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1. WSES consensus guidelines on sigmoid volvulus management

Author

Tian, B.W.C.A., Vigutto, G., Tan, E.C.T.H., Goor, H. van, Bendinelli, C., Abu-Zidan, F., Ivatury, R., Sakakushev, B., Carlo, I. Di, Sganga, G., Maier, R.V., Coimbra, R., Leppäniemi, A., Litvin, A., Damaskos, D., Broek, R.P.G ten, Biffl, W., Saverio, S. Di, Simone, B. De, Ceresoli, M., Picetti, E., Galante, J., Tebala, G.D., Beka, S.G., Bonavina, L., Cui, Y., Khan, J., Cicuttin, E., Amico, F., Kenji, I., Hecker, A., Ansaloni, L., Sartelli, M., Moore, E.E., Kluger, Y., Testini, M., Weber, D., Agnoletti, V., Angelis, N.D., Coccolini, F., Sall, I., Catena, F., Tian, B, Vigutto, G, Tan, E, van Goor, H, Bendinelli, C, Abu-Zidan, F, Ivatury, R, Sakakushev, B, Di Carlo, I, Sganga, G, Maier, R, Coimbra, R, Leppaniemi, A, Litvin, A, Damaskos, D, Broek, R, Biffl, W, Di Saverio, S, De Simone, B, Ceresoli, M, Picetti, E, Galante, J, Tebala, G, Beka, S, Bonavina, L, Cui, Y, Khan, J, Cicuttin, E, Amico, F, Kenji, I, Hecker, A, Ansaloni, L, Sartelli, M, Moore, E, Kluger, Y, Testini, M, Weber, D, Agnoletti, V, Angelis, N, Coccolini, F, Sall, I, and Catena, F

Subjects
Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], All institutes and research themes of the Radboud University Medical Center, Emergency Medicine, sigmoid volvolus, Surgery
Abstract

Contains fulltext : 293045.pdf (Publisher’s version ) (Open Access) Sigmoid volvulus is a common surgical emergency, especially in elderly patients. Patients can present with a wide range of clinical states: from asymptomatic, to frank peritonitis secondary to colonic perforation. These patients generally need urgent treatment, be it endoscopic decompression of the colon or an upfront colectomy. The World Society of Emergency Surgery united a worldwide group of international experts to review the current evidence and propose a consensus guidelines on the management of sigmoid volvulus.

Published
2023

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

Author

Coccolini F., Gubbiotti F., Ceresoli M., Tartaglia D., Fugazzola P., Ansaloni L., Sartelli M., Kluger Y., Kirkpatrick A., Amico F., Catena F., Chiarugi M., Montori G., Salvetti F., Negoi I., Zese M., Occhionorelli S., Shlyapnikov S., Sugrue M., Demetrashvili Z., Dondossola D., Ioannidis O., Novelli G., Nacoti M., Khor D., Inaba K., Demetriades D., Kaussen T., Jusoh A. C., Ghannam W., Sakakushev B., Guetta O., Dogjani A., Costa S., Singh S., Damaskos D., Isik A., Yuan K. -C., Trotta F., Rausei S., Martinez-Perez A., Bellanova G., Fonseca V. C., Hernandez F., Marinis A., Fernandes W., Quiodettis M., Bala M., Vereczkei A., Curado R., Fraga G. P., Pereira B. M., Gachabayov M., Chagerben G. P., Arellano M. L., Ozyazici S., Costa G., Tezcaner T., Porta M., Li Y., Karateke F., Manatakis D., Mariani F., Lora F., Sahderov I., Atanasov B., Zegarra S., Fattori L., Ivatury R., Xiao J., Ben-Ishay O., Lippi A., Improta M., Zharikov A., Dubuisson V., Coccolini, F, Gubbiotti, F, Ceresoli, M, Tartaglia, D, Fugazzola, P, Ansaloni, L, Sartelli, M, Kluger, Y, Kirkpatrick, A, Amico, F, Catena, F, Chiarugi, M, Montori, G, Salvetti, F, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Sugrue, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernandez, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Ivatury, R, Xiao, J, Ben-Ishay, O, Lippi, A, Improta, M, Zharikov, A, and Dubuisson, V

Subjects
Adult, Male, medicine.medical_specialty, Original Scientific Report, Fistula, medicine.medical_treatment, open abdomen, Peritonitis, 030230 surgery, NO, 03 medical and health sciences, 0302 clinical medicine, Sepsis, peritoneal resuscitation, Negative-pressure wound therapy, Abdomen, medicine, Humans, Surgical Wound Infection, Prospective Studies, fascial closure, peritoneal resuscitation, management, therapy, fascial closure, Digestive System Surgical Procedures, Aged, therapy, business.industry, Peritoneal fluid, Abdominal Cavity, Abdominal Wound Closure Techniques, Middle Aged, medicine.disease, Surgery, Cardiac surgery, Treatment Outcome, medicine.anatomical_structure, Cardiothoracic surgery, 030220 oncology & carcinogenesis, fluid instillation, Fluid Therapy, Female, business, Negative-Pressure Wound Therapy, management, Abdominal surgery
Abstract

Background Open abdomen (OA) is a surgical option that can be used in patients with severe peritonitis. Few evidences exist to recommend the use of intraperitoneal fluid instillation associated with OA in managing septic abdomen. Materials and methods A prospective analysis of adult patients enrolled in the International Register of Open Abdomen (trial registration: NCT02382770) was performed. Results A total of 387 patients were enrolled in two groups: 84 with peritoneal fluid instillation (FI) and 303 without (NFI). The groups were homogeneous for baseline characteristics. Overall complications were 92.9% in FI and 86.3% in NFI (p = 0.106). Complications during OA were 72.6% in FI and 59.9% in NFI (p = 0.034). Complications after definitive closure were 70.8% in FI and 61.1% in NFI (p = 0.133). Entero-atmospheric fistula was 13.1% in FI and 12% in NFI (p = 0.828). Fascial closure was 78.6% in FI and 63.7% in NFI (p = 0.02). Analysis of FI in negative pressure wound therapy (NPWT) showed: Overall morbidity in NPWT was 94% and in non-NPWT 91.2% (p = 0.622) and morbidity during OA was 68% and 79.4% (p = 0.25), respectively. Definitive fascial closure in NPWT was 87.8% and 96.8% in non-NPWT (p = 0.173). Overall mortality was 40% in NPWT and 29.4% in non-NPWT (p = 0.32) and morality during OA period was 18% and 8.8% (p = 0.238), respectively. Conclusion We found intraperitoneal fluid instillation during open abdomen in peritonitic patients to increase the complication rate during the open abdomen period, with no impact on mortality, entero-atmospheric fistula rate and opening time. Fascial closure rate is increased by instillation. Fluid instillation is feasible even when associated with nonnegative pressure temporary abdominal closure techniques.

Published
2020
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3. The Operative management in Bariatric Acute abdomen (OBA) Survey: long-term complications of bariatric surgery and the emergency surgeon's point of view

Author

De Simone B, Ansaloni L, Sartelli M, Kluger Y, Abu-Zidan F, Biffl W, Heyer A, Coccolini F, Baiocchi G, Catena F, Campanile F, Mario D, Raziel A, Zaccaroni A, Tarasconi A, Dazzi A, Lasithiotakisi K, Maccatrozzo S, Ioannidis O, Pata F, Waledziak M, Dogjani A, Ariffin A, Khokha V, Kho L, Kessel B, Negoi I, Lostoridis E, Conti L, Ponchietti L, Papadia F, Ghilardi G, Calu V, Bilecik T, Alemu B, Reichert M, Hutan M, Seretis C, Radu M, Gomes C, Karateke F, da Fonseca V, Isik A, Nikolopoulos I, Fomin A, Ghnnam W, Sydorchuk R, Paolillo C, Sagnotta A, Solaini L, Sawyer R, Spain D, McFarlane M, Arvieux C, Litvin A, Pereira B, Maurel T, Barberis A, Gachabayov M, O'Connor D, Cruz D, Colak E, Mesina C, Manzano-Nunez R, Abdelkarim, Pintar T, Koshy R, Triantos G, Gautam S, Guner A, Ordonez C, Manatakis D, Chiarugi M, Buonomo L, Major P, Andreas H, Roberts D, Cherry-Bukowiec J, Das K, Costanzi A, van Goor H, Kok K, Martinez-Perez A, Villa R, Fattori L, Nita G, Damaskos D, Yuan K, Lizarazu A, Kelly M, Di Carlo I, Ceresoli M, Galleano R, Herzog, Chatzakis C, Bala M, Piscioneri F, Bonilauri S, Lohse H, Demetrashvili Z, Smirnov D, Kim D, Martina F, Bruni G, Campanelli G, Cavalli M, Kong V, Michalopoulos N, Cui Y, Diana M, and OBA Trial Supporters

Subjects
Acute abdomen, Emergency surgery, Outcome bariatric surgery, Abdominal pain after bariatric surgery, Complication bariatric surgery
Abstract

Background The number of bariatric procedures is increasing worldwide. No consensus or guidelines about the emergency management of long-term complications following bariatric surgery are currently available. The aim of this study is to investigate by a web survey how an emergency surgeon approaches this unique group of patients in an emergency medical scenario and to report their personal experience. Method An international web survey was sent to 197 emergency surgeons with the aim to collect data about emergency surgeons' experience in the management of patients admitted in the emergency department for acute abdominal pain after bariatric surgery. The survey was conceived as a questionnaire composed by 26 (multiple choice and open) questions and approved by a steering committee. Results One hundred seventeen international emergency surgeons decided to join the project and answered to the web survey with a response rate of 59.39%. Conclusions The aim of this WSES web survey was to highlight the current management of patients previously submitted to bariatric surgical procedures by ES. Emergency surgeons must be mindful of postoperative bariatric surgery complications. CT scan with oral intestinal opacification may be useful in making a diagnosis if carefully interpreted by the radiologist and the surgeon. In case of inconclusive clinical and radiological findings, when symptoms fail to improve, surgical exploration for bariatric patients presenting acute abdominal pain, by laparoscopy if expertise is available, is mandatory in the first 12-24 h, to have good outcomes and decrease morbidity rate.

Published
2020

4. A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway

Author

Sartelli, M, Kluger, Y, Ansaloni, L, Carlet, J, Brink, A, Hardcastle, TC, Khanna, A, Chicom-Mefire, A, Rodríguez-Baño, J, Nathwani, D, Mendelson, M, Watkins, RR, Pulcini, C, Beović, B, May, AK, Itani, KMF, Mazuski, JE, Fry, DE, Coccolini, F, Rasxa, K, Montravers, P, Eckmann, C, Abbo, LM, Abubakar, S, Abu-Zidan, FM, Adesunkanmi, AK, Al-Hasan, MN, Althani, AA, Ticas, JEA, Ansari, S, Ansumana, R, Da Silva, ARA, Augustin, G, Bala, M, Balogh, ZJ, Baraket, O, Bassetti, M, Bellanova, G, Beltran, MA, Ben-Ishay, O, Biffl, WL, Boermeester, MA, Brecher, SM, Bueno, J, Cainzos, MA, Cairns, K, Camacho-Ortiz, A, Ceresoli, M, Chandy, SJ, Cherry-Bukowiec, JR, Cirocchi, R, Colak, E, Corcione, A, Cornely, OA, Cortese, F, Cui, Y, Curcio, D, Damaskos, D, Dasx, K, Delibegovic, S, Demetrashvili, Z, De Simone, B, De Souza, HP, De Waele, J, Dhingra, S, Diaz, JJ, Di Carlo, I, Di Marzo, F, Di Saverio, S, Dogjani, A, Dorj, G, Dortet, L, Duane, TM, Dupont, H, Egiev, VN, Eid, HO, Elmangory, M, El-Sayed Marei, H, Enani, MA, Escandón-Vargas, K, Faro, MP, Ferrada, P, Foghetti, D, Foianini, E, Fraga, GP, Frattima, S, Gandhi, C, Gattuso, G, Giamarellou, E, Ghnnam, W, Gkiokas, G, Girardis, M, Goff, DA, Gomes, CA, Gomi, H, Gronerth, RIG, Guirao, X, Guzman-Blanco, M, Haque, M, and Hecker, A

Subjects
Antimicrobial Stewardship, Antifungal Agents, Anti-Infective Agents, Surgical Procedures, Operative, Humans, Surgical Wound Infection, Surgery, Drug Resistance, Microbial, Antibiotic Prophylaxis, Global Health, Anti-Bacterial Agents
Abstract

© Copyright 2017, Mary Ann Liebert, Inc. This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by antimicrobial resistance and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections. As such, it is our intent to raise awareness among healthcare workers and improve antimicrobial prescribing. To facilitate its dissemination, the declaration was translated in different languages.

Published
2017

5. IROA: International Register of Open Abdomen, preliminary results (vol 12, pg 13, 2017)

Author

Coccolini F, Montori G, Ceresoli M, Catena F, Ivatury R, Sugrue M, Sartelli M, Fugazzola P, Corbella D, Salvetti F, Negoi I, Zese M, Occhionorelli S, Maccatrozzo S, Shlyapnikov S, Galatioto C, Chiarugi M, Demetrashvili Z, Dondossola D, Yovtchev Y, Ioannidis O, Novelli G, Nacoti M, Khor D, Inaba K, Demetriades D, Kaussen T, Jusoh AC, Ghannam W, Sakakushev B, Guetta O, Dogjani A, Costa S, Singh S, Damaskos D, Isik A, Yuan KC, Trotta F, Rausei S, Martinez-Perez A, Bellanova G, Fonseca VC, Hernández F, Marinis A, Fernandes W, Quiodettis M, Bala M, Vereczkei A, Curado RL, Fraga GP, Pereira BM, Gachabayov M, Chagerben GP, Arellano ML, Ozyazici S, Costa G, Tezcaner T, and Ansaloni L

Abstract

[This corrects the article DOI: 10.1186/s13017-017-0123-8.].

Published
2017

6. 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 Pararas, Yoram Kluger, Elias Chahine, Vanni Agnoletti, Gustavo Fraga, Walter L. Biffl, Fausto Catena, De Simone, B, Chouillard, E, Ramos, A, Donatelli, G, Pintar, T, Gupta, R, Renzi, F, Mahawar, K, Madhok, B, Maccatrozzo, S, Abu-Zidan, F, E. Moore, E, Weber, D, Coccolini, F, Di Saverio, S, Kirkpatrick, A, Shelat, V, Amico, F, Pikoulis, E, Ceresoli, M, Galante, J, Wani, I, De' Angelis, N, Hecker, A, Sganga, G, Tan, E, Balogh, Z, Bala, M, Coimbra, R, Damaskos, D, Ansaloni, L, Sartelli, M, Parasas, N, Kluger, Y, Chahine, E, Agnoletti, V, Fraga, G, Biffl, W, Catena, F, De Simone B., Chouillard E., Ramos A.C., Donatelli G., Pintar T., Gupta R., Renzi F., Mahawar K., Madhok B., Maccatrozzo S., Abu-Zidan F.M., E. Moore E., Weber D.G., Coccolini F., Di Saverio S., Kirkpatrick A., Shelat V.G., Amico F., Pikoulis E., Ceresoli M., Galante J.M., Wani I., De' Angelis N., Hecker A., Sganga G., Tan E., Balogh Z.J., Bala M., Coimbra R., Damaskos D., Ansaloni L., Sartelli M., Parasas N., Kluger Y., Chahine E., Agnoletti V., Fraga G., Biffl W.L., Catena F., De Simone, Belinda, Chouillard, Elie, Ramos, Almino C., Donatelli, Gianfranco, Pintar, Tadeja, Gupta, Rahul, Renzi, Federica, Mahawar, Kamal, Madhok, Brijesh, Maccatrozzo, Stefano, Abu-Zidan, Fikri M., E. Moore, Ernest, Weber, Dieter G., Coccolini, Federico, Di Saverio, Salomone, Kirkpatrick, Andrew, Shelat, Vishal G., Amico, Francesco, Pikoulis, Emmanouil, Ceresoli, Marco, Galante, Joseph M., Wani, Imtiaz, De’ Angelis, Nicola, Hecker, Andrea, Sganga, Gabriele, Tan, Edward, Balogh, Zsolt J., Bala, Miklosh, Coimbra, Raul, Damaskos, Dimitrio, Ansaloni, Luca, Sartelli, Massimo, Parasas, Nikolao, Kluger, Yoram, Chahine, Elia, Agnoletti, Vanni, Fraga, Gustavo, Biffl, Walter L., and Catena, Fausto

Subjects
Sleeve gastrectomy, Abdomen, Acute, Bariatric surgery, Abdominal pain, Perforation, Occlusion, Peritoniti, Bleeding, Obesity, Morbid, Acute abdomen, Meta-Analysis as Topic, Gastric bypa, Long-term complication, Weight Loss, Emergency surgery, Emergency Medicine, Humans, Surgery, Systematic Reviews as Topic
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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7. Management of acute mesenteric ischaemia: Results of a worldwide survey

Author

Benjamin Hess, Martin Cahenzli, Alastair Forbes, Rosa Burgos, Federico Coccolini, Olivier Corcos, Mette Holst, Øivind Irtun, Stanislaw Klek, Loris Pironi, Henrik Højgaard Rasmussen, Mireille J. Serlie, Ronan Thibault, Simon Gabe, Annika Reintam Blaser, Emrah Akin, Syed Muhammad Ali, Giulio Argenio, Semra Demirli Atici, Goran Augustin, Efstratia Baili, Lovenish Bains, Miklosh Bala, Edoardo Baldini, Oussama Baraket, Mirko Barone, Alan Biloslavo, null Roberto Bini, Cristina Bombardini, Giuseppe Brisinda, Luis Buonomo, Fausto Catena, Marco Ceresoli, Maria Michela Chiarello, Christos Chouliaras, Fabrizio D'Acapito, Dimitrios Damaskos, Belinda De Simone, Daniele Delogu, Zaza Demetrashvili, Isidoro Di Carlo, Mario D'Oria, Virginia María Durán-Muñoz-Cruzado, Patrice Forget, Laura Fortuna, Pietro Fransvea, Christian Frey, Olga Gapejeva, Pierre Garcon, Jörn-Markus Gass, Ricardo Alessandro Teixeira Gonsaga, Ewen Griffiths, Kursat Gundogan, Mohan Gurjar, Hytham K.S. Hamid, Juan Ignacio Silesky Jiménez, Karri Kase, Syed Sajid Hussain Kazmi, Aristotelis Kechagias, Vladimir Khokha, Yoshiro Kobe, Dimitrios P. Korkolis, Andrey Litvin, Eftychios Lostoridis, Hans Alexander Mahendran, Fabio Marino, Andres Martinuzzi, Cristian Mesina, Vincenzo Neri, Marina Panisic, Ciro Paolillo, Nikolaos Pararas, Gennaro Perrone, Antonio Pesce, Biagio Picardi, Charlotte Pither, Mauro Podda, Tomas Poskus, Florian Poullenot, Matras Przemyslaw, Massimo Sartelli, Diego Sasia, Maximilian Scheiterle, Fotios Seretis, Kjetil Søreide, Ruslan Sydorchuk, Kinga Szczepanek, Zsolt Bodnar, Fabienne Tamion, Antonio Tarasconi, Martin Teraa, Matti Tolonen, Tim Vanuytsel, Massimiliano Veroux, Lars Vinter-Jensen, Diego Visconti, Lukas Widmer, Andee Dzulkarnaen Zakaria, Nadezhda Zubareva, null Endorsing International Societies, null ESICM (European Society of Intensive Care Medicine), null WSES (World Society of Emergency Surgery), null WSACS (The Abdominal Compartment Society), null In-principle support, null WFICC (World Federation of Intensive and Critical Care), Endocrinology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Lucerne Cantonal Hospital [Luzern, Switzerland], University of Tartu, Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Aalborg University [Denmark] (AAU), Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (MCMCC), Alma Mater Studiorum Università di Bologna [Bologna] (UNIBO), Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Universiteit van Amsterdam (UvA), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), None, Hess, B, Cahenzli, M, Forbes, A, Burgos, R, Coccolini, F, Corcos, O, Holst, M, Irtun, Ø, Klek, S, Pironi, L, Rasmussen, H, Serlie, M, Thibault, R, Gabe, S, Reintam Blaser, A, Akin, E, Ali, S, Argenio, G, Atici, S, Augustin, G, Baili, E, Bains, L, Bala, M, Baldini, E, Baraket, O, Barone, M, Biloslavo, A, Roberto, B, Bombardini, C, Brisinda, G, Buonomo, L, Catena, F, Ceresoli, M, Chiarello, M, Chouliaras, C, D'Acapito, F, Damaskos, D, De Simone, B, Delogu, D, Demetrashvili, Z, Di Carlo, I, D'Oria, M, Durán-Muñoz-Cruzado, V, Forget, P, Fortuna, L, Fransvea, P, Frey, C, Gapejeva, O, Garcon, P, Gass, J, Teixeira Gonsaga, R, Griffiths, E, Gundogan, K, Gurjar, M, Hamid, H, Silesky Jiménez, J, Kase, K, Hussain Kazmi, S, Kechagias, A, Khokha, V, Kobe, Y, Korkolis, D, Litvin, A, Lostoridis, E, Mahendran, H, Marino, F, Martinuzzi, A, Mesina, C, Neri, V, Panisic, M, Paolillo, C, Pararas, N, Perrone, G, Pesce, A, Picardi, B, Pither, C, Podda, M, Poskus, T, Poullenot, F, Przemyslaw, M, Sartelli, M, Sasia, D, Scheiterle, M, Seretis, F, Søreide, K, Sydorchuk, R, Szczepanek, K, Bodnar, Z, Tamion, F, Tarasconi, A, Teraa, M, Tolonen, M, Vanuytsel, T, Veroux, M, Vinter-Jensen, L, Visconti, D, Widmer, L, Zakaria, A, Zubareva, N, Endorsing International, S, Institut Català de la Salut, [Hess B, Cahenzli M] Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland. [Forbes A] Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia. [Burgos R] Unitat de Suport Nutricional, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Coccolini F] General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy. [Corcos O] Intestinal Vascular Emergencies Structure (SURVI), Beaujon Hospital/Assistance Publique, Hopitaux de Paris, France, and Vall d'Hebron Barcelona Hospital Campus

Subjects
Investigative Techniques::Epidemiologic Methods::Data Collection::Surveys and Questionnaires [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Occlusive intestinal ischaemia, Nutrition and Dietetics, Acute mesenteric ischaemia, [SDV]Life Sciences [q-bio], Endocrinology, Diabetes and Metabolism, NOMI (Non-occlusive mesentericandnbsp, enfermedades del sistema digestivo::enfermedades gastrointestinales::enfermedades intestinales::isquemia mesentérica [ENFERMEDADES], Otros calificadores::/diagnóstico [Otros calificadores], Isquèmia intestinal - Tractament, 610 Medicine & health, técnicas de investigación::métodos epidemiológicos::recopilación de datos::encuestas y cuestionarios [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Acute mesenteric infarction, Intestinal failure, Enquestes, Treatment, Isquèmia intestinal - Diagnòstic, Other subheadings::/diagnosis [Other subheadings], NOMI (Non-occlusive mesenteric ischaemia), Survey, Digestive System Diseases::Gastrointestinal Diseases::Intestinal Diseases::Mesenteric Ischemia [DISEASES], ischaemia)
Abstract

Background: Acute mesenteric ischaemia (AMI) is a condition with high mortality. This survey assesses current attitudes and practices to manage AMI worldwide.Methods: A questionnaire survey about the practices of diagnosing and managing AMI, endorsed by several specialist societies, was sent to different medical specialists and hospitals worldwide. Data from individual health care professionals and from medical teams were collected.Results: We collected 493 individual forms from 71 countries and 94 team forms from 34 countries. Almost half of respondents were surgeons, and most of the responding teams (70%) were led by surgeons. Most of the respondents indicated that diagnosis of AMI is often delayed but rarely missed. Emergency revascularisation is often considered for patients with AMI but rarely in cases of transmural ischaemia (intestinal infarction). Responses from team hospitals with a dedicated special unit (14 team forms) indicated more aggressive revascularisation. Abdominopelvic CT-scan with intravenous contrast was suggested as the most useful diagnostic test, indicated by approximately 90% of respondents. Medical history and risk factors were thought to be more important in diagnosis of AMI without transmural ischaemia, whereas for intestinal infarction, plasma lactate concentrations and surgical exploration were considered more useful. In elderly patients, a palliative approach is often chosen over extensive bowel resection. There was a large variability in anticoagulant treatment, as well as in timing of surgery to restore bowel continuity.Conclusions: Delayed diagnosis of AMI is common despite wide availability of an adequate imaging modality, i.e. CT-scan. Large variability in treatment approaches exists, indicating the need for updated guidelines. Increased awareness and knowledge of AMI may improve current practice until more robust evidence becomes available. Adherence to the existing guidelines may help in improving differences in treatment and outcomes. Background: Acute mesenteric ischaemia (AMI) is a condition with high mortality. This survey assesses current attitudes and practices to manage AMI worldwide.Methods: A questionnaire survey about the practices of diagnosing and managing AMI, endorsed by several specialist societies, was sent to different medical specialists and hospitals worldwide. Data from individual health care professionals and from medical teams were collected.Results: We collected 493 individual forms from 71 countries and 94 team forms from 34 countries. Almost half of respondents were surgeons, and most of the responding teams (70%) were led by surgeons. Most of the respondents indicated that diagnosis of AMI is often delayed but rarely missed. Emergency revascularisation is often considered for patients with AMI but rarely in cases of transmural ischaemia (intestinal infarction). Responses from team hospitals with a dedicated special unit (14 team forms) indicated more aggressive revascularisation. Abdominopelvic CT-scan with intravenous contrast was suggested as the most useful diagnostic test, indicated by approximately 90% of respondents. Medical history and risk factors were thought to be more important in diagnosis of AMI without transmural ischaemia, whereas for intestinal infarction, plasma lactate concentrations and surgical exploration were considered more useful. In elderly patients, a palliative approach is often chosen over extensive bowel resection. There was a large variability in anticoagulant treatment, as well as in timing of surgery to restore bowel continuity.Conclusions: Delayed diagnosis of AMI is common despite wide availability of an adequate imaging modality, i.e. CT-scan. Large variability in treatment approaches exists, indicating the need for updated guidelines. Increased awareness and knowledge of AMI may improve current practice until more robust evidence becomes available. Adherence to the existing guidelines may help in improving differences in treatment and outcomes.

Published
2023
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8. Perceptions and practices surrounding the perioperative management of frail emergency surgery patients: a WSES-endorsed cross-sectional qualitative survey

Author

Mallaika Viswanath, Darja Clinch, Marco Ceresoli, Jugdeep Dhesi, Mario D’Oria, Belinda De Simone, Mauro Podda, Salomone Di Saverio, Federico Coccolini, Massimo Sartelli, Fausto Catena, Ernest Moore, Deepa Rangar, Walter L. Biffl, Dimitrios Damaskos, Viswanath, M, Clinch, D, Ceresoli, M, Dhesi, J, D'Oria, M, De Simone, B, Podda, M, Di Saverio, S, Coccolini, F, Sartelli, M, Catena, F, Moore, E, Rangar, D, Biffl, W, and Damaskos, D

Subjects
Clinical frailty score, Frailty, Emergency surgery, Emergency Medicine, Surgery, Comprehensive geriatric assessment
Abstract

Background Frailty is associated with poor post-operative outcomes in emergency surgical patients. Shared multidisciplinary models have been developed to provide a holistic, reactive model of care to improve outcomes for older people living with frailty. We aimed to describe current perioperative practices, and surgeons’ awareness and perception of perioperative frailty management, and barriers to its implementation. Methods A qualitative cross-sectional survey was sent via the World Society of Emergency Surgery e-letter to their members. Responses were analysed using descriptive statistics and reported by themes: risk scoring systems, frailty awareness and assessment and barriers to implementation. Result Of 168/1000 respondents, 38% were aware of the terms “Perioperative medicine for older people undergoing surgery” (POPS) and Comprehensive Geriatric Assessment (CGA). 66.6% of respondents assessed perioperative risk, with 45.2% using the American Society of Anaesthesiologists Physical Status Classification System (ASA-PS). 77.8% of respondents mostly agreed or agreed with the statement that they routinely conducted medical comorbidity management, and pain and falls risk assessment during emergency surgical admissions. Although 98.2% of respondents agreed that frailty was important, only 2.4% performed CGA and 1.2% used a specific frailty screening tool. Clinical frailty score was the most commonly used tool by those who did. Screening was usually conducted by surgical trainees. Key barriers included a lack of knowledge about frailty assessment, a lack of clarity on who should be responsible for frailty screening, and a lack of trained staff. Conclusions Our study highlights the ubiquitous lack of awareness regarding frailty assessment and the POPS model of care. More training and clear guidelines on frailty scoring, alongside support by multidisciplinary teams, may reduce the burden on surgical trainees, potentially improving rates of appropriate frailty assessment and management of the frailty syndrome in emergency surgical patients.

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

Author

de'Angelis, Nicola, Marchegiani, Francesco, Schena, Carlo Alberto, Khan, Jim, Agnoletti, Vanni, Ansaloni, Luca, Barría Rodríguez, Ana Gabriela, Bianchi, Paolo Pietro, Biffl, Walter, Bravi, Francesca, Ceccarelli, Graziano, Ceresoli, Marco, Chiara, Osvaldo, Chirica, Mircea, Cobianchi, Lorenzo, Coccolini, Federico, Coimbra, Raul, Cotsoglou, Christian, D'Hondt, Mathieu, Damaskos, Dimitris, De Simone, Belinda, Di Saverio, Salomone, Diana, Michele, Espin-Basany, Eloy, Fichtner-Feigl, Stefan, Fugazzola, Paola, Gavriilidis, Paschalis, Gronnier, Caroline, Kashuk, Jeffry, Kirkpatrick, Andrew W., Ammendola, Michele, Kouwenhoven, Ewout A., Laurent, Alexis, Leppaniemi, Ari, Lesurtel, Mickaël, Memeo, Riccardo, Milone, Marco, Moore, Ernest, Pararas, Nikolaos, Peitzmann, Andrew, Pessaux, Patrick, Picetti, Edoardo, Pikoulis, Manos, Pisano, Michele, Ris, Frederic, Robison, Tyler, Sartelli, Massimo, Shelat, Vishal G., Spinoglio, Giuseppe, Sugrue, Michael, Tan, Edward, Van Eetvelde, Ellen, Kluger, Yoram, Weber, Dieter, Catena, Fausto, Universitat Autònoma de Barcelona, Institut Català de la Salut, [de'Angelis N] Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, Paris, France. Faculty of Medicine, University of Paris Est, UPEC, Créteil, France. [Marchegiani F, Schena CA] Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, Paris, France. [Khan J] Department of Colorectal Surgery, Queen Alexandra Hospital, University of Portsmouth, Southwick Hill Road, Cosham, Portsmouth, UK. [Agnoletti V] Intensive Care Unit, Bufalini Hospital, Cesena, Italy. [Ansaloni L] Intensive Care Unit, Bufalini Hospital, Cesena, Italy. [Espin-Basany E] Servei de Cirurgia General i Digestiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain, Vall d'Hebron Barcelona Hospital Campus, De'Angelis, N, Marchegiani, F, Schena, C, Khan, J, Agnoletti, V, Ansaloni, L, Barria Rodriguez, A, Bianchi, P, Biffl, W, Bravi, F, Ceccarelli, G, Ceresoli, M, Chiara, O, Chirica, M, Cobianchi, L, Coccolini, F, Coimbra, R, Cotsoglou, C, D'Hondt, M, Damaskos, D, De Simone, B, Di Saverio, S, Diana, M, Espin-Basany, E, Fichtner-Feigl, S, Fugazzola, P, Gavriilidis, P, Gronnier, C, Kashuk, J, Kirkpatrick, A, Ammendola, M, Kouwenhoven, E, Laurent, A, Leppaniemi, A, Lesurtel, M, Memeo, R, Milone, M, Moore, E, Pararas, N, Peitzmann, A, Pessaux, P, Picetti, E, Pikoulis, M, Pisano, M, Ris, F, Robison, T, Sartelli, M, Shelat, V, Spinoglio, G, Sugrue, M, Tan, E, Van Eetvelde, E, Kluger, Y, Weber, D, and Catena, F

Subjects
educación::programa de estudios [ANTROPOLOGÍA, EDUCACIÓN, SOCIOLOGÍA Y FENÓMENOS SOCIALES], Surgical Procedures, Operative::Digestive System Surgical Procedures [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Robotic surgery, intervenciones quirúrgicas::procedimientos quirúrgicos del sistema digestivo [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Robòtica en medicina, Sciences du Vivant [q-bio]/Médecine humaine et pathologie, Training curriculum in surgery, intervenciones quirúrgicas::cirugía asistida por ordenador::procedimientos quirúrgicos robotizados [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Aparell digestiu - Malalties - Cirurgia, All institutes and research themes of the Radboud University Medical Center, Formació, Education::Curriculum [ANTHROPOLOGY, EDUCATION, SOCIOLOGY, AND SOCIAL PHENOMENA], Minimally invasive surgery, Emergency Medicine, Emergency surgery, Surgery, Laparoscopy, Surgical Procedures, Operative::Surgery, Computer-Assisted::Robotic Surgical Procedures [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT]
Abstract

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. 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. journal article review 2023 Jan 27 2023 01 27 imported

Published
2023

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

Author

Leslie Kobayashi, Raul Coimbra, Adenauer M.O. Goes, Viktor Reva, Jarrett Santorelli, Ernest E. Moore, Joseph M. Galante, Fikri Abu-Zidan, Andrew B. Peitzman, Carlos A. Ordonez, Ronald V. Maier, Salomone Di Saverio, Rao Ivatury, Nicola De Angelis, Thomas Scalea, Fausto Catena, Andrew Kirkpatrick, Vladimir Khokha, Neil Parry, Ian Civil, Ari Leppaniemi, Mircea Chirica, Emmanouil Pikoulis, Gustavo P. Fraga, Massimo Chiarugi, Dimitrios Damaskos, Enrico Cicuttin, Marco Ceresoli, Belinda De Simone, Felipe Vega-Rivera, Massimo Sartelli, Walt Biffl, Luca Ansaloni, Dieter G. Weber, Federico Coccolini, Kobayashi, L, Coimbra, R, Goes, A, Reva, V, Santorelli, J, Moore, E, Galante, J, Abu-Zidan, F, Peitzman, A, Ordonez, C, Maier, R, Di Saverio, S, Ivatury, R, De Angelis, N, Scalea, T, Catena, F, Kirkpatrick, A, Khokha, V, Parry, N, Civil, I, Leppaniemi, A, Chirica, M, Pikoulis, E, Fraga, G, Chiarugi, M, Damaskos, D, Cicuttin, E, Ceresoli, M, De Simone, B, Vega-Rivera, F, Sartelli, M, Biffl, W, Ansaloni, L, Weber, D, and Coccolini, F

Subjects
Hemorrhage, Wounds, Penetrating, abdominal aorta, 030208 emergency & critical care medicine, Shock, Hemorrhagic, Vascular System Injuries, Wounds, Nonpenetrating, Critical Care and Intensive Care Medicine, United States, 03 medical and health sciences, 0302 clinical medicine, Abdomen, Practice Guidelines as Topic, Abdominal vascular trauma, Humans, celiac artery, Surgery, Military Medicine, inferior vena cava, Societies, Medical, portal vein
Abstract

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

Published
2020
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11. 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, Ernest E. Moore, Bala, M, Catena, F, Kashuk, J, De Simone, B, Gomes, C, Weber, D, Sartelli, M, Coccolini, F, Kluger, Y, Abu-Zidan, F, Picetti, E, Ansaloni, L, Augustin, G, Biffl, W, Ceresoli, M, Chiara, O, Chiarugi, M, Coimbra, R, Cui, Y, Damaskos, D, Di Saverio, S, Galante, J, Khokha, V, Kirkpatrick, A, Inaba, K, Leppaniemi, A, Litvin, A, Peitzman, A, Shelat, V, Sugrue, M, Tolonen, M, Rizoli, S, Sall, I, Beka, S, Di Carlo, I, Ten Broek, R, Mircea, C, Tebala, G, Pisano, M, van Goor, H, Maier, R, Jeekel, H, Civil, I, Hecker, A, Tan, E, Soreide, K, Lee, M, Wani, I, Bonavina, L, Malangoni, M, Koike, K, Velmahos, G, Fraga, G, Fette, A, De'Angelis, N, Balogh, Z, Scalea, T, Sganga, G, Kelly, M, Khan, J, Stahel, P, and Moore, E

Subjects
Endovascular Procedures, Mesenteric artery stenting, Guideline, Recommendation, Bowel ischemia, Intestines, Mesenteric ischemia, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], Ischemia, Mesenteric Vascular Occlusion, World Society of Emergency Surgery, Emergency Medicine, Humans, Surgery, Mesenteric arterial occlusion
Abstract

Contains fulltext : 288450.pdf (Publisher’s version ) (Open Access) 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

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

Author

Ari Leppäniemi, Mircea Chirica, Viktor A. Reva, Felipe Vega-Rivera, Enrico Cicuttin, Massimo Chiarugi, Carlos A. Ordoñez, Federico Coccolini, Vladimir Khokha, W.L. Biffl, Adenauer Marinho de Oliveira Góes, Massimo Sartelli, Nicola De Angelis, Thomas M. Scalea, Emmanouil Pikoulis, Dimitrios Damaskos, Ronald V. Maier, Rao R. Ivatury, Fausto Catena, Ian Civil, Andrew W. Kirkpatrick, Salomone Di Saverio, Gustavo Pereira Fraga, Belinda De Simone, Joseph M. Galante, Jarrett Santorelli, Dieter G. Weber, Andrew B. Peitzman, Fikri M. Abu-Zidan, Neil Parry, Marco Ceresoli, Luca Ansaloni, Raul Coimbra, Leslie Kobayashi, Ernest E. Moore, Kobayashi, L, Coimbra, R, Goes, A, Reva, V, Santorelli, J, Moore, E, Galante, J, Abu-Zidan, F, Peitzman, A, Ordonez, C, Maier, R, Di Saverio, S, Ivatury, R, De Angelis, N, Scalea, T, Catena, F, Kirkpatrick, A, Khokha, V, Parry, N, Civil, I, Leppaniemi, A, Chirica, M, Pikoulis, E, Fraga, G, Chiarugi, M, Damaskos, D, Cicuttin, E, Ceresoli, M, De Simone, B, Vega-Rivera, F, Sartelli, M, Biffl, W, Ansaloni, L, Weber, D, and Coccolini, F

Subjects
tibial artery injury, medicine.medical_specialty, Computed Tomography Angiography, medicine.medical_treatment, femoral artery injury, Physical examination, Wounds, Penetrating, Critical Care and Intensive Care Medicine, Wounds, Nonpenetrating, Inferior vena cava, Amputation, Surgical, Military medicine, 03 medical and health sciences, 0302 clinical medicine, Blunt, medicine, peroneal artery injury, Humans, Minimally Invasive Surgical Procedures, Military Medicine, Physical Examination, Societies, Medical, Computed tomography angiography, Surgical repair, popliteal artery injury, medicine.diagnostic_test, business.industry, Endovascular Procedures, 030208 emergency & critical care medicine, Evidence-based medicine, Vascular System Injuries, United States, Surgery, Extremity vascular injury, medicine.vein, Amputation, Practice Guidelines as Topic, business
Abstract

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

Published
2020

13. Open Abdomen in Obese Patients: Pay Attention! New Evidences from IROA, the International Register of Open Abdomen

Author

Marco Ceresoli, Francesco Salvetti, Yoram Kluger, Marco Braga, Jacopo Viganò, Paola Fugazzola, Massimo Sartelli, Luca Ansaloni, Fausto Catena, Federico Coccolini, Ionut Negoi, Monica Zese, Savino Occhionorelli, Francesca Gubbiotti, Sergei Shlyapnikov, Christian Galatioto, Massimo Chiarugi, Zaza Demetrashvili, Daniele Dondossola, Orestis Ioannidis, Giuseppe Novelli, Mirco Nacoti, Desmond Khor, Kenji Inaba, Demetrios Demetriades, Torsten Kaussen, Asri Che Jusoh, Wagih Ghannam, Boris Sakakushev, Ohad Guetta, Agron Dogjani, Stefano Costa, Sandeep Singh, Dimitrios Damaskos, Arda Isik, Kuo-Ching Yuan, Francesco Trotta, Stefano Rausei, Aleix Martinez-Perez, Giovanni Bellanova, Vinicius Cordeiro Fonseca, Fernando Hernández, Athanasios Marinis, Wellington Fernandes, Martha Quiodettis, Miklosh Bala, Andras Vereczkei, Rafael Curado, Gustavo Pereira Fraga, Bruno M Pereira, Mahir Gachabayov, Guillermo Perez Chagerben, Miguel Leon Arellano, Sefa Ozyazici, Gianluca Costa, Tugan Tezcaner, Matteo Porta, Yousheng Li, Faruk Karateke, Dimitrios Manatakis, Federico Mariani, Federic Lora, Ivan Sahderov, Boyko Atanasov, Sergio Zegarra, Luca Fattori, Alice Nigro, Andrew Kirkpatrick, Anton Parfenov, Giulia Montori, Paolo Dionigi, Michael Sugrue, Vincent Dubuisson, Joel Noutakdie Tochie, Rao Ivatury, Ceresoli, M, Salvetti, F, Kluger, Y, Braga, M, Viganò, J, Fugazzola, P, Sartelli, M, Ansaloni, L, Catena, F, Coccolini, F, Negoi, I, Zese, M, Occhionorelli, S, Gubbiotti, F, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Che Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Cordeiro Fonseca, V, Hernández, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Pereira Fraga, G, M Pereira, B, Gachabayov, M, Perez Chagerben, G, Leon Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Nigro, A, Kirkpatrick, A, Parfenov, A, Montori, G, Dionigi, P, Sugrue, M, Dubuisson, V, Noutakdie Tochie, J, and Ivatury, R

Subjects
Adult, Male, medicine.medical_specialty, Abdominal compartment syndrome, Fistula, open abdomen, NO, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Acute care, Abdomen, Female, Humans, Intensive Care Units, Length of Stay, Middle Aged, Obesity, Registries, medicine, business.industry, Fascia, medicine.disease, Cardiac surgery, Surgery, medicine.anatomical_structure, Cardiothoracic surgery, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, business, Trauma surgery, Abdominal surgery
Abstract

Background: Open abdomen is the cornerstone of damage control strategies in acute care and trauma surgery. The role of BMI has not been well investigated. The aim of the study was to assess the role of BMI in determining outcomes after open abdomen. Methods: This is an analysis of patients recorded into the International Register of Open Abdomen; patients were classified in two groups according to BMI using a cutoff of 30 kg/m2. The primary outcome was in-hospital mortality; secondary outcomes were primary fascia closure rate, length of treatment, complication rate, entero-atmospheric fistula rate and length of ICU stay. Results: A total of 591 patients were enrolled from 57 centers, and obese patients were 127 (21.5%). There was no difference in mortality between the two groups; complications developed during the open treatment were higher in obese patients (63.8% vs. 53.4%, p = 0.038) while post-closure complications rate was similar. Obese patients had a significantly longer duration of the open treatment (9.1 ± 11.5 days vs. 6.3 ± 7.5 days; p = 0,002) and lower primary fascia closure rate (75.5% vs. 89.5%; p < 0,001). No differences in fistula rate were found. There was a linear correlation between the duration of open abdomen and the BMI (Pearson’s linear correlation coefficient = 0,201; p < 0,001). Conclusions: Open abdomen in obese patients seems to be safe as in non-obese patients with similar mortality; however, in obese patients the length of open abdomen is significantly higher with higher complication rate, longer ICU length of stay and lower primary fascia closure rate. Trial registration number: ClinicalTrials.gov, Identifier: NCT02382770.

Published
2019

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