barranquero, Alberto, Arturo Barreras, Jorge, Alan Bass, Gary, Bayhan, Zulfu, Bellanova, Giovanni, Ben-Ishay, Offir, Bert, Fabrizio, Bianchi, Valentina, Biancuzzi, Helena, Bidoli, Chiara, Bievel Radulescu, Raluca, Brian Bignell, Mark, Biloslavo, Alan, Bissacco, Daniele, Bini, Roberto, Boati, Paolo, Boddaert, Guillaume, Bogdanic, Branko, Bombardini, Cristina, Bonavina, Luigi, Bonomo, Luca, Bottari, Andrea, Bouliaris, Konstantino, Brachini, Gioia, Brillantino, Antonio, Brisinda, Giuseppe, Mamada Bulanauca, Maloni, Antonio Buonomo, Lui, Burcharth, Jakob, Buscemi, Salvatore, Calabretto, Francesca, Calini, Giacomo, Calu, Valentin, Cesare Campanile, Fabio, Campo Dall Orto, Riccardo, Campos-Serra, Andrea, Campostrini, Stefano, Capoglu, Recayi, Miguel Carvas, Joao, Cascella, Marco, Casoni Pattacini, Gianmaria, Celentano, Valerio, Corrado Centonze, Danilo, Ceresoli, Marco, Chatzipetris, Dimitrio, Chessa, Antonella, Michela Chiarello, Maria, Chirica, Mircea, Chooklin, Serge, Chouliaras, Christo, Chowdhury, Sharfuddin, Cianci, Pasquale, Cillara, Nicola, Cimbanassi, Stefania, Piero Bernardo Cioffi, Stefano, Colak, Elif, Colás Ruiz, Enrique, Conti, Luigi, Coppola, Alessandro, Correia De Sa, Tiago, Dantas Costa, Silvia, Cozza, Valerio, Curro', Giuseppe, Felicia Ann-Sophie Aimee Dabekaussen, Kirsten, D'Acapito, Fabrizio, Damaskos, Dimitrio, D'Ambrosio, Giancarlo, Das, Koray, Justin Davies, Richard, Charles De Beaux, Andrew, Patricia De Lebrusant Fernandez, Sara, De Luca, Alessandro, De Stefano, Francesca, Degrate, Luca, Demetrashvili, Zaza, Kyriacou Demetriades, Andrea, Smail Detanac, Dzemail, Dezi, Agnese, Di Buono, Giuseppe, Di Carlo, Isidoro, Di Lascio, Pierpaolo, Di Martino, Marcello, Di Saverio, Salomone, Diaconescu, Bogdan, J Diaz, Jose, Dibra, Riger, Nikolaev Dimitrov, Evgeni, Paola Dinuzzi, Vincenza, Dios-Barbeito, Sandra, Farman Ali Diyani, Jehangir, Dogjani, Agron, Domanin, Maurizio, D'Oria, Mario, Duran Munoz-Cruzado, Virginia, East, Barbora, Ekelund, Mikael, Takem Ekwen, Gerald, Hamed Elbaih, Adel, Elhadi, Muhammed, Enninghorst, Natalie, Ernisova, Mairam, Pablo Escalera-Antezana, Juan, Esposito, Sofia, Esposito, Giuseppe, Estaire, Mercede, Nikita Farè, Camilla, Farre, Roser, Favi, Francesco, Ferrario, Luca, Ferrario di Tor Vajana, Antonjacopo, Filisetti, Claudia, Fleres, Francesco, Cordeiro Fonseca, Viniciu, Forero-Torres, Alexander, Forfori, Francesco, Fortuna, Laura, Fradelos, Evangelo, P Fraga, Gustavo, Fransvea, Pietro, Frassini, Simone, Frazzetta, Giuseppe, Pizzocaro, Erica, Frountzas, Maximo, Gachabayov, Mahir, Galeiras, Rita, A Garcia Vazquez, Alain, Gargarella, Simone, Umar Garzali, Ibrahim, Mommtaz Ghannam, Wagih, Najmuddin Ghazi, Faiz, Marshall Gillman, Lawrence, Gioco, Rossella, Giordano, Alessio, Giordano, Luca, Giove, Carlo, Giraudo, Giorgio, Giuffrida, Mario, Giulii Capponi, Michela, Gois Jr, Emanuel, Augusto Gomes, Carlo, Couto Gomes, Felipe, Alessandro Teixeira Gonsaga, Ricardo, Gonullu, Emre, Goosen, Jacque, Goranovic, Tatjana, Gracia-Roman, Raquel, Maria Paolo Graziano, Giorgio, Alexander Griffiths, Ewen, Guagni, Tommaso, Bozhidarov Hadzhiev, Dimitar, Gamil Haidar, Muad, S Hamid, Hytham K, Craig Hardcastle, Timothy, Hayati, Firdau, James Healey, Andrew, Hecker, Andrea, Hecker, Matthia, Fernando Hernandez Garcia, Edgar, Montcho Hodonou, Adrien, Cancio Huaman, Eduardo, Huerta, Martin, Fahriza Ibrahim, Aini, Mohamed Salabeldin Ibrahim, Basil, Ietto, Giuseppe, Inama, Marco, Ioannidis, Oresti, Isik, Arda, Ismail, Nizar, Mahadi Hamid Ismail, Azzain, Fadzlyana Jailani, Ruhi, Young Jang, Ji, Kalfountzos, Christo, Niatarika Rajsain Kalipershad, Sujala, Kaouras, Emmanouil, Jay Kaplan, Lewi, Kara, Yasin, Karamagioli, Evika, Karamarkovia, Aleksandar, Katsaros, Ioanni, J Kavalakat, Alfie, Kechagias, Aristoteli, Kenig, Jakub, Juli Kessel, Bori, S Khan, Jim, Khokha, Vladimir, Il Kim, Jae, Wallace Kirkpatrick, Andrew, Klappenbach, Roberto, Kluger, Yoram, Kobe, Yoshiro, Kofopoulos Lymperis, Efstratio, Yuh Yen Kok, Kenneth, Kong, Victor, P Korkolis, Dimitri, Koukoulis, Georgio, Kovacevic, Bojan, Favali Kruger, Vitor, A Kryvoruchko, Igor, Kurihara, Hayato, Kuriyama, Akira, Landaluce-Olavarria, Aitor, Lapolla, Pierfrancesco, Leppäniemi, Ari, Licari, Leo, Lisi, Giorgio, Litvin, Andrey, Lizarazu, Aintzane, Llaquet Bayo, Heura, Lohsiriwat, Varut, Cristina Lopes Moreira, Claudia, Lostoridis, Eftychio, Tovar Luna, Agustãn, Luppi, Davide, V, Gustavo Miguel Machain, Maegele, Marc, Maggiore, Daniele, Magnone, Stefano, V Maier, Ronald, Major, Piotr, Manangi, Mallikarjuna, Manetti, Andrea, Mantoglu, Bari, Marafante, Chiara, Mariani, Federico, Marinis, Athanasio, Antonio Sbalcheiro Mariot, Evandro, Martines, Gennaro, Martinez Perez, Aleix, Martino, Costanza, Mascagni, Pietro, Massalou, Damien, Massaro, Maurizio, Matías-García, Belen, Mazzarella, Gennaro, Mazzarolo, Giorgio, Bessa Melo, Renato, Mendoza-Moreno, Fernando, Meric, Serhat, Meyer, Jeremy, Miceli, Luca, V Michalopoulos, Nikolao, Milana, Flavio, Mingoli, Andrea, S Mishra, Tushar, Mohamed, Muyed, Isam Eldin Abbas Mohamed, Musab, Yasen Mohamedahmed, Ali, Jibreel Suliman Mohammed, Mohammed, Mohan, Rajashekar, E Moore, Ernest, Morales-Garcia, Dieter, Ns Muhrbeck, Mã, Mulita, Francesk, Mohamed Siddig Mustafa, Sami, Maria Muttillo, Edoardo, David Naimzada, Mukhammad, H Navsaria, Pradeep, Negoi, Ionut, Nespoli, Luca, Nguyen, Christine, Kibret Nidaw, Melkamu, Nigri, Giuseppe, Nikolopoulos, Ioanni, Brendan O'Connor, Donal, Damilola Ogundipe, Habeeb, Oliveri, Cristina, Olmi, Stefano, Cun Wang Ong, Ernest, Orecchia, Luca, V Osipov, Aleksei, Faeid Othman, Muhammad, Pace, Marco, Pacilli, Mario, Pagani, Leonardo, Palomba, Giuseppe, Pantalone, Desire', Panyko, Arpad, Paolillo, Ciro, Virgilio Papa, Mario, Papaconstantinou, Dimitrio, Papadoliopoulou, Maria, Papadopoulos, Aristeidi, Papis, Davide, Pararas, Nikolao, Gustavo Parreira, Jose, Geordie Parry, Neil, Pata, Francesco, Patel, Tapan, Paterson-Brown, Simon, Pavone, Giovanna, Pecchini, Francesca, Pegoraro, Veronica, Pellino, Gianluca, Pelloni, Maria, Peloso, Andrea, Perea Del Pozo, Eduardo, Goncalves Pereira, Rita, Monteiro Pereira, Bruno, Lizarazu Perez, Aintzane, Pérez, Silvia, Perra, Teresa, Perrone, Gennaro, Pesce, Antonio, Petagna, Lorenzo, Petracca, Giovanni, Phupong, Vorapong, Picardi, Biagio, Picciariello, Arcangelo, Piccoli, Micaela, Picetti, Edoardo, Pikoulis Pikoulis, Emmanouil, Pintar, Tadeja, Pirozzolo, Giovanni, Piscioneri, Francesco, Podda, Mauro, Porcu, Alberto, Privitera, Francesca, Punzo, Clelia, Quaresima, Silvia, Alexa Quiodettis, Martha, Qvist, Niel, Rahim, Razrim, Ramalho de Almeida, Filipe, Bin Ramely, Rosnelifaizur, Kemal Rasa, Huseyin, Reichert, Martin, Reinisch-Liese, Alexander, Renne, Angela, Riccetti, Camilla, Rita Rodriguez-Luna, Maria, Roizblatt, Daniel, Romanzi, Andrea, Romeo, Luigi, Pietro Maria Roscio, Francesco, Bin Rosnelifaizur, Ramely, Rossi, Stefano, M Rubiano, Andre, Ruiz-Ucar, Elena, Evgeniev Sakakushev, Bori, Carlos Salamea, Juan, Sall, Ibrahima, Bhagya Samarakoon, Lasitha, Sammartano, Fabrizio, Sanchez Arteaga, Alejandro, Sanchez-Cordero, Sergi, Pietro Maria Santoanastaso, Domenico, Sartelli, Massimo, Sasia, Diego, Sato, Norio, Savchuk, Artem, Grant Sawyer, Robert, Scaioli, Giacomo, Schizas, Dimitrio, Sebastiani, Simone, Seeliger, Barbara, Alfredo Segovia Lohse, Helmut, Seretis, Charalampo, Sermonesi, Giacomo, Serradilla-Martin, Mario, G Shelat, Vishal, Shlyapnikov, Sergei, Sidiropoulos, Theodoro, Lages Simoes, Romeo, Siragusa, Leandro, Siribumrungwong, Boonying, Slavchev, Mihail, Solaini, Leonardo, Soldini, Gabriele, Sopuev, Andrey, Soreide, Kjetil, Sovatzidis, Apostolo, Frank Stahel, Philip, Strickland, Matt, Arif Hameed Sultan, Mohamed, Sydorchuk, Ruslan, Sydorchuk, Larysa, Muhammad Ali Muhammad Syed, Syed, Tallon-Aguilar, Lui, Marco Tamburini, Andrea, Tamini, Nicolò, H Tan, Edward C T, Huei Tan, Jih, Tarasconi, Antonio, Tartaglia, Nicola, Tartaglia, Giuseppe, Tartaglia, Dario, Vincent Taylor, John, Domenico Tebala, Giovanni, Teuben, Michel, Theodorou, Alexi, Tolonen, Matti, Tomasicchio, Giovanni, Toro, Adriana, Torre, Beatrice, Triantafyllou, Tania, Trigiante Trigiante, Giuseppe, Tripepi, Marzia, Trostchansky, Julio, Tsekouras, Konstantino, Turrado-Rodriguez, Victor, Tutino, Roberta, Uccelli, Matteo, Angelov Uchikov, Petar, Ugarte-Sierra, Bakarne, Tapani Ukkonen, Mika, Vailas, Michail, G Vassiliu, Panteleimon, Garcia Vazquez, Alain, Galeiras Vazquez, Rita, Velmahos, George, Ezequiel Verde, Juan, Manuel Verde, Juan, Veroux, Massimiliano, Viganò, Jacopo, Vilallonga, Ramon, Visconti, Diego, Vittori, Alessandro, Waledziak, Maciej, Wannatoop, Tongporn, Werner Widmer, Luka, Samuel James Wilson, Michael, Woltz, Sarah, Hway Wong, Ting, Xenaki, Sofia, Yu, Byungchul, Yule, Steven, Koshy Zachariah, Sanoop, Zacharis, Georgio, Zaghi, Claudia, Dzulkarnaen Zakaria, Andee, A Zambrano, Diego, Zampitis, Nikolao, Zampogna, Biagio, Zanghì, Simone, Zantedeschi, Maristella, Zapsalis, Konstantino, Zattoni, Fabio, Zese, Monica, Cobianchi L., Piccolo D., Mas F.D., Agnoletti V., Ansaloni L., Balch J., Biffl W., Butturini G., Catena F., Coccolini F., Denicolai S., De Simone B., Frigerio I., Fugazzola P., Marseglia G., Marseglia G.R., Martellucci J., Modenese M., Previtali P., Ruta F., Venturi A., Kaafarani H.M., Loftus T.J., Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Team Dynamics Study Group, Cobianchi, L, Piccolo, D, Dal Mas, F, Agnoletti, V, Ansaloni, L, Balch, J, Biffl, W, Butturini, G, Catena, F, Coccolini, F, Denicolai, S, De Simone, B, Frigerio, I, Fugazzola, P, Marseglia, G, Martellucci, J, Modenese, M, Previtali, P, Ruta, F, Venturi, A, Kaafarani, H, Loftus, T, Abbott, K, Abdelmalik, A, Abebe, N, Abu-Zidan, F, Adam, Y, Adamou, H, Adamovich, D, Agresta, F, Agrusa, A, Akin, E, Alessiani, M, Alexandrino, H, Ali, S, Mihai, V, Almeida, P, Al-Shehari, M, Altomare, M, Amico, F, Ammendola, M, Andreuccetti, J, Anestiadou, E, Angelos, P, Annicchiarico, A, Antonelli, A, Aparicio-Sanchez, D, Ardito, A, Argenio, G, Arvieux, C, Askevold, I, Atanasov, B, Augustin, G, Awad, S, Bacchiocchi, G, Bagnoli, C, Bahouth, H, Baili, E, Bains, L, Baiocchi, G, Bala, M, Balague, C, Balalis, D, Baldini, E, Baraket, O, Baral, S, Barone, M, Barranquero, A, Barreras, J, Bass, G, Bayhan, Z, Bellanova, G, Ben-Ishay, O, Bert, F, Bianchi, V, Biancuzzi, H, Bidoli, C, Radulescu, R, Bignell, M, Biloslavo, A, Bini, R, Bissacco, D, Boati, P, Boddaert, G, Bogdanic, B, Bombardini, C, Bonavina, L, Bonomo, L, Bottari, A, Bouliaris, K, Brachini, G, Brillantino, A, Brisinda, G, Bulanauca, M, Buonomo, L, Burcharth, J, Buscemi, S, Calabretto, F, Calini, G, Calu, V, Campanile, F, Dall'Orto, R, Campos-Serra, A, Campostrini, S, Capoglu, R, Carvas, J, Cascella, M, Pattacini, G, Celentano, V, Centonze, D, Ceresoli, M, Chatzipetris, D, Chessa, A, Chiarello, M, Chirica, M, Chooklin, S, Chouliaras, C, Chowdhury, S, Cianci, P, Cillara, N, Cimbanassi, S, Cioffi, S, Colak, E, Ruiz, E, Conti, L, Coppola, A, De Sa, T, Costa, S, Cozza, V, Curro', G, Dabekaussen, K, D'Acapito, F, Damaskos, D, D'Ambrosio, G, Das, K, Davies, R, De Beaux, A, Fernandez, S, De Luca, A, De Stefano, F, Degrate, L, Demetrashvili, Z, Demetriades, A, Detanac, D, Dezi, A, Di Buono, G, Di Carlo, I, Di Lascio, P, Di Martino, M, Di Saverio, S, Diaconescu, B, Diaz, J, Dibra, R, Dimitrov, E, Dinuzzi, V, Dios-Barbeito, S, Diyani, J, Dogjani, A, Domanin, M, D'Oria, M, Munoz-Cruzado, V, East, B, Ekelund, M, Ekwen, G, Elbaih, A, Elhadi, M, Enninghorst, N, Ernisova, M, Escalera-Antezana, J, Esposito, S, Esposito, G, Estaire, M, Fare, C, Farre, R, Favi, F, Ferrario, L, Vajana, A, Filisetti, C, Fleres, F, Fonseca, V, Forero-Torres, A, Forfori, F, Fortuna, L, Fradelos, E, Fraga, G, Fransvea, P, Frassini, S, Frazzetta, G, Pizzocaro, E, Frountzas, M, Gachabayov, M, Galeiras, R, Vazquez, A, Gargarella, S, Garzali, I, Ghannam, W, Ghazi, F, Gillman, L, Gioco, R, Giordano, A, Giordano, L, Giove, C, Giraudo, G, Giuffrida, M, Capponi, M, Gois, E, Gomes, C, Gomes, F, Gonsaga, R, Gonullu, E, Goosen, J, Goranovic, T, Gracia-Roman, R, Graziano, G, Griffiths, E, Guagni, T, Hadzhiev, D, Haidar, M, Hamid, H, Hardcastle, T, Hayati, F, Healey, A, Hecker, A, Hecker, M, Garcia, E, Hodonou, A, Huaman, E, Huerta, M, Ibrahim, A, Ibrahim, B, Ietto, G, Inama, M, Ioannidis, O, Isik, A, Ismail, N, Ismail, A, Jailani, R, Jang, J, Kalfountzos, C, Kalipershad, S, Kaouras, E, Kaplan, L, Kara, Y, Karamagioli, E, Karamarkovia, A, Katsaros, I, Kavalakat, A, Kechagias, A, Kenig, J, Kessel, B, Khan, J, Khokha, V, Kim, J, Kirkpatrick, A, Klappenbach, R, Kluger, Y, Kobe, Y, Lymperis, E, Kok, K, Kong, V, Korkolis, D, Koukoulis, G, Kovacevic, B, Kruger, V, Kryvoruchko, I, Kurihara, H, Kuriyama, A, Landaluce-Olavarria, A, Lapolla, P, Leppaniemi, A, Licari, L, Lisi, G, Litvin, A, Lizarazu, A, Bayo, H, Lohsiriwat, V, Moreira, C, Lostoridis, E, Luna, A, Luppi, D, Machain, V, Maegele, M, Maggiore, D, Magnone, S, Maier, R, Major, P, Manangi, M, Manetti, A, Mantoglu, B, Marafante, C, Mariani, F, Marinis, A, Mariot, E, Martines, G, Perez, A, Martino, C, Mascagni, P, Massalou, D, Massaro, M, Matias-Garcia, B, Mazzarella, G, Mazzarolo, G, Melo, R, Mendoza-Moreno, F, Meric, S, Meyer, J, Miceli, L, Michalopoulos, N, Milana, F, Mingoli, A, Mishra, T, Mohamed, M, Mohamedahmed, A, Mohammed, M, Mohan, R, Moore, E, Morales-Garcia, D, Muhrbeck, M, Mulita, F, Mustafa, S, Muttillo, E, Naimzada, M, Navsaria, P, Negoi, I, Nespoli, L, Nguyen, C, Nidaw, M, Nigri, G, Nikolopoulos, I, O'Connor, D, Ogundipe, H, Oliveri, C, Olmi, S, Ong, E, Orecchia, L, Osipov, A, Othman, M, Pace, M, Pacilli, M, Pagani, L, Palomba, G, Pantalone, D, Panyko, A, Paolillo, C, Papa, M, Papaconstantinou, D, Papadoliopoulou, M, Papadopoulos, A, Papis, D, Pararas, N, Parreira, J, Parry, N, Pata, F, Patel, T, Paterson-Brown, S, Pavone, G, Pecchini, F, Pegoraro, V, Pellino, G, Pelloni, M, Peloso, A, Del Pozo, E, Pereira, R, Pereira, B, Perez, S, Perra, T, Perrone, G, Pesce, A, Petagna, L, Petracca, G, Phupong, V, Picardi, B, Picciariello, A, Piccoli, M, Picetti, E, Pikoulis, E, Pintar, T, Pirozzolo, G, Piscioneri, F, Podda, M, Porcu, A, Privitera, F, Punzo, C, Quaresima, S, Quiodettis, M, Qvist, N, Rahim, R, de Almeida, F, Ramely, R, Rasa, H, Reichert, M, Reinisch-Liese, A, Renne, A, Riccetti, C, Rodriguez-Luna, M, Roizblatt, D, Romanzi, A, Romeo, L, Roscio, F, Rosnelifaizur, R, Rossi, S, Rubiano, A, Ruiz-Ucar, E, Sakakushev, B, Salamea, J, Sall, I, Samarakoon, L, Sammartano, F, Arteaga, A, Sanchez-Cordero, S, Santoanastaso, D, Sartelli, M, Sasia, D, Sato, N, Savchuk, A, Sawyer, R, Scaioli, G, Schizas, D, Sebastiani, S, Seeliger, B, Lohse, H, Seretis, C, Sermonesi, G, Serradilla-Martin, M, Shelat, V, Shlyapnikov, S, Sidiropoulos, T, Simoes, R, Siragusa, L, Siribumrungwong, B, Slavchev, M, Solaini, L, Soldini, G, Sopuev, A, Soreide, K, Sovatzidis, A, Stahel, P, Strickland, M, Sultan, M, Sydorchuk, R, Sydorchuk, L, Syed, S, Tallon-Aguilar, L, Tamburini, A, Tamini, N, Tan, E, Tan, J, Tarasconi, A, Tartaglia, N, Tartaglia, G, Tartaglia, D, Taylor, J, Tebala, G, Teuben, M, Theodorou, A, Tolonen, M, Tomasicchio, G, Toro, A, Torre, B, Triantafyllou, T, Trigiante, G, Tripepi, M, Trostchansky, J, Tsekouras, K, Turrado-Rodriguez, V, Tutino, R, Uccelli, M, Uchikov, P, Ugarte-Sierra, B, Ukkonen, M, Vailas, M, Vassiliu, P, Vazquez, R, Velmahos, G, Verde, J, Veroux, M, Vigano, J, Vilallonga, R, Visconti, D, Vittori, A, Waledziak, M, Wannatoop, T, Widmer, L, Wilson, M, Woltz, S, Wong, T, Xenaki, S, Yu, B, Yule, S, Zachariah, S, Zacharis, G, Zaghi, C, Zakaria, A, Zambrano, D, Zampitis, N, Zampogna, B, Zanghi, S, Zantedeschi, M, Zapsalis, K, Zattoni, F, and Zese, M

Subjects
Settore SECS-P/10 - Organizzazione Aziendale, Settore MED/18 - Chirurgia Generale, Artificial intelligence, Settore SECS-P/07 - Economia Aziendale, Decision aid, Emergency Medicine, Decision aids, Surgery, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Trauma and emergency surgery, Clinical decision-making, Survey
Abstract

Background Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons’ knowledge and perception of using AI-based tools in clinical decision-making processes. Methods An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society’s website and Twitter profile. Results 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust. Discussion The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI.

Published
2023

21. Clinical application of advances and innovation in radiation treatment of hepatocellular carcinoma

Author

Valerie J W, Tong, Vishal G, Shelat, and Yew Kuo, Chao

Subjects
general surgery, hepatology, oncology, Review Article, hepatocellular carcinoma, Erratum, radiation therapy
Abstract

Background: Hepatocellular carcinoma (HCC) management has evolved over the past two decades, with the development of newer treatment modalities. While various options are available, unmet needs are reflected through the mixed treatment outcome for intermediate-stage HCC. As HCC is radiosensitive, radiation therapies have a significant role in management. Radiation therapies offer local control for unresectable lesions and for patients who are not surgical candidates. Radiotherapy also provides palliation in metastatic disease, and acts as a bridge to resection and transplantation in selected patients. Advancements in radiotherapy modalities offer improved dose planning and targeted delivery, allowing for better tumor response and safer dose escalations while minimizing the risks of radiation-induced liver damage. Radiotherapy modalities are broadly classified into external beam radiation therapy and selective internal radiation therapy. With emerging modalities, radiotherapy plays a complementary role in the multidisciplinary care of HCC patients. Aim: We aim to provide an overview of the role and clinical application of radiation therapies in HCC management. Relevance for Patients: The continuous evolution of radiotherapy techniques allows for improved therapeutic outcomes while mitigating unwanted adverse effects, making it an attractive modality in HCC management. Rigorous clinical studies, quality research and comprehensive datasets will further its application in the present era of evidence-based practice in Medicine.

Published
2021

22. Ameliorating effect of olive oil on fertility of male rats fed on genetically modified soya bean

Author

Thanaa A. F. El-Kholy, Hatim A. Al-Abbadi, Dina Qahwaji, Ahmed K. Al-Ghamdi, Vishal G. Shelat, Hanan M. Sobhy, and Mohammad Abu Hilal

Subjects
fertility, genetic modification, olive oil, soya bean, Nutrition. Foods and food supply, TX341-641
Abstract

Background: Genetically modified soya bean (GMSB) is a commercialized food. It has been shown to have adverse effects on fertility in animal trials. Extra virgin olive oil (EVOO) has many beneficial effects including anti-oxidant properties. The aim of this study is to elucidate if addition of EVOO ameliorates the adverse effects on reproductive organs of rats fed on GMSB containing diet. Methods: Forty adult male albino rats (150–180 g) of Sprague Dawley strain were separated into four groups of 10 rats each: Group 1 – control group fed on basal ration, Group 2 – fed on basal ration mixed with EVOO (30%), Group 3 – fed on basal ration mixed with GMSB (15%), and Group 4 – fed on basal ration mixed with GMSB (15%) and EVOO (30%). This feeding regimen was administered for 65 days. Blood samples were collected to analyze serum zinc, vitamin E, and testosterone levels. Histopathological and weight changes in sex organs were evaluated. Results: GMSB diet reduced weight of testis (0.66±0.06 vs. 1.7±0.06, p

Published
2015
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23. Outcomes of patients with post-hepatectomy hypophosphatemia: a narrative review

Author

Kai Siang Chan, Swetha Mohan, Vishal G Shelat, Lee Kong Chian School of Medicine (LKCMedicine), and Tan Tock Seng Hospital

Subjects
Hepatology, Hepatectomy, Medicine [Science], Hepatocellular Carcinoma
Abstract

Phosphate is an essential electrolyte for proper mineralisation of bone, buffering of urine, and diverse cellular actions. Hypophosphatemia (HP) is a clinical spectrum which range from asymptomatic to severe complications such as neuromuscular and pulmonary complications, or even death. Post-hepatectomy HP (PHH) has been reported to be 55.5%-100%. Post-hepatectomy, there is rapid uptake of phosphate and increased mitotic counts to aid in regeneration of residual liver. Concurrently, PHH may be due to increased urinary phosphorous from activation of matrix extracellular phosphoglycoprotein in the injured liver, which decreases phosphate influx into hepatocytes to sustain adenosine triphosphate synthesis. A literature review was performed on PubMed till January 2022. We included 8 studies which reported on impact of PHH on post-operative outcomes. In patients with diseased liver, PHH was reported to have either beneficial or deleterious effects on post-hepatectomy liver failure (PHLF), morbidity and/or mortality in various cohorts. In living donor hepatectomy, PHLF was higher in PHH. Benefits of correction of PHH with reduced post-operative complications have been shown. Correction of PHH should be done based on extent of PHH. Existing studies were however heterogenous; further studies should be conducted to assess PHH on post-operative outcomes with standardized phosphate replacement regimes. Published version

Published
2022

24. Intrahepatic splenosis: a world review

Author

Weh Shien Toh, Cristine Szu Lyn Ding, Cher Heng Tan, Vishal G Shelat, and Kai Siang Chan

Subjects
medicine.medical_specialty, Review Paper, Cirrhosis, Hepatology, business.industry, medicine.medical_treatment, intrahepatic splenosis, Splenectomy, hepatocellular carcinoma, Hepatitis B, medicine.disease, Malignancy, liver tumour, Asymptomatic, Autotransplantation, splenectomy, liver mass, Abdominal trauma, Hepatocellular carcinoma, medicine, Radiology, medicine.symptom, business
Abstract

Splenosis is defined as the autotransplantation of viable splenic tissue throughout various anatomic compartments. Intrahepatic splenosis (IHS) is rare and diagnosis is often challenging. This study aims to provide a comprehensive review on IHS. A literature review was performed on PubMed database. Fifty-six articles with 59 reported cases were included. The majority of the patients were male (n = 49, 83.1%). Median age was 51 years. Risk factors for hepatocellular carcinoma (HCC) included hepatitis B (n = 8, 13.6%) and cirrhosis (n = 12, 20.3%). The majority of the patients were asymptomatic (62.7%) and did not have risk factors for HCC (55.9%). We report a diagnostic triad for IHS: 1) previous history of abdominal trauma or splenectomy, 2) absence of risk factors for liver malignancy and 3) typical imaging features. Non-invasive diagnostic tests such as technetium-99m-tagged heat-damaged red blood cell scintigraphy are useful in diagnosis. Malignancy should be ruled out in the presence of risk factors for HCC.

Published
2020

25. Validation of Tokyo Guidelines 2007 and Tokyo Guidelines 2013/2018 Criteria for Acute Cholangitis and Predictors of In-Hospital Mortality

Author

Stefanie Wei Lynn Goh, Cheong Wei Terence Huey, Yen Pin Tan, Vishal G Shelat, Jee Keem Low, Ramkumar Mohan, Sameer P. Junnarkar, and Guan Wei Tan

Subjects
Abdominal pain, medicine.medical_specialty, Multivariate analysis, business.industry, Gastroenterology, Glasgow Coma Scale, Type 2 Diabetes Mellitus, medicine.disease, Sepsis, Blood pressure, Internal medicine, Etiology, Vomiting, Medicine, Surgery, medicine.symptom, business, Research Article
Abstract

Background: Acute cholangitis (AC) is a common emergency with a significant mortality risk. The Tokyo Guidelines (TG) provide recommendations for diagnosis, severity stratification, and management of AC. However, validation of the TG remains poor. This study aims to validate TG07, TG13, and TG18 criteria and identify predictors of in-hospital mortality in patients with AC. Methods: This is a retrospective audit of patients with a discharge diagnosis of AC in the year 2016. Demographic, clinical, investigation, management and mortality data were documented. We performed a multinomial logistic regression analysis with stepwise variable selection to identify severity predictors for in-hospital mortality. Results: Two hundred sixty-two patients with a median age of 75.9 years (IQR 64.8–82.8) years were included for analysis. TG13/TG18 diagnostic criteria were more sensitive than TG07 diagnostic criteria (85.1 vs. 75.2%; p < 0.006). The majority of the patients (n = 178; 67.9%) presented with abdominal pain, pyrexia (n = 156; 59.5%), and vomiting (n = 123; 46.9%). Blood cultures were positive in 95 (36.3%) patients, and 79 (83.2%) patients had monomicrobial growth. The 30-day, 90-day, and in-hospital mortality numbers were 3 (1.1%), 11 (4.2%), and 15 (5.7%), respectively. In multivariate analysis, type 2 diabetes mellitus (OR = 12.531; 95% CI 0.354–116.015; p = 0.026), systolic blood pressure p = 0.041), Glasgow coma score p = 0.019), and malignancy (OR = 14.135; 95% CI 1.017–196.394; p = 0.049) predicted in-hospital mortality. Conclusion: TG13/18 diagnostic criteria are more sensitive than TG07 diagnostic criteria. Type 2 diabetes mellitus, systolic blood pressure

Published
2021

26. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections

Author

Cristian Mesina, Oussama Baraket, Arda Isik, Iyiade Olaoye, Tadeja Pintar, Wagih Ghnnam, Andreas Hecker, Ionut Negoi, Andrey Litvin, A R K Adesunkanmi, Julival Ribeiro, Stijn W. de Jonge, Norio Sato, Carlos Augusto Gomes, Manos Pikoulis, Federico Coccolini, Yeong Yeh Lee, Frederick A. Moore, Gustavo M. Machain, Francesco Cortese, Elif Colak, Luca Ansaloni, Daniela Corsi, Enrico Cicuttin, Fikri M. Abu-Zidan, Fausto Catena, Andrew W. Kirkpatrick, Raul Coimbra, I. A. Kryvoruchko, Chiara Gurioli, Paola Fugazzola, Gabriele Sganga, András Vereczkei, Sanjay Marwah, Kenji Inaba, Agron Dogjani, Antonio Tarasconi, Elisabetta Cerutti, Rao R. Ivatury, Ibrahima Sall, Michael Sugrue, Francesco M. Labricciosa, Marco Ceresoli, Renol M. Koshy, Jae Il Kim, Goran Augustin, Mauro Podda, Therese M. Duane, Katia Iskandar, Osvaldo Chiara, Dimitris Damaskos, Timothy Craig Hardcastle, Yunfeng Cui, Vishal G Shelat, Joel Noutakdie Tochie, Andrew B. Peitzman, Sameer Dhingra, Miklosh Bala, Ashraf Abbas, Samir Delibegovic, Leonardo Pagani, George Gkiokas, Claudio Casella, Mahir Gachabayov, Gabriel Rodrigues, Stefano Di Bella, Vladimir Khokha, Kemal Rasa, Nicola de’ Angelis, Ernest E. Moore, Robert G. Sawyer, Ronald V. Maier, Yoram Kluger, Ines Rubio-Perez, Victor Y. Kong, Gennaro Perrone, Francesco Di Marzo, Jan Ulrych, Gian Luca Baiocchi, Matti Tolonen, Athanasios Marinis, Cristina Marmorale, G. Tomadze, Peter K. Kim, Belinda De Simone, Aleksandar Karamarkovic, Ian Stephens, Mouaqit Ouadii, Massimo Sartelli, Davide Luppi, Boyko Atanasov, Helmut Alfredo Segovia Lohse, Ervis Agastra, Syed Mohammad Umar Kabir, Massimo Chiarugi, Carlos A. Ordoñez, Giuseppe Pipitone, Bruno Viaggi, Joseph M. Galante, Suman Baral, Ewen A. Griffiths, Mushira Enani, Marja A. Boermeester, Zaza Demetrashvili, Ari Leppäniemi, Torsten Herzog, Walter L. Biffl, Salomone Di Saverio, Sartelli, Massimo, Coccolini, Federico, Kluger, Yoram, Agastra, Ervi, Abu-Zidan, Fikri M, Abbas, Ashraf El Sayed, Ansaloni, Luca, Adesunkanmi, Abdulrashid Kayode, Atanasov, Boyko, Augustin, Goran, Bala, Miklosh, Baraket, Oussama, Baral, Suman, Biffl, Walter L, Boermeester, Marja A, Ceresoli, Marco, Cerutti, Elisabetta, Chiara, Osvaldo, Cicuttin, Enrico, Chiarugi, Massimo, Coimbra, Raul, Colak, Elif, Corsi, Daniela, Cortese, Francesco, Cui, Yunfeng, Damaskos, Dimitri, De' Angelis, Nicola, Delibegovic, Samir, Demetrashvili, Zaza, De Simone, Belinda, de Jonge, Stijn W, Dhingra, Sameer, Di Bella, Stefano, Di Marzo, Francesco, Di Saverio, Salomone, Dogjani, Agron, Duane, Therese M, Enani, Mushira Abdulaziz, Fugazzola, Paola, Galante, Joseph M, Gachabayov, Mahir, Ghnnam, Wagih, Gkiokas, George, Gomes, Carlos Augusto, Griffiths, Ewen A, Hardcastle, Timothy C, Hecker, Andrea, Herzog, Torsten, Kabir, Syed Mohammad Umar, Karamarkovic, Aleksandar, Khokha, Vladimir, Kim, Peter K, Kim, Jae Il, Kirkpatrick, Andrew W, Kong, Victor, Koshy, Renol M, Kryvoruchko, Igor A, Inaba, Kenji, Isik, Arda, Iskandar, Katia, Ivatury, Rao, Labricciosa, Francesco M, Lee, Yeong Yeh, Leppäniemi, Ari, Litvin, Andrey, Luppi, Davide, Machain, Gustavo M, Maier, Ronald V, Marinis, Athanasio, Marmorale, Cristina, Marwah, Sanjay, Mesina, Cristian, Moore, Ernest E, Moore, Frederick A, Negoi, Ionut, Olaoye, Iyiade, Ordoñez, Carlos A, Ouadii, Mouaqit, Peitzman, Andrew B, Perrone, Gennaro, Pikoulis, Mano, Pintar, Tadeja, Pipitone, Giuseppe, Podda, Mauro, Raşa, Kemal, Ribeiro, Julival, Rodrigues, Gabriel, Rubio-Perez, Ine, Sall, Ibrahima, Sato, Norio, Sawyer, Robert G, Segovia Lohse, Helmut, Sganga, Gabriele, Shelat, Vishal G, Stephens, Ian, Sugrue, Michael, Tarasconi, Antonio, Tochie, Joel Noutakdie, Tolonen, Matti, Tomadze, Gia, Ulrych, Jan, Vereczkei, Andra, Viaggi, Bruno, Gurioli, Chiara, Casella, Claudio, Pagani, Leonardo, Baiocchi, Gian Luca, Catena, Fausto, Sartelli, M, Coccolini, F, Kluger, Y, Agastra, E, Abu-Zidan, F, Abbas, A, Ansaloni, L, Adesunkanmi, A, Atanasov, B, Augustin, G, Bala, M, Baraket, O, Baral, S, Biffl, W, Boermeester, M, Ceresoli, M, Cerutti, E, Chiara, O, Cicuttin, E, Chiarugi, M, Coimbra, R, Colak, E, Corsi, D, Cortese, F, Cui, Y, Damaskos, D, de' Angelis, N, Delibegovic, S, Demetrashvili, Z, De Simone, B, de Jonge, S, Dhingra, S, Di Bella, S, Di Marzo, F, Di Saverio, S, Dogjani, A, Duane, T, Enani, M, Fugazzola, P, Galante, J, Gachabayov, M, Ghnnam, W, Gkiokas, G, Gomes, C, Griffiths, E, Hardcastle, T, Hecker, A, Herzog, T, Kabir, S, Karamarkovic, A, Khokha, V, Kim, P, Kim, J, Kirkpatrick, A, Kong, V, Koshy, R, Kryvoruchko, I, Inaba, K, Isik, A, Iskandar, K, Ivatury, R, Labricciosa, F, Lee, Y, Leppaniemi, A, Litvin, A, Luppi, D, Machain, G, Maier, R, Marinis, A, Marmorale, C, Marwah, S, Mesina, C, Moore, E, Moore, F, Negoi, I, Olaoye, I, Ordonez, C, Ouadii, M, Peitzman, A, Perrone, G, Pikoulis, M, Pintar, T, Pipitone, G, Podda, M, Rasa, K, Ribeiro, J, Rodrigues, G, Rubio-Perez, I, Sall, I, Sato, N, Sawyer, R, Segovia Lohse, H, Sganga, G, Shelat, V, Stephens, I, Sugrue, M, Tarasconi, A, Tochie, J, Tolonen, M, Tomadze, G, Ulrych, J, Vereczkei, A, Viaggi, B, Gurioli, C, Casella, C, Pagani, L, Baiocchi, G, Catena, F, HUS Abdominal Center, II kirurgian klinikka, and University of Helsinki

Subjects
Review, DAMAGE CONTROL LAPAROTOMY, Intra-abdominal infections, Peritonitis, Sepsis, Anti-Bacterial Agents, Critical Pathways, Humans, Treatment Outcome, Anti-Infective Agents, Intraabdominal Infections, 0302 clinical medicine, PERFORATED DIVERTICULITIS, Medicine, LAPAROSCOPIC CHOLECYSTECTOMY, Surgical approach, Iais, biology, Peritoniti, Anti-Infective Agents / therapeutic use, Medical emergencies. Critical care. Intensive care. First aid, 3. Good health, SURGICAL-TREATMENT, 030220 oncology & carcinogenesis, embryonic structures, Emergency Medicine, 030211 gastroenterology & hepatology, KLEBSIELLA-PNEUMONIAE, medicine.medical_specialty, RD1-811, Sepsi, MEDLINE, ANTIBIOTIC-THERAPY, 03 medical and health sciences, Intra-abdominal infection, Emergency surgery, Effective treatment, COMPUTED-TOMOGRAPHY, Intensive care medicine, Anti-Bacterial Agents / therapeutic use, Task force, business.industry, RC86-88.9, Abdominal Infection, SEPTIC SHOCK, Intraabdominal Infections / surgery, 3126 Surgery, anesthesiology, intensive care, radiology, biology.organism_classification, Review article, PRIMARY RESECTION, ACUTE COLONIC DIVERTICULITIS, Surgery, business, Intraabdominal Infections / drug therapy
Abstract

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The cornerstones of effective treatment of IAIs include early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using a critical care environment, combined with an optimal surgical approach. Together, the World Society of Emergency Surgery (WSES), the Global Alliance for Infections in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) have jointly completed an international multi-society document in order to facilitate clinical management of patients with IAIs worldwide building evidence-based clinical pathways for the most common IAIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting information was shared by an international task force from 46 countries with different clinical backgrounds. The aim of the document is to promote global standards of care in IAIs providing guidance to clinicians by describing reasonable approaches to the management of IAIs.

Published
2021

27. A pilot study of estrogen receptor (ER) expression in pancreatic ductal adenocarcinoma (PDAC)

Author

Vishal G Shelat, Kai Siang Chan, Bernard Ho, and Lee Kong Chian School of Medicine (LKCMedicine)

Subjects
Stromal cell, Hepatology, business.industry, Gastroenterology, Hormonal Therapy, Estrogen receptor, Sex hormone receptor, medicine.disease, Breast cancer, Pancreatic cancer, Cancer research, Medicine, Neoplasm, Adenocarcinoma, Hormonal therapy, Original Article, Medicine [Science], business, Estrogen Receptor
Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) is the most common pancreatic neoplasm with 5-year survival as low as 6%. It is therefore imperative to explore potential treatment avenues to improve survival in these groups of patients. Anti-estrogenic hormone therapy (AEHT) is well-tolerated and has been used in estrogen receptor (ER) subgroups of breast cancer. ER is a type of sex hormone receptor which have been reported to be expressed inconsistently in pancreatic cancer. This study aims to identify the presence of ER in PDAC specimens to guide potential use of AEHT in the management of unresectable PDAC. Methods: This is a retrospective case control study of 10 patients (5 males, 5 females) who underwent pancreatic resections for PDAC from 2011 to 2012. Sections of the post-operative specimens were prepared and sent for ER staining. Pancreatic tissue specimens that were analysed included (I) ductal epithelial cells; (II) acinar cells; (III) islet cells; (IV) intralobular stromal cells; and (V) adenocarcinoma cells. Results: Intralobular stromal cells were positively stained for ER in 7/10 (70%) of the cases, but were of weak intensity and patchy in distribution. Islet cells (

Published
2021

28. Predictors of 90-Day Mortality following Hepatic Resection for Hepatocellular Carcinoma

Author

Liang Shen, Sameer P. Junnarkar, Vishal G Shelat, Geraldine Yanlei Lei, J.K. Low, and CheongWei Terence Huey

Subjects
medicine.medical_specialty, Multivariate analysis, business.industry, Hepatic resection, Mortality rate, Gastroenterology, Perioperative, medicine.disease, Blood loss, Hepatocellular carcinoma, Internal medicine, medicine, Retrospective analysis, Surgery, In patient, business, Research Article
Abstract

Background/Purpose: 90-day mortality is a key performance indicator for short-term perioperative outcome of hepatic resection (HR). Although many preoperative, intraoperative, and postoperative variables predict 90-day mortality following elective HR, only few are specific to hepatocellular carcinoma (HCC). This study aims to determine the predictors of 90-day mortality following elective HR for HCC. Methods: We report a retrospective analysis of patients who underwent elective HR between January 1, 2007, and December 31, 2017. Health status, perioperative variables, and the presence of post-hepatectomy liver failure (PHLF) were studied. Cox’s regression evaluated factors predicting 90-day mortality. Results: Two hundred and forty-four patients diagnosed with HCC underwent HR; 102 (41.8%) underwent a major HR. The postoperative 90-day mortality rate was 5.3%. Multivariate analysis demonstrated that Child-Pugh score (p < 0.001), intraoperative blood loss (p = 0.013), the 50-50 criteria for PHLF (p < 0.001) on postoperative day 5, and peak serum bilirubin >119 µmol/L (p = 0.007) on postoperative day 3 predict 90-day mortality. Conclusion: In patients with HCC undergoing HR, Child-Pugh score, intraoperative blood loss, the 50-50 criteria for PHLF on postoperative day 5, and peak serum bilirubin >119 µmol/L on postoperative day 3 predict 90-day mortality following elective HR for HCC.

Published
2020

29. Ectopic breast tissue in the vulva masquerading as an abscess

Author

Vishal G Shelat, Cristine Ding, and Saleem Ahmed

Subjects
Pathology, medicine.medical_specialty, medicine.anatomical_structure, Ectopic breast tissue, business.industry, medicine, General Medicine, Abscess, medicine.disease, business, Letter to the Editor, Vulva
Published
2020

30. Perforated and bleeding peptic ulcer: WSES guidelines

Author

Walter L. Biffl, Matteo Tomasoni, Federico Coccolini, Marco Ceresoli, Fabio Cesare Campanile, Edoardo Picetti, Vittoria Pattonieri, Luca Ansaloni, Andrew B. Peitzman, Vishal G Shelat, Michael Kelly, Massimo Sartelli, Stefania Cimbanassi, Fausto Catena, Yoram Kluger, Ernest E. Moore, Gustavo Pereira Fraga, Claudio Casella, Michael Sugrue, Fikri M. Abu-Zidan, George C. Velmahos, Salomone Di Saverio, Gian Luca Baiocchi, Sarah Molfino, Antonio Tarasconi, Dieter G. Weber, Imtaz Wani, Ari Leppäniemi, Ronald V. Maier, Gennaro Perrone, Andrew W Kirkpatrick, Tarasconi, A, Coccolini, F, Biffl, W, Tomasoni, M, Ansaloni, L, Picetti, E, Molfino, S, Shelat, V, Cimbanassi, S, Weber, D, Abu-Zidan, F, Campanile, F, Di Saverio, S, Baiocchi, G, Casella, C, Kelly, M, Kirkpatrick, A, Leppaniemi, A, Moore, E, Peitzman, A, Fraga, G, Ceresoli, M, Maier, R, Wani, I, Pattonieri, V, Perrone, G, Velmahos, G, Sugrue, M, Sartelli, M, Kluger, Y, Catena, F, Tarasconi, Antonio [0000-0001-6588-2268], Apollo - University of Cambridge Repository, HUS Abdominal Center, and II kirurgian klinikka

Subjects
Non-operative management, Review, Disease, EMERGENCY-SURGERY, OMENTAL PATCH, Guideline, THE-SCOPE CLIP, 0302 clinical medicine, Antibiotics, UPPER GASTROINTESTINAL HEMORRHAGE, Health care, Diagnosis, High-risk patient, 1ST-LINE ENDOSCOPIC TREATMENT, education.field_of_study, Evidence-Based Medicine, Peritoniti, Incidence (epidemiology), LAPAROSCOPIC REPAIR, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Angiography, High-risk patients, Combined Modality Therapy, Embolization, Guidelines, Intra-abdominal infection, Pancreatitis, Peptic ulcer, Peritonitis, Surgery, Technique, Timing, 3. Good health, HELICOBACTER-PYLORI ERADICATION, Peptic Ulcer Hemorrhage, 030220 oncology & carcinogenesis, Radiological weapon, Emergency Medicine, 030211 gastroenterology & hepatology, WORKING GROUP CONSENSUS, Diagnosi, Adult, medicine.medical_specialty, Population, lcsh:Surgery, 03 medical and health sciences, Antibiotic therapy, medicine, Humans, Intensive care medicine, education, Pancreatiti, business.industry, INTERNATIONAL CONSENSUS DEFINITIONS, Antibiotic, lcsh:RD1-811, lcsh:RC86-88.9, 3126 Surgery, anesthesiology, intensive care, radiology, medicine.disease, digestive system diseases, Review article, Peptic Ulcer Perforation, TIME TRENDS, business
Abstract

Background Peptic ulcer disease is common with a lifetime prevalence in the general population of 5–10% and an incidence of 0.1–0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10–20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment. Methods The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached. Conclusions The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.

Published
2020

31. Persimmon fruit causing simultaneous small bowel and stomach obstruction

Author

Thomas Zheng Jie Teng, Vishal G Shelat, and Yen Pin Tan

Subjects
Adult, medicine.medical_specialty, business.industry, Treatment outcome, Stomach, General Medicine, Diospyros, Gastroenterology, Bezoars, Treatment Outcome, Internal medicine, Intestine, Small, medicine, Humans, Intestinal obstruction surgery, Female, Stomach obstruction, business, Letter to the Editor, Intestinal Obstruction
Published
2019

32. 2018 WSES/SIS-E consensus conference: Recommendations for the management of skin and soft-tissue infections

Author

Andrey Litvin, Maddalena Giannella, Antonio Tarasconi, Massimo Chiarugi, Luca Ansaloni, Raul Coimbra, Fikri M. Abu-Zidan, Michele Bartoletti, Xavier Guirao, Salomone Di Saverio, Fausto Catena, Federico Coccolini, Vishal G Shelat, Guntars Pupelis, Francesco M. Labricciosa, Gabriele Sganga, Helmut Segovia-Lohse, Timothy Craig Hardcastle, Kemal Rasa, Cristian Tranà, Belinda De Simone, Vladimir Khokha, Maddalena Peghin, Ionut Negoi, Ernest E. Moore, Yoram Kluger, Edoardo Picetti, Jan Ulrych, Massimo Sartelli, Ines Rubio-Perez, Philippe Montravers, Michael Sugrue, Osvaldo Chiara, Francesco Giuseppe De Rosa, Ari Leppäniemi, Walter L. Biffl, Pierluigi Viale, Marja A. Boermeester, Offir Ben-Ishay, Matteo Bassetti, Boris Sakakushev, Leonardo Pagani, George Gkiokas, Tadeja Pintar, Sartelli, Massimo, Guirao, Xavier, Hardcastle, Timothy C., Kluger, Yoram, Boermeester, Marja.A., Raşa, Kemal, Ansaloni, Luca, Coccolini, Federico, Montravers, Philippe, Abu-Zidan, Fikri M., Bartoletti, Michele, Bassetti, Matteo, Ben-Ishay, Offir, Biffl, Walter L., Chiara, Osvaldo, Chiarugi, Massimo, Coimbra, Raul, De Rosa, Francesco Giuseppe, De Simone, Belinda, Di Saverio, Salomone, Giannella, Maddalena, Gkiokas, George, Khokha, Vladimir, Labricciosa, Francesco M., Leppäniemi, Ari, Litvin, Andrey, Moore, Ernest E., Negoi, Ionut, Pagani, Leonardo, Peghin, Maddalena, Picetti, Edoardo, Pintar, Tadeja, Pupelis, Guntar, Rubio-Perez, Ine, Sakakushev, Bori, Segovia-Lohse, Helmut, Sganga, Gabriele, Shelat, Vishal, Sugrue, Michael, Tarasconi, Antonio, Tranà, Cristian, Ulrych, Jan, Viale, Pierluigi, and Catena, Fausto

Subjects
0301 basic medicine, medicine.medical_specialty, Consensus, Settore MED/18 - CHIRURGIA GENERALE, 030106 microbiology, lcsh:Surgery, Guidelines as Topic, Review, Key issues, 03 medical and health sciences, 0302 clinical medicine, Soft-tissue infection, Emergency surgery, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, Soft-tissue infections, Necrotizing infection, Surgical site infection, Surgery, Emergency Medicine, business.industry, Task force, Soft Tissue Infections, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Consensus conference, Soft tissue, Congresses as Topic, Italy, lcsh:RD1-811, lcsh:RC86-88.9, 3. Good health, Clinical Practice, Infectious disease (medical specialty), business, Surgical Infections
Abstract

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.

Published
2018

33. Outcomes of repeat laparoscopic liver resection compared to the primary resection

Author

Marc G. Besselink, M. Abu Hilal, H. Al Saati, Kürşat Rahmi Serin, Morsal Samim, Neil W. Pearce, Vishal G Shelat, P. Di Gioia, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA -Cancer Center Amsterdam, and Surgery

Subjects
Adult, Male, Reoperation, medicine.medical_specialty, Carcinoma, Hepatocellular, Operative Time, Blood Loss, Surgical, Subgroup analysis, Young Adult, medicine, Carcinoma, Hepatectomy, Humans, Aged, Retrospective Studies, business.industry, Liver Neoplasms, Retrospective cohort study, Vascular surgery, Length of Stay, Middle Aged, medicine.disease, Conversion to Open Surgery, Surgery, Cardiac surgery, Neuroendocrine Tumors, Cardiothoracic surgery, Hepatocellular carcinoma, Female, Laparoscopy, business, Colorectal Neoplasms, Abdominal surgery
Abstract

Repeat laparoscopic liver resection (R-LLR) can be technically challenging. Data on this topic are scarce and many investigators would question its feasibility and outcomes. The aim of the present study was to evaluate the safety, feasibility, oncological efficiency and outcomes of R-LLR. We reviewed a prospectively collected database of 403 patients undergoing 422 laparoscopic liver resections (LLRs) from August 2003 to August 2013. Data of 19 patients undergoing R-LLR were analyzed and compared to the primary resection (P-LLR) in these patients. Demographic and clinical data were studied. A subgroup analysis was done for minor resections. Twenty R-LLRs were performed in 19 patients (female 58 %; mean age: 57.5 years; age range: 23–79 years). Colorectal liver metastases (CRLM) were the commonest indication for R-LLR (60 %), followed by neuroendocrine tumor liver metastases (NETLM) (20 %) and hepatocellular carcinoma (HCC) (10 %). The majority (90 %) of resections were for malignant disease (18/20). There were three conversions (15 %), and two patients developed complications (10 %). The operative time (p = 0.005) and blood loss (p = 0.03) were both significantly greater in R-LLR compared to P-LLR, whereas length of stay (median 4 days; p = 0.30) and complications (p = 0.58) did not differ between the groups. R0 resection rates for P-LLR and R-LLR were 95 and 90 %, respectively (p = 0.73). Repeat LLR is safe, feasible, and can be performed with minimal morbidity. It appears to be technically more challenging than P-LLR, but without any increase in complications or length of hospital stay.

Published
2014

34. Antimicrobials : a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

Author

Richard R. Watkins, Adrien Hodonou, Brad Spellberg, Fausto Catena, Marc Maegele, Sanoop K. Zachariah, András Vereczkei, Katia Iskandar, Jill R. Cherry-Bukowiec, Jean-Ralph Zahar, Shamshul Ansari, Luca Ansaloni, Addison K. May, Aneel Bhangu, Rao R. Ivatury, Sujith J Chandy, Joseph R Fitchett, Gustavo Pereira Fraga, Peep Talving, Tonny Loho, Amos Massele, Kaoru Koike, Marcelo A. Beltrán, Salomone Di Saverio, Zaza Demetrashvili, Isidoro Di Carlo, Rifat Latifi, Christian Eckmann, Miran Rems, Adrián Camacho-Ortiz, Dieter G. Weber, Majdi N. Al-Hasan, Manuel Guzman-Blanco, Soumitra R. Eachempati, Ravinder S. Vohra, Kjetil Søreide, Etienne Ruppé, Matteo Bassetti, Arda Isik, Andrew W. Kirkpatrick, Hany E. Marei, Gereltuya Dorj, Belinda De Simone, Aleksandar Karamarkovic, Adrian Brink, Jason A. Roberts, Caroline Colijn, Francesco M. Labricciosa, Mainul Haque, Frederick A. Moore, Michael Bernhard, Miguel Caínzos, Ari Leppäniemi, Sara Al-Dahir, Sonja Hansen, Maurizio Labbate, Boonying Siribumrungwong, Hervé Dupont, Rita Maria Melotti, Helen Giamarellou, Vishal G Shelat, Martin G. Kees, Rodolfo Soto, F. Corcione, Michael McFarlane, Kenji Inaba, Samir Delibegovic, Kuo Ching Yuan, David P. Nicolau, Gerson Alves Pereira Júnior, Jose J. Diaz, Dominik Mertz, Claudio Viscoli, Lewis J. Kaplan, George Gkiokas, Torsten Herzog, Alain Chichom-Mefire, Agron Dogjani, Jan Ulrych, Jan J. De Waele, Jean-François Timsit, Warren Lowman, Yunfeng Cui, Asmaa Althani, Yousheng Li, Diego Piazza, Staphanie R. Goldberg, Yoram Kluger, Carlos A. Ordoñez, Carl Erik Nord, Waldemar Uhl, O.R. Buyne, Imtiaz Wani, Wolfgang R. Heizmann, Valery N. Egiev, Timothy M. Rawson, Abdel K. Omari, Renato Bessa Melo, A R K Adesunkanmi, Miguel Sanchez-Garcia, Pierre-François Laterre, Vladimir Khokha, Harumi Gomi, Massimo Sartelli, Boris Sakakhushev, Ewen A. Griffiths, Ngo Tat Trung, Young R. Lee, Tanya L. Zakrison, Mushira Enani, Ignacio Martin-Loeches, Gabriele Sganga, Ionut Negoi, Carlos Augusto Gomes, Jakub Kenig, Ronald V. Maier, Norio Sato, Gabriel Trueba, Kelly A. Cairns, Claudio Rocha, Anand Kumar, Andreas Hecker, Fikri M. Abu-Zidan, Marja A. Boermeester, Michael P. Doyle, Peter K. Kim, Federico Coccolini, Paula Ferrada, Sandro Rizoli, Stephen M. Brecher, Robert G. Sawyer, Victory Kong, Jean Louis Vincent, Goran Augustin, Suk-Kyung Hong, Stephen Y. Liang, Helmut Alfredo Segovia Lohse, Walter L. Biffl, Reinhold Kafka-Ritsch, Jae Gil Lee, Ernest E. Moore, Sameer Dhingra, Miklosh Bala, Sydney Malama, Kenneth Y.Y. Kok, Oussama Baraket, Harry van Goor, Garima Kapoor, Philippe Montravers, Iain J. Abbott, Wagih Ghnnam, Angel Dillip, Raul Coimbra, Sanjay Marwah, Mouaqit Ouadii, Zsolt J. Balogh, Nathalie Guessennd, Richard Ofori-Asenso, Jonathan Tilsed, Antonio Corcione, Daniel Curcio, Marc Leone, Guntars Pupelis, Yonghong Xiao, Ferdinando Agresta, Mutasim M. Elmangory, Brian J. Wright, John E. Mazuski, Asri Che Jusoh, Perluigi Viale, Ronald Kiguba, Rashid Ansumana, Matthew C Knox, CHU Amiens-Picardie, 6th Department of Internal Medicine, Diagnostic and Therapeutic Center of Athens 'Hygeia', Department of Anesthesiology and Intensive Care, Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Hartford Hospital, Department of Laboratory Medicine, Karolinska Institutet [Stockholm], Equipe mobile d'infectiologie, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service Microbiologie-Hygiène Hospitalière, Infectious Diseases, Università degli studi di Genova = University of Genoa (UniGe), Service d'anesthésie - réanimation chirurgicale [CHU Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Université libre de Bruxelles (ULB), Sartelli, Massimo, Weber, Dieter G., Ruppé, Etienne, Bassetti, Matteo, Wright, Brian J., Ansaloni, Luca, Catena, Fausto, Coccolini, Federico, Abu-Zidan, Fikri M., Coimbra, Raul, Moore, Ernest E., Moore, Frederick A., Maier, Ronald V., De Waele, Jan J., Kirkpatrick, Andrew W., Griffiths, Ewen A., Eckmann, Christian, Brink, Adrian J., Mazuski, John E., May, Addison K., Sawyer, Rob G., Mertz, Dominik, Montravers, Philippe, Kumar, Anand, Roberts, Jason A., Vincent, Jean-Loui, Watkins, Richard R., Lowman, Warren, Spellberg, Brad, Abbott, Iain J., Adesunkanmi, Abdulrashid Kayode, Al-Dahir, Sara, Al-Hasan, Majdi N., Agresta, Ferdinando, Althani, Asma A., Ansari, Shamshul, Ansumana, Rashid, Augustin, Goran, Bala, Miklosh, Balogh, Zsolt J., Baraket, Oussama, Bhangu, Aneel, Beltrán, Marcelo A., Bernhard, Michael, Biffl, Walter L., Boermeester, Marja A., Brecher, Stephen M., Cherry-Bukowiec, Jill R., Buyne, Otmar R., Cainzos, Miguel A., Cairns, Kelly A., Camacho-Ortiz, Adrian, Chandy, Sujith J., Che Jusoh, Asri, Chichom-Mefire, Alain, Colijn, Caroline, Corcione, Francesco, Cui, Yunfeng, Curcio, Daniel, Delibegovic, Samir, Demetrashvili, Zaza, De Simone, Belinda, Dhingra, Sameer, Diaz, José J., Di Carlo, Isidoro, Dillip, Angel, Di Saverio, Salomone, Doyle, Michael P., Dorj, Gereltuya, Dogjani, Agron, Dupont, Hervé, Eachempati, Soumitra R., Enani, Mushira Abdulaziz, Egiev, Valery N., Elmangory, Mutasim M., Ferrada, Paula, Fitchett, Joseph R., Fraga, Gustavo P., Guessennd, Nathalie, Giamarellou, Helen, Ghnnam, Wagih, Gkiokas, George, Goldberg, Staphanie R., Gomes, Carlos Augusto, Gomi, Harumi, Guzmán-Blanco, Manuel, Haque, Mainul, Hansen, Sonja, Hecker, Andrea, Heizmann, Wolfgang R., Herzog, Torsten, Hodonou, Adrien Montcho, Hong, Suk-Kyung, Kafka-Ritsch, Reinhold, Kaplan, Lewis J., Kapoor, Garima, Karamarkovic, Aleksandar, Kees, Martin G., Kenig, Jakub, Kiguba, Ronald, Kim, Peter K., Kluger, Yoram, Khokha, Vladimir, Koike, Kaoru, Kok, Kenneth Y. Y., Kong, Victory, Knox, Matthew C., Inaba, Kenji, Isik, Arda, Iskandar, Katia, Ivatury, Rao R., Labbate, Maurizio, Labricciosa, Francesco M., Laterre, Pierre-Françoi, Latifi, Rifat, Lee, Jae Gil, Lee, Young Ran, Leone, Marc, Leppaniemi, Ari, Li, Yousheng, Liang, Stephen Y., Loho, Tonny, Maegele, Marc, Malama, Sydney, Marei, Hany E., Martin-Loeches, Ignacio, Marwah, Sanjay, Massele, Amo, Mcfarlane, Michael, Melo, Renato Bessa, Negoi, Ionut, Nicolau, David P., Nord, Carl Erik, Ofori-Asenso, Richard, Omari, AbdelKarim H., Ordonez, Carlos A., Ouadii, Mouaqit, Pereira Júnior, Gerson Alve, Piazza, Diego, Pupelis, Guntar, Rawson, Timothy Mile, Rems, Miran, Rizoli, Sandro, Rocha, Claudio, Sakakhushev, Bori, Sanchez-Garcia, Miguel, Sato, Norio, Segovia Lohse, Helmut A., Sganga, Gabriele, Siribumrungwong, Boonying, Shelat, Vishal G., Soreide, Kjetil, Soto, Rodolfo, Talving, Peep, Tilsed, Jonathan V., Timsit, Jean-Francoi, Trueba, Gabriel, Trung, Ngo Tat, Ulrych, Jan, van Goor, Harry, Vereczkei, Andra, Vohra, Ravinder S., Wani, Imtiaz, Uhl, Waldemar, Xiao, Yonghong, Yuan, Kuo-Ching, Zachariah, Sanoop K., Zahar, Jean-Ralph, Zakrison, Tanya L., Corcione, Antonio, Melotti, Rita M., Viscoli, Claudio, Viale, Perluigi, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service de soins intensifs, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), University of Genoa (UNIGE), Sartelli, M, Weber, DG, Ruppe, E, Bassetti, M, Dorj, G, Kok, Kenneth Y.Y., and Viale, Pierluigi

Subjects
Anti-Infective Agent, 0301 basic medicine, INTENSIVE-CARE-UNIT, International Cooperation, Settore MED/18 - CHIRURGIA GENERALE, Drug Resistance, morbidity, Review, Drug resistance, Tigecycline, CLOSTRIDIUM-DIFFICILE INFECTION, VANCOMYCIN-RESISTANT ENTEROCOCCI, Microbial, SPECTRUM-BETA-LACTAMASE, 0302 clinical medicine, Anti-Infective Agents, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Medicine and Health Sciences, Agora, 030212 general & internal medicine, wb_330, computer.programming_language, Iais, biology, Microbial Sensitivity Test, Antimicrobials, Drug Resistance, Microbial, Antimicrobials, (AGORA), Prognosis, Antimicrobial, 3. Good health, CARBAPENEMASE-PRODUCING ENTEROBACTERIACEAE, antibiotic-resistance, Intra-abdominal infections (IAI), Surgery, Emergency Medicine, CLINICAL-PRACTICE GUIDELINES, 7c0bbdab, BLOOD-STREAM INFECTIONS, CRITICALLY-ILL PATIENTS, Human, medicine.drug, medicine.medical_specialty, Prognosi, 030106 microbiology, Microbial Sensitivity Tests, wa_110, qw_45, Emerging and Re-emerging Infectious Diseases, 03 medical and health sciences, wi_140, Antibiotic resistance, Intraabdominal Infection, medicine, Humans, intra-abdominal infections, GRAM-NEGATIVE BACTERIA, Intensive care medicine, Chirurgie, VENTILATOR-ASSOCIATED PNEUMONIA, business.industry, Médecine pathologie humaine, Intraabdominal Infections, biology.organism_classification, Review article, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], business, computer
Abstract

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs., 0, SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2016

35. Ameliorating effect of olive oil on fertility of male rats fed on genetically modified soya bean

Author

Mohammad Abu Hilal, Ahmed K. Al-Ghamdi, Vishal G Shelat, Hatim A. Al-Abbadi, Thanaa A. El-Kholy, Hanan M. Sobhy, and Dina M Qahwaji

Subjects
0301 basic medicine, medicine.medical_specialty, medicine.medical_treatment, Fertility, Olive oil, Soyabean, lcsh:TX341-641, 030209 endocrinology & metabolism, Biology, 03 medical and health sciences, Basal (phylogenetics), 0302 clinical medicine, Seminal vesicle, Prostate, Internal medicine, medicine, genetic modification, Public Health Nutrition, Adverse effect, Testosterone, soya bean, fertility, 030109 nutrition & dietetics, Nutrition and Dietetics, Vitamin E, Public Health, Environmental and Occupational Health, Epididymis, olive oil, Sperm, Endocrinology, medicine.anatomical_structure, Original Article, lcsh:Nutrition. Foods and food supply, Food Science
Abstract

Background : Genetically modified soya bean (GMSB) is a commercialized food. It has been shown to have adverse effects on fertility in animal trials. Extra virgin olive oil (EVOO) has many beneficial effects including anti-oxidant properties. The aim of this study is to elucidate if addition of EVOO ameliorates the adverse effects on reproductive organs of rats fed on GMSB containing diet. Methods : Forty adult male albino rats (150–180 g) of Sprague Dawley strain were separated into four groups of 10 rats each: Group 1 – control group fed on basal ration, Group 2 – fed on basal ration mixed with EVOO (30%), Group 3 – fed on basal ration mixed with GMSB (15%), and Group 4 – fed on basal ration mixed with GMSB (15%) and EVOO (30%). This feeding regimen was administered for 65 days. Blood samples were collected to analyze serum zinc, vitamin E, and testosterone levels. Histopathological and weight changes in sex organs were evaluated. Results : GMSB diet reduced weight of testis (0.66±0.06 vs. 1.7±0.06, p

Published
2015

36. Strict Selection Criteria During Surgical Training Ensures Good Outcomes in Laparoscopic Omental Patch Repair (LOPR) for Perforated Peptic Ulcer (PPU)

Author

Clement L. K. Chia, Saleem Ahmed, Vishal G Shelat, and Yee Lee Cheah

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Upper Gastrointestinal Surgery, Young Adult, Peptic Ulcer Perforation, medicine, Humans, Laparoscopy, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, Minimal access surgery, General surgery, Patient Selection, Microsoft excel, Perioperative, Length of Stay, Middle Aged, medicine.disease, Surgical training, Surgery, Omental patch, Treatment Outcome, Peptic ulcer, Female, business, Omentum
Abstract

Application of minimal access surgery in acute care surgery is limited due to various reasons. Laparoscopic omental patch repair (LOPR) for perforated peptic ulcer (PPU) surgery is safe and feasible but not widely implemented. We report our early experience of LOPR with emphasis on strict selection criteria. This is a descriptive study of all patients operated on for PPU at academic university-affiliated institutes from December 2010 to February 2012. All the patients who were operated on for LOPR were included as the study population and their records were studied. Perioperative outcomes, Boey score, Mannheim Peritonitis Index (MPI), and physiologic and operative severity scores for enumeration of mortality and morbidity (POSSUM) scores were calculated. All the data were tabulated in a Microsoft Excel spreadsheet and analyzed using Stata Version 8.x. (StataCorp, College Station, TX, USA). Fourteen patients had LOPR out of a total of 45 patients operated for the PPU. Mean age was 46 years (range 22−87 years). Twelve patients (86%) had a Boey score of 0 and all patients had MPI < 21 (mean MPI = 14). The predicted POSSUM morbidity and mortality were 36% and 7%, respectively. Mean ulcer size was 5 mm (range 2−10 mm), mean operating time was 100 minutes (range 70−123 minutes) and mean length of hospital stay was 4 days (range 3−6 days). There was no morbidity or mortality pertaining to LOPR. LOPR should be offered by acute care surgical teams when local expertise is available. This can optimize patient outcomes when strict selection criteria are applied.

Published
2015

37. WSES guidelines for management of Clostridium difficile infection in surgical patients

Author

Francis D. LaBarbera, Carlos Augusto Gomes, Miguel Caínzos, Ari Leppäniemi, Libor Urbánek, Massimo Sartelli, Adrián Camacho-Ortiz, Pierre Tattevin, Goran Augustin, Wen Chien Ko, Varut Lohsiriwat, Torsten Herzog, Nicola Petrosillo, Federico Coccolini, Arnab Ray, Yunfeng Cui, Paula Ferrada, Raul Coimbra, Paul Juang, Jill R. Cherry-Bukowiec, Sanjay Marwah, Rao R. Ivatury, Fausto Catena, Offir Ben-Ishay, David B. Stewart, Mario Paulo Faro, Charles H. Cook, Kathleen B. To, Lynne V. McFarland, Pierluigi Viale, Basant K. Puri, Ian Eltringham, Rita Galeiras, Shirley Chan, Jean-Ralph Zahar, Zaza Demetrashvili, Harry van Goor, Luca Ansaloni, Christian Eckmann, Patrizia Spigaglia, Jean-François Timsit, Catherine Eckert, Boris Sakakushev, Stefano Di Bella, Aneel Bhangu, Layan Alrahmani, Gustavo Pereira Fraga, Jae Gil Lee, Ernest E. Moore, Salomone Di Saverio, Ciaran P. Kelly, Frederick A. Moore, Jacek Czepiel, Carl Erik Nord, Luis Furuya-Kanamori, Stephen M. Brecher, Waldemar Uhl, Zaid M. Abdelsattar, Cristian Tranà, Jean-Louis Frossard, Ewen A. Griffiths, Mushira Enani, George C. Velmahos, Mohamed Hassan Ahmed, Irina Magdalena Dumitru, Wagih Ghnnam, Sahil Khanna, Gerson Alves Pereira Júnior, Mansoor Raza, Felicia Humphrey, Miran Rems, Laura A. Canterbury, Frédéric Barbut, Mark A. Malangoni, Emanuele Caproli, Edward H. Eiland, Maria-Elena Cocuz, Arda Isik, Yoram Kluger, Walter L. Biffl, Gabriele Sganga, Miklosh Bala, Koray Das, Vishal G Shelat, Peter K. Kim, Gökhan Metan, Fikri M. Abu-Zidan, Angela Vassallo, Jesse Clanton, Yeong Yeh Lee, Francisco Portela, Joseph D. Forrester, Isidoro Di Carlo, Aleksandar Karamarkovic, Jae Il Kim, John E. Mazuski, Carlos A. Ordoñez, Venkata Subhash Gorrepati, Sartelli, Massimo, Malangoni Mark, A., Abu-Zidan Fikri, M., Griffiths Ewen, A., Di Bella, S, McFarland Lynne, V., Eltringham, Ian, Shelat Vishal, G., Velmahos George, C., Kelly Ciarán, P., Khanna, Sahil, Abdelsattar Zaid, M., Alrahmani, Layan, Ansaloni, Luca, Augustin, Goran, Bala, Miklosh, Barbut, Frédéric, Ben-Ishay, Offir, Bhangu, Aneel, Biffl Walter, L., Brecher Stephen, M., Camacho-Ortiz, Adrián, Caínzos Miguel, A., Canterbury Laura, A., Catena, Fausto, Chan, Shirley, Cherry-Bukowiec Jill, R., Clanton, Jesse, Coccolini, Federico, Cocuz Maria, Elena, Coimbra, Raul, Cook Charles, H., Cui, Yunfeng, Czepiel, Jacek, Das, Koray, Demetrashvili, Zaza, Di Carlo, Isidoro, Di Saverio, Salomone, Dumitru Irina, Magdalena, Eckert, Catherine, Eckmann, Christian, Eiland Edward, H., Enani Mushira, Abdulaziz, Faro, Mario, Ferrada, Paula, Forrester Joseph, Derek, Fraga Gustavo, P., Frossard Jean, Loui, Galeiras, Rita, Ghnnam, Wagih, Gomes Carlos, Augusto, Gorrepati, Venkata, Ahmed Mohamed, Hassan, Herzog, Torsten, Humphrey, Felicia, Kim Jae, Il, Isik, Arda, Ivatury, Rao, Lee Yeong, Yeh, Juang, Paul, Furuya-Kanamori, Lui, Karamarkovic, Aleksandar, Kim Peter, K., Kluger, Yoram, Ko Wen, Chien, LaBarbera Francis, D., Lee Jae, Gil, Leppaniemi, Ari, Lohsiriwat, Varut, Marwah, Sanjay, Mazuski John, E., Metan, Gokhan, Moore Ernest, E., Moore Frederick, Alan, Nord Carl, Erik, Ordoñez Carlos, A., Júnior Gerson Alves, Pereira, Petrosillo, Nicola, Portela, Francisco, Puri Basant, K., Ray, Arnab, Raza, Mansoor, Rems, Miran, Sakakushev Boris, E., Sganga, Gabriele, Spigaglia, Patrizia, Stewart David, B., Tattevin, Pierre, Timsit Jean, Francoi, To Kathleen, B., Tranà, Cristian, Uhl, Waldemar, Urbánek, Libor, van Goor, Harry, Vassallo, Angela, Zahar Jean, Ralph, Caproli, Emanuele, Viale, Pierluigi, Centre de Recherche des Cordeliers (CRC (UMR_S 872)), Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service des maladies infectieuses, CHU Pontchaillou [Rennes], Fonction, structure et inactivation d'ARN bactériens, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Hôpital Bichat - Claude Bernard, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Department of Internal Medicine, Geriatrics and Nephrologic Diseases, Section of Infectious Diseases, S.Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna (UNIBO), Centre de Recherche des Cordeliers ( CRC (UMR_S 872) ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Angers, Alma Mater Studiorum University of Bologna ( UNIBO ), Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Malangoni, Mark A., Abu-Zidan, Fikri M., Griffiths, Ewen A., Di Bella, Stefano, Mcfarland, Lynne V., Shelat, Vishal G., Velmahos, George C., Kelly, Ciarán P., Abdelsattar, Zaid M., Biffl, Walter L., Brecher, Stephen M., Caínzos, Miguel A., Canterbury, Laura A., Cherry-Bukowiec, Jill R., Cocuz, Maria Elena, Cook, Charles H., Dumitru, Irina Magdalena, Eiland, Edward H., Enani, Mushira Abdulaziz, Forrester, Joseph Derek, Fraga, Gustavo P., Frossard, Jean Loui, Gomes, Carlos Augusto, Ahmed, Mohamed Hassan, Kim, Jae Il, Lee, Yeong Yeh, Kim, Peter K, Ko, Wen Chien, Labarbera, Francis D., Lee, Jae Gil, Mazuski, John E., Moore, Ernest E., Moore, Frederick Alan, Nord, Carl Erik, Ordoñez, Carlos A., Júnior, Gerson Alves Pereira, Puri, Basant K., Sakakushev, Boris E., Stewart, David B., Timsit, Jean Francoi, To, Kathleen B., Zahar, Jean Ralph, and İç Hastalıkları

Subjects
medicine.medical_specialty, Pathology, genetic structures, Settore MED/18 - CHIRURGIA GENERALE, [SDV]Life Sciences [q-bio], Disease, Review, Inflammatory bowel disease, 03 medical and health sciences, 0302 clinical medicine, Emergency surgery, Clostridium difficile, guidelines, management, Epidemiology, medicine, 030212 general & internal medicine, Intensive care medicine, [ SDV ] Life Sciences [q-bio], business.industry, Incidence (epidemiology), WSES, Pseudomembranous colitis, medicine.disease, 3. Good health, Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10], Emergency Medicine, 030211 gastroenterology & hepatology, Surgery, business, guideline, Surgical patients
Abstract

Contains fulltext : 154431.pdf (Publisher’s version ) (Open Access) In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.

Published
2015

38. Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections : a prospective multicentre study (WISS Study)

Author

Elif Colak, Iyiade Olaoye, Raghuveer Mn, Tugan Tezcaner, David W da Costa, Varut Lohsiriwat, Vinod V. Prabhu, Tadeja Pintar, Fausto Catena, Raul Coimbra, Daniel Rios-Cruz, Zaza Demetrashvili, Dimitrios Anyfantakis, Isidoro Di Carlo, John Agboola, Konstantinos Pouggouras, Charalampos Spyropoulos, AA Munyika, Sanjay Marwah, Stefano Rausei, Giovanni Bellanova, Francesco Pata, András Vereczkei, Piotr Major, Nereo Vettoretto, Ari Leppäniemi, Ramakrishnapillai Padmakumar, Geanina Loredana Curca, Oussama Baraket, Marco Catani, Massimo Sartelli, Miguel Leon, Konstantinos Bouliaris, Maria Luisa Sánchez de Molina, Eftychios Lostoridis, Gianfranco Cocorullo, Bandar Alharthi, Ionut Negoi, Zygimantas Kuliesius, Sanjay Gupta, Maurice Zida, Terry Curry, Savas Bayrak, Frederic Branger, Pedro Leão, Teresa Giménez Maurel, Saleh Abdel Kader, Cristian Mesina, Marcelo A. Beltrán, Eudaldo López-Tomassetti Fernandez, Carlos A. Ordoñez, Martin Hutan, Jakub Kenig, Avidyl Krasniqi, Sumita A Jain, Tonguç Utku Yılmaz, Miran Rems, Dmitry Smirnov, Gabrielle H. van Ramshorst, Robin Kaushik, Renato Bessa Melo, Mario Paulo Faro, Ouadii Mouaqit, Asri Che Jusoh, Adamu Amhed, Abdelkarim H. Omari, Jaan Tepp, Ali Guner, Miklosh Bala, Charampolos Seretis, Alain Chichom-Mefire, Nadezda Drozdova, Matej Skrovina, Saila Kauhanen, Aurélien Venara, Aintzane Lizarazu Pérez, Kuo-Ching Yuan, Adesina Ajibade, Silvia Figueiredo Costa, Yoshimitsu Izawa, Mahir Gachabayov, Michael McFarlane, Ricardo Alessandro Teixeira Gonsaga, Ashok Kshirsagar, Jae Gil Lee, Gustavo Pereira Fraga, Koray Das, Jan Ulrych, Tamer El Zalabany, Luca Ansaloni, Victor Y. Kong, Matti Tolonen, Jorge Pereira, Nick Michalopoulos, Georgios Gkiokas, Arda Isik, Orestis Ioannidis, Aleix Martínez-Pérez, Seckin Akkucuk, Giovanni Sinibaldi, Gabriela Elisa Nita, Jae Il Kim, Yunfeng Cui, Federico Coccolini, Ewen A. Griffiths, Roberto Bini, Salomone Di Saverio, Mushira Enani, Boris Sakakushev, Mustafa Yener Uzunoglu, Asrhaf Abbas, Fikri M. Abu-Zidan, David van Dellen, Sandra Gutierrez, Samir Delibegovic, Ioannis Nikolopoulos, Daniele Brunelli, Vishal G Shelat, Ferdinando Agresta, Gerson Alves Pereira Júnior, Goran Augustin, Mantas Jokubauskas, Zeynep Özkan, Sanoop K. Zachariah, Nutu Vlad, Romeo Lages Simões, Konstantinos Lasithiotakis, Giorgio Vasquez, Matthew Boal, Daniele Marrelli, Sanjay Kumar Yadav, Paola Rodriguez Ossa, Vladimir Khokha, Carlos Augusto Gomes, Justas Zilinskas, Gianluca Guercioni, Renol M. Koshy, Gian Luca Baiocchi, Athanasios Marinis, Aleksandar Karamarkovic, Radu Moldovanu, Andrey V. Borodach, Myftar Torba, II kirurgian klinikka, Clinicum, [et al.], Universidade do Minho, Sartelli, M., Abu Zidan, F., Catena, F., Griffiths, E., Di Saverio, S., Coimbra, R., Ordoñez, C., Leppaniemi, A., Fraga, G., Coccolini, F., Agresta, F., Abbas, A., Abdel Kader, S., Agboola, J., Amhed, A., Ajibade, A., Akkucuk, S., Alharthi, B., Anyfantakis, D., Augustin, G., Baiocchi, G., Bala, M., Baraket, O., Bayrak, S., Bellanova, G., Beltràn, M., Bini, R., Boal, M., Borodach, A., Bouliaris, K., Branger, F., Brunelli, D., Catani, M., Che Jusoh, A., Chichom Mefire, A., Cocorullo, G., Colak, E., Costa, D., Costa, S., Cui, Y., Curca, G., Curry, T., Das, K., Delibegovic, S., Demetrashvili, Z., Di Carlo, I., Drozdova, N., El Zalabany, T., Enani, M., Faro, M., Gachabayov, M., Giménez Maurel, T., Gkiokas, G., Gomes, C., Gonsaga, R., Guercioni, G., Guner, A., Gupta, S., Gutierrez, S., Hutan, M., Ioannidis, O., Isik, A., Izawa, Y., Jain, S., Jokubauskas, M., Karamarkovic, A., Kauhanen, S., Kaushik, R., Kenig, J., Khokha, V., Kim, J., Kong, V., Koshy, R., Krasniqi, A., Kshirsagar, A., Kuliesius, Z., Lasithiotakis, K., Leão, P., Lee, J., Leon, M., Lizarazu Pérez, A., Lohsiriwat, V., López Tomassetti Fernandez, E., Lostoridis, E., Mn, R., Major, P., Marinis, A., Marrelli, D., Martinez Perez, A., Marwah, S., Mcfarlane, M., Melo, R., Mesina, C., Michalopoulos, N., Moldovanu, R., Mouaqit, O., Munyika, A., Negoi, I., Nikolopoulos, I., Nita, G., Olaoye, I., Omari, A., Ossa, P., Ozkan, Z., Padmakumar, R., Pata, F., Pereira Junior, G., Pereira, J., Pintar, T., Pouggouras, K., Prabhu, V., Rausei, S., Rems, M., Rios Cruz, D., Sakakushev, B., Sánchez de Molina, M., Seretis, C., Shelat, V., Simões, R., Sinibaldi, G., Skrovina, M., Smirnov, D., Spyropoulos, C., Tepp, J., Tezcaner, T., Tolonen, M., Torba, M., Ulrych, J., Uzunoglu, M., van Dellen, D., van Ramshorst, G., Vasquez, G., Venara, A., Vereczkei, A., Vettoretto, N., Vlad, N., Yadav, S., Yilmaz, T., Yuan, K., Zachariah, S., Zida, M., Zilinskas, J., and Ansaloni, L.

Subjects
medicine.medical_specialty, Infections, Intra-abdominal, Sepsis, Septic shock, Ciências da Saúde [Ciências Médicas], Surgery, Emergency Medicine, Ciências Médicas::Ciências da Saúde, Sepsi, medicine.medical_treatment, macromolecular substances, 030230 surgery, GUIDELINES, Likelihood ratios in diagnostic testing, PERITONITIS, 03 medical and health sciences, PROGNOSTIC-FACTORS, 0302 clinical medicine, Internal medicine, Medicine and Health Sciences, MANAGEMENT, medicine, Intra-abdominal Sepsis, Univariate analysis, Science & Technology, COLONIC PERFORATION, Receiver operating characteristic, business.industry, Abdominal Infection, Immunosuppression, 3126 Surgery, anesthesiology, intensive care, radiology, medicine.disease, 3. Good health, 030220 oncology & carcinogenesis, Infections, Intra-abdominal Sepsis, Observational study, Infection, business, SYSTEM, Research Article
Abstract

BACKGROUND: To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. ----- METHODS: The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. ----- RESULTS: Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p

Published
2015

39. The 2023 WSES guidelines on the management of trauma in elderly and frail patients

Author

Belinda De Simone, Elie Chouillard, Mauro Podda, Nikolaos Pararas, Gustavo de Carvalho Duarte, Paola Fugazzola, Arianna Birindelli, Federico Coccolini, Andrea Polistena, Maria Grazia Sibilla, Vitor Kruger, Gustavo P. Fraga, Giulia Montori, Emanuele Russo, Tadeja Pintar, Luca Ansaloni, Nicola Avenia, Salomone Di Saverio, Ari Leppäniemi, Andrea Lauretta, Massimo Sartelli, Alessandro Puzziello, Paolo Carcoforo, Vanni Agnoletti, Luca Bissoni, Arda Isik, Yoram Kluger, Ernest E. Moore, Oreste Marco Romeo, Fikri M. Abu-Zidan, Solomon Gurmu Beka, Dieter G. Weber, Edward C. T. H. Tan, Ciro Paolillo, Yunfeng Cui, Fernando Kim, Edoardo Picetti, Isidoro Di Carlo, Adriana Toro, Gabriele Sganga, Federica Sganga, Mario Testini, Giovanna Di Meo, Andrew W. Kirkpatrick, Ingo Marzi, Nicola déAngelis, Michael Denis Kelly, Imtiaz Wani, Boris Sakakushev, Miklosh Bala, Luigi Bonavina, Joseph M. Galante, Vishal G. Shelat, Lorenzo Cobianchi, Francesca Dal Mas, Manos Pikoulis, Dimitrios Damaskos, Raul Coimbra, Jugdeep Dhesi, Melissa Red Hoffman, Philip F. Stahel, Ronald V. Maier, Andrey Litvin, Rifat Latifi, Walter L. Biffl, and Fausto Catena

Subjects
Elderly, Geriatric patient, Trauma management, Imaging, Laboratory test, Trauma score, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. Methods Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. Results The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient’s directives, family feelings and representatives' desires, and all decisions should be shared. Conclusions The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes. Graphical abstract

Published
2024
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40. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper

Author

Jae Gil Lee, Ernest E. Moore, Sanjay Gupta, Raul Coimbra, Sanjay Marwah, Salomone Di Saverio, Ari Leppäniemi, Wagih Ghnnam, Gustavo Pereira Fraga, Maria Paula Garcia, Walter L. Biffl, Zaza Demetrashvili, Luca Ansaloni, Martin D. Zielinski, Frederick A. Moore, Massimo Sartelli, Reinhold Kafka-Ritsch, Ewen A. Griffiths, Rifat Latifi, Fausto Catena, Yoram Kluger, Carlos A. Ordoñez, Gerson Alves Pereira, H. Plaudis, Miklosh Bala, Federico Coccolini, Sanoop K. Zachariah, Demetrios Demetriades, Michael McFarlane, Victor Y. Kong, Marcelo A. Beltrán, Jan Ulrych, Andreas Hecker, Vishal G Shelat, Fikri M. Abu-Zidan, Osvaldo Chiara, Aleksandar Karamarkovic, and Jose J. Diaz

Subjects
Damage control, medicine.medical_specialty, Abdominal compartment syndrome, business.industry, Peritoneal fluid, Review, Anastomosis, medicine.disease, Bioinformatics, 3. Good health, Surgery, Sepsis, Abdominal wall, medicine.anatomical_structure, Abdominal trauma, Damage control surgery, medicine, Emergency Medicine, business
Abstract

The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis and always keep in mind the option of using open abdomen to be able to use it in the right patient at the right time.

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41. Enhanced perioperative care in emergency general surgery: the WSES position paper

Author

Marco Ceresoli, Marco Braga, Nicola Zanini, Fikri M. Abu-Zidan, Dario Parini, Thomas Langer, Massimo Sartelli, Dimitrios Damaskos, Walter L. Biffl, Francesco Amico, Luca Ansaloni, Zsolt J. Balogh, Luigi Bonavina, Ian Civil, Enrico Cicuttin, Mircea Chirica, Yunfeng Cui, Belinda De Simone, Isidoro Di Carlo, Andreas Fette, Giuseppe Foti, Michele Fogliata, Gustavo P. Fraga, Paola Fugazzola, Joseph M. Galante, Solomon Gurmu Beka, Andreas Hecker, Johannes Jeekel, Andrew W. Kirkpatrick, Kaoru Koike, Ari Leppäniemi, Ingo Marzi, Ernest E. Moore, Edoardo Picetti, Emmanouil Pikoulis, Michele Pisano, Mauro Podda, Boris E. Sakakushev, Vishal G. Shelat, Edward Tan, Giovanni D. Tebala, George Velmahos, Dieter G. Weber, Vanni Agnoletti, Yoram Kluger, Gianluca Baiocchi, Fausto Catena, and Federico Coccolini

Subjects
Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Enhanced perioperative care protocols become the standard of care in elective surgery with a significant improvement in patients’ outcome. The key element of the enhanced perioperative care protocol is the multimodal and interdisciplinary approach targeted to the patient, focused on a holistic approach to reduce surgical stress and improve perioperative recovery. Enhanced perioperative care in emergency general surgery is still a debated topic with little evidence available. The present position paper illustrates the existing evidence about perioperative care in emergency surgery patients with a focus on each perioperative intervention in the preoperative, intraoperative and postoperative phase. For each item was proposed and approved a statement by the WSES collaborative group.

Published
2023
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42. A proposal for a CT driven classification of left colon acute diverticulitis

Author

Salomone Di Saverio, Fausto Catena, Zaza Demetrashvili, Fikri M. Abu-Zidan, Damien Massalou, Carlos Augusto Gomes, Federico Coccolini, Miran Rems, Charalampos Spyropoulos, András Vereczkei, Jae Il Kim, Offir Ben-Ishay, Goran Augustin, Yunfeng Cui, Rodolfo Soto, Darija Soldatenkova, Massimo Sartelli, Gerson Alves Pereira, Imtiaz Wani, Renato Bessa Melo, Norio Sato, Matej Skrovina, Jakub Kenig, Victor Y. Kong, Carlos A. Ordoñez, Daniel Rios-Cruz, Abdelkarim H. Omari, Sanoop K. Zachariah, Marco Catani, Dmitry Smirnov, Jaan Tepp, Koray Das, Zurabs Kecbaja, Ferdinando Agresta, Michael McFarlane, Ewen A. Griffiths, Frederick A. Moore, Roberto Bini, Boris Sakakushev, Emanuele Caproli, Miklosh Bala, Diego Piazza, Georgios Gkiokas, Isidoro Di Carlo, Varut Lohsiriwat, Mahir Gachabayov, Raul Coimbra, Ioannis Nikolopoulos, Sanjay Marwah, Helmut Alfredo Segovia Lohse, Jan Ulrych, Tadaja Pintar, Mario Paulo Faro, Ionut Negoi, Gian Luca Baiocchi, Athanasios Marinis, Aleksandar Karamarkovic, Ashraf Abbas, Konstantinos Bouliaris, Giovanni Bellanova, Cristian Tranà, F. Corcione, David Costa Navarro, Arda Isik, Kenneth Y.Y. Kok, Vishal G Shelat, Luca Ansaloni, Gabriele Anania, and Elif Colak

Subjects
medicine.medical_specialty, Acute diverticulitis, medicine.diagnostic_test, business.industry, Computed tomography, Review, Diverticulitis, medicine.disease, Surgery, NO, Left colon, medicine, Emergency Medicine, Radiology, Day to day, Ct imaging, business, Radiation treatment planning
Abstract

Computed tomography (CT) imaging is the most appropriate diagnostic tool to confirm suspected left colonic diverticulitis. However, the utility of CT imaging goes beyond accurate diagnosis of diverticulitis; the grade of severity on CT imaging may drive treatment planning of patients presenting with acute diverticulitis. The appropriate management of left colon acute diverticulitis remains still debated because of the vast spectrum of clinical presentations and different approaches to treatment proposed. The authors present a new simple classification system based on both CT scan results driving decisions making management of acute diverticulitis that may be universally accepted for day to day practice.

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43. Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines

Author

Federico Coccolini, Massimo Sartelli, Robert Sawyer, Kemal Rasa, Bruno Viaggi, Fikri Abu-Zidan, Kjetil Soreide, Timothy Hardcastle, Deepak Gupta, Cino Bendinelli, Marco Ceresoli, Vishal G. Shelat, Richard ten Broek, Gian Luca Baiocchi, Ernest E. Moore, Ibrahima Sall, Mauro Podda, Luigi Bonavina, Igor A. Kryvoruchko, Philip Stahel, Kenji Inaba, Philippe Montravers, Boris Sakakushev, Gabriele Sganga, Paolo Ballestracci, Manu L. N. G. Malbrain, Jean-Louis Vincent, Manos Pikoulis, Solomon Gurmu Beka, Krstina Doklestic, Massimo Chiarugi, Marco Falcone, Elena Bignami, Viktor Reva, Zaza Demetrashvili, Salomone Di Saverio, Matti Tolonen, Pradeep Navsaria, Miklosh Bala, Zsolt Balogh, Andrey Litvin, Andreas Hecker, Imtiaz Wani, Andreas Fette, Belinda De Simone, Rao Ivatury, Edoardo Picetti, Vladimir Khokha, Edward Tan, Chad Ball, Carlo Tascini, Yunfeng Cui, Raul Coimbra, Michael Kelly, Costanza Martino, Vanni Agnoletti, Marja A. Boermeester, Nicola De’Angelis, Mircea Chirica, Walt L. Biffl, Luca Ansaloni, Yoram Kluger, Fausto Catena, and Andrew W. Kirkpatrick

Subjects
Source control, Emergency, Infections, Abdominal, Surgery, Trauma, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.

Published
2023
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44. Should Empiric Anti-Fungals Be Administered Routinely for All Patients with Perforated Peptic Ulcers? A Critical Review of the Existing Literature

Author

Kai Siang Chan, Lee Yee Calista Tan, Sunder Balasubramaniam, and Vishal G. Shelat

Subjects
anti-fungal, culture, intra-abdominal sepsis, microbiology, peptic ulcer perforation, Medicine
Abstract

A perforated peptic ulcer (PPU) is a surgical emergency with a high mortality rate. PPUs cause secondary peritonitis due to bacterial and fungal peritoneal contamination. Surgery is the main treatment modality and patient’s comorbidites impacts perioperative morbidity and surgical outcomes. Even after surgery, resuscitation efforts should continue. While empiric antibiotics are recommended, the role of empiric anti-fungal treatment is unclear due to a lack of scientific evidence. This literature review demonstrated a paucity of studies evaluating the role of empiric anti-fungals in PPUs, and with conflicting results. Studies were heterogeneous in terms of patient demographics and underlying surgical pathology (PPUs vs. any gastrointestinal perforation), type of anti-fungal agent, timing of administration and duration of use. Other considerations include the need to differentiate between fungal colonization vs. invasive fungal infection. Despite positive fungal isolates from fluid culture, it is important for clinical judgement to identify the right group of patients for anti-fungal administration. Biochemistry investigations including new fungal biomarkers may help to guide management. Multidisciplinary discussions may help in decision making for this conundrum. Moving forward, further research may be conducted to select the right group of patients who may benefit from empiric anti-fungal use.

Published
2024
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45. The Ongoing Debate on the Use of Prophylactic Antibiotics in Acute Pancreatitis—Is There a Conclusion? A Comprehensive Narrative Review

Author

Kai Siang Chan and Vishal G. Shelat

Subjects
antibiotics, cholangitis, culture, infection, microbiology, pancreatitis, Therapeutics. Pharmacology, RM1-950
Abstract

Acute pancreatitis (AP) is a common but often self-limiting disease in the majority of patients. However, in the minority, who may progress to moderately severe or severe AP, high mortality risk has been reported. Infected pancreatitis necrosis (IPN) in necrotising pancreatitis has been shown to result in more than twice the mortality rate compared with in sterile pancreatic necrosis. This raises the question on whether prophylactic antibiotics (PABs) should be given in subgroups of AP to prevent superimposed infection to improve survival outcomes. Despite numerous randomised controlled trials (RCTs), meta-analyses, and guidelines on the management of AP, there is a lack of strong evidence to suggest the use of PABs in AP. Additionally, use of PABs is associated with antimicrobial resistance. Considerable heterogeneity exists and limits the interpretation of results—subgroup of AP benefitting from PAB use, choice/class of PAB, and timing of administration from symptom onset and duration of PAB use. Only a minority of existing meta-analyses suggest mortality benefits and reduction in IPN. The majority of existing guidelines do not recommend the use of PABs in AP. More research is required to make more definitive conclusions. Currently, PAB should only be administered after multidisciplinary discussions led by pancreatology experts.

Published
2024
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46. The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study

Author

Belinda De Simone, Yoram Kluger, Ernest E. Moore, Massimo Sartelli, Fikri M. Abu-Zidan, Federico Coccolini, Luca Ansaloni, Giovanni D. Tebala, Salomone Di Saverio, Isidoro Di Carlo, Boris E. Sakakushev, Luigi Bonavina, Michael Sugrue, Joseph M. Galante, Rao Ivatury, Edoardo Picetti, Mircea Chirica, Imtiaz Wani, Miklosh Bala, Ibrahima Sall, Andrew W. Kirkpatrick, Vishal G. Shelat, Emmanouil Pikoulis, Ari Leppäniemi, Edward Tan, Richard P. G. ten Broek, Solomon Gurmu Beka, Andrey Litvin, Elie Chouillard, Raul Coimbra, Yunfeng Cui, Nicola De’ Angelis, Gabriele Sganga, Philip F. Stahel, Vanni Agnoletti, Alessia Rampini, WSES TACS panel of experts, Mario Testini, Francesca Bravi, Ronald V. Maier, Walter L. Biffl, and Fausto Catena

Subjects
Emergency surgery, Priority, Time to surgery, Delay in surgery, Healthcare system, Classification, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The “timing in acute care surgery” (TACS) classification was previously published to introduce a new tool to triage the timely and appropriate access of EGS patients to the operating room. However, the clinical and operational effectiveness of the TACS classification has not been investigated in subsequent validation studies. This study aimed to improve the TACS classification and provide further consensus around the appropriate use of the new TACS classification through a standardized Delphi approach with international experts. Methods This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4–5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease. Results Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority. Conclusion The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a “safe” timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients. Graphical Abstract

Published
2023
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47. Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

Author

Nicola de’Angelis, Francesco Marchegiani, Carlo Alberto Schena, Jim Khan, Vanni Agnoletti, Luca Ansaloni, Ana Gabriela Barría Rodríguez, Paolo Pietro Bianchi, Walter Biffl, Francesca Bravi, Graziano Ceccarelli, Marco Ceresoli, Osvaldo Chiara, Mircea Chirica, Lorenzo Cobianchi, Federico Coccolini, Raul Coimbra, Christian Cotsoglou, Mathieu D’Hondt, Dimitris Damaskos, Belinda De Simone, Salomone Di Saverio, Michele Diana, Eloy Espin‐Basany, Stefan Fichtner‐Feigl, Paola Fugazzola, Paschalis Gavriilidis, Caroline Gronnier, Jeffry Kashuk, Andrew W. Kirkpatrick, Michele Ammendola, Ewout A. Kouwenhoven, Alexis Laurent, Ari Leppaniemi, Mickaël Lesurtel, Riccardo Memeo, Marco Milone, Ernest Moore, Nikolaos Pararas, Andrew Peitzmann, Patrick Pessaux, Edoardo Picetti, Manos Pikoulis, Michele Pisano, Frederic Ris, Tyler Robison, Massimo Sartelli, Vishal G. Shelat, Giuseppe Spinoglio, Michael Sugrue, Edward Tan, Ellen Van Eetvelde, Yoram Kluger, Dieter Weber, and Fausto Catena

Subjects
Emergency surgery, Minimally invasive surgery, Robotic surgery, Laparoscopy, Training curriculum in surgery, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS. Methods This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements. Results Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20–107) depending on the initial surgeon’s experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon’s proficiency. Conclusions Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.

Published
2023
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48. Mirizzi Syndrome—The Past, Present, and Future

Author

Jonathan G. A. Koo, Hui Yu Tham, En Qi Toh, Christopher Chia, Amy Thien, and Vishal G. Shelat

Subjects
Mirizzi syndrome, cholelithiasis, choledocholithiasis, cholecystectomy, subtotal cholecystectomy, laparoscopic, Medicine (General), R5-920
Abstract

Mirizzi syndrome is a complication of gallstone disease caused by an impacted gallstone in the infundibulum of the gallbladder or within the cystic duct, causing chronic inflammation and extrinsic compression of the common hepatic duct or common bile duct. Eventually, mucosal ulceration occurs and progresses to cholecystobiliary fistulation. Numerous systems exist to classify Mirizzi syndrome, with the Csendes classification widely adopted. It describes five types of Mirizzi syndrome according to the presence of a cholecystobiliary fistula and its corresponding severity, and whether a cholecystoenteric fistula is present. The clinical presentation of Mirizzi syndrome is non-specific, and patients typically have a longstanding history of gallstones. It commonly presents with obstructive jaundice, and can mimic gallbladder, biliary, or pancreatic malignancy. Achieving a preoperative diagnosis guides surgical planning and improves treatment outcomes. However, a significant proportion of cases of Mirizzi syndrome are diagnosed intraoperatively, and the presence of dense adhesions and distorted anatomy at Calot’s triangle increases the risk of bile duct injury. Cholecystectomy remains the mainstay of treatment for Mirizzi syndrome, and laparoscopic cholecystectomy is increasingly becoming a viable option, especially for less severe stages of cholecystobiliary fistula. Subtotal cholecystectomy is feasible if total cholecystectomy cannot be performed safely. Additional procedures may be required, such as common bile duct exploration, choledochoplasty, and bilioenteric anastomosis. Conclusions: There is currently no consensus for the management of Mirizzi syndrome, as the management options depend on the extent of surgical pathology and availability of surgical expertise. Multidisciplinary collaboration is important to achieve diagnostic accuracy and guide treatment planning to ensure good clinical outcomes.

Published
2023
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50. Should Procalcitonin Be Included in Acute Cholecystitis Guidelines? A Systematic Review

Author

Clyve Yu Leon Yaow, Ryan Ian Houe Chong, Kai Siang Chan, Christopher Tze Wei Chia, and Vishal G. Shelat

Subjects
acute cholecystitis, gallstones, inflammatory markers, procalcitonin, prognosis, Medicine (General), R5-920
Abstract

Background and Objectives: Acute cholecystitis (AC) is a common surgical emergency. Recent evidence suggests that serum procalcitonin (PCT) is superior to leukocytosis and serum C-reactive protein in the diagnosis and severity stratification of acute infections. This review evaluates the role of PCT in AC diagnosis, severity stratification, and management. Materials and Methods: PubMed, Embase, and Scopus were searched from inception till 21 August 2022 for studies reporting the role of PCT in AC. A qualitative analysis of the existing literature was conducted. Results: Five articles, including 688 patients, were included. PCT ≤ 0.52 ng/mL had fair discriminative ability (Area under the curve (AUC) 0.721, p < 0.001) to differentiate Grade 1 from Grade 2–3 AC, and PCT > 0.8 ng/mL had good discriminatory ability to differentiate Grade 3 from 1–2 AC (AUC 0.813, p < 0.001). PCT cut-off ≥ 1.50 ng/mL predicted difficult laparoscopic cholecystectomy (sensitivity 91.3%, specificity 76.8%). The incidence of open conversion was higher with PCT ≥ 1 ng/mL (32.4% vs. 14.6%, p = 0.013). A PCT value of >0.09 ng/mL could predict major complications (defined as open conversion, mechanical ventilation, and death). Conclusions: Current evidence is plagued by the heterogeneity of small sample studies. Though PCT has some role in assessing severity and predicting difficult cholecystectomy, and postoperative complications in AC patients, more evidence is necessary to validate its use.

Published
2023
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