Search

Your search keyword '"Fugazzola P."' showing total 34 results
Start Over Author "Fugazzola P." Topic business.industry
34 results on '"Fugazzola P."'

1. 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
Full Text
View/download PDF

2. Team dynamics in emergency surgery teams: results from a first international survey

Author

Cobianchi L., Dal Mas F., Massaro M., Fugazzola P., Coccolini F., Kluger Y., Leppaniemi A., Moore E. E., Sartelli M., Angelos P., Ansaloni L., Abdelmalik A., Abebe N. S., Abu-Zidan F. M., Adam Y. A. Y., Adamou H., Agrusa A., Akin E., Alexandrino H., Ali S. M., Almeida P. M., Amico F., Ammendola M., Andreuccetti J., Aparicio-Sanchez D., Ardito A., Argenio G., Askevold I. H., Atanasov B. T., Augustin G., Awad S. S., Bagnoli C., Bains L., Balalis D., Baldini E., Baraket O., Barone M., Barreras J. A., Bellanova G., Biancuzzi H., Bignell M. B., Bini R., Bissacco D., Boati P., Bottari A., Bouliaris K., Brillantino A., Buonomo L. A., Buscemi S., Calu V., Campo Dall'Orto R., Carvas J. M., Casoni Pattacini G., Catena F., Celentano V., Ceresoli M., Chirica M., Cianci P., Cillara N., Cimbanassi S., Cioffi S. P. B., Colak E., Conti L., Dantas Costa S., D'acapito F., Damaskos D., Das K., Davies R. J., De Beaux A. C., De Simone B., Demetrashvili Z., Demetriades A. K., Denicolai S., Di Buono G., Di Carlo I., Di Saverio S., Diaconescu B., Dibra R., Dios-Barbeito S., Dogjani A., Domanin M., D'Oria M., Duran Munoz-Cruzado V., East B., Ekwen G. T., Elbaih A. H., Escalera-Antezana J. P., Esposito G., Farre R., Ferrario di Tor Vajana A., Cordeiro Fonseca V., Forfori F., Fortuna L., Fradelos E., Fraga G. P., Fransvea P., Gachabayov M., Garcia Vazquez A., Ghannam W. M., Gioco R., Giraudo G., Giuffrida M., Giulii Capponi M., Gomes C. A., Teixeira Gonsaga R. A., Gonullu E., Goosen J., Goranovic T., Griffiths E. A., Haidar M. G., Hamid H. K. S., Harddastle T. C., Hecker M., Hernandez Garcia E. F., Cancio Huaman E., Hutan M., Ioannidis O., Isik A., Ismail A. M. H., Ismail N., Jang J. Y., Kalipershad S. N. R., Kaplan L. J., Kara Y., Karamagioli E., Karamarkovia A., Kavalakat A. J., Kechagias A., Kenig J., Khan J. S., Khokha V., Klappenbach R. F., Klappenbach R., Kobe Y., Kong V., Korkolis D., Kurihara H., Kuriyama A., Landaluce-Olavarria A., Licari L., Litvin A., Lohsiriwat V., Lopes Moreira C. C., Lostoridis E., Tovar Luna A., Luppi D., Machain G. M., Maegele M., Maggiore D., Maier R. V., Manangi M., Manetti A., Mantoglu B., Mariani F., Marinis A., Sbalcheiro Mariot E. A., Martines G., Martinez Perez A., Mascagni P., Massalou D., Bessa Melo R., Miceli L., Mingoli A., Mishra T. S., Mohamedahmed A. Y. Y., Mohan R., Morales-Garcia D., Mustafa S. M. S., Naimzada M. D., Negoi I., Nidaw M. K., Nigri G., Ogundipe H. D., Oliveri C., Olmi S., Pagani L., Palomba G., Pantalone D., Panyko A., Paolillo C., Papis D., Pararas N., Pata F., Pavone G., Pecchini F., Pellino G., Pelloni M., Peloso A., Perea Del Pozo E., Goncalves Pereira R., Monteiro Pereira B., Lizarazu Perez A., Perrone G., Pesce A., Petracca G., Piccoli M., Picetti E., Pikoulis E., Pintar T., Pirozzolo G., Podda M., Previtali P., Privitera F., Punzo C., Quiodettis M. A., Qvist N., Rahim R., Reinisch-Liese A., Rodriguez-Luna M. R., Roizblatt D., Roscio F. P. M., Rossi S., Sakakushev B. E., Salamea J. C., Sall I., Sammartano F., Sanchez Arteaga A., Sanchez-Cordero S., Sasia D., Sawyer R. G., Seretis C., Serradilla-Martin M., Shelat V. G., Shlyapnikov S., Lages Simoes R., Siribumrungwong B., Slavchev M., Solaini L., Soldini G., Soreide K., Sydorchuk L., Sydorchuk R., Syed A. M., Tallon-Aguilar L., Tan J. H., Tarasconi A., Tartaglia D., Tartaglia N., Taylor J., Tebala G. D., Teuben M., Tolonen M., Tomasicchio G., Triantafyllou T., Trigiante G., Turrado-Rodriguez V., Tutino R., Uccelli M., Ugarte-Sierra B., Ukkonen M., Vassiliu P. G., Verde J. M., Veroux M., Vilallonga R., Visconti D., Waledziak M., Wannatoop T., Widmer L. W., Wilson M. S. J., Wong T. H., Xenaki S., Yu B., Zakaria A. D., Zambrano D. A., Zese M., Cobianchi, L., Dal Mas, F., Massaro, M., Fugazzola, P., Coccolini, F., Kluger, Y., Leppaniemi, A., Moore, E. E., Sartelli, M., Angelos, P., Ansaloni, L., Abdelmalik, A., Abebe, N. S., Abu-Zidan, F. M., Adam, Y. A. Y., Adamou, H., Agrusa, A., Akin, E., Alexandrino, H., Ali, S. M., Almeida, P. M., Amico, F., Ammendola, M., Andreuccetti, J., Aparicio-Sanchez, D., Ardito, A., Argenio, G., Askevold, I. H., Atanasov, B. T., Augustin, G., Awad, S. S., Bagnoli, C., Bains, L., Balalis, D., Baldini, E., Baraket, O., Barone, M., Barreras, J. A., Bellanova, G., Biancuzzi, H., Bignell, M. B., Bini, R., Bissacco, D., Boati, P., Bottari, A., Bouliaris, K., Brillantino, A., Buonomo, L. A., Buscemi, S., Calu, V., Campo Dall'Orto, R., Carvas, J. M., Casoni Pattacini, G., Catena, F., Celentano, V., Ceresoli, M., Chirica, M., Cianci, P., Cillara, N., Cimbanassi, S., Cioffi, S. P. B., Colak, E., Conti, L., Dantas Costa, S., D'Acapito, F., Damaskos, D., Das, K., Davies, R. J., De Beaux, A. C., De Simone, B., Demetrashvili, Z., Demetriades, A. K., Denicolai, S., Di Buono, G., Di Carlo, I., Di Saverio, S., Diaconescu, B., Dibra, R., Dios-Barbeito, S., Dogjani, A., Domanin, M., D'Oria, M., Duran Munoz-Cruzado, V., East, B., Ekwen, G. T., Elbaih, A. H., Escalera-Antezana, J. P., Esposito, G., Farre, R., Ferrario di Tor Vajana, A., Cordeiro Fonseca, V., Forfori, F., Fortuna, L., Fradelos, E., Fraga, G. P., Fransvea, P., Gachabayov, M., Garcia Vazquez, A., Ghannam, W. M., Gioco, R., Giraudo, G., Giuffrida, M., Giulii Capponi, M., Gomes, C. A., Teixeira Gonsaga, R. A., Gonullu, E., Goosen, J., Goranovic, T., Griffiths, E. A., Haidar, M. G., Hamid, H. K. S., Harddastle, T. C., Hecker, M., Hernandez Garcia, E. F., Cancio Huaman, E., Hutan, M., Ioannidis, O., Isik, A., Ismail, A. M. H., Ismail, N., Jang, J. Y., Kalipershad, S. N. R., Kaplan, L. J., Kara, Y., Karamagioli, E., Karamarkovia, A., Kavalakat, A. J., Kechagias, A., Kenig, J., Khan, J. S., Khokha, V., Klappenbach, R. F., Klappenbach, R., Kobe, Y., Kong, V., Korkolis, D., Kurihara, H., Kuriyama, A., Landaluce-Olavarria, A., Licari, L., Litvin, A., Lohsiriwat, V., Lopes Moreira, C. C., Lostoridis, E., Tovar Luna, A., Luppi, D., Machain, G. M., Maegele, M., Maggiore, D., Maier, R. V., Manangi, M., Manetti, A., Mantoglu, B., Mariani, F., Marinis, A., Sbalcheiro Mariot, E. A., Martines, G., Martinez Perez, A., Mascagni, P., Massalou, D., Bessa Melo, R., Miceli, L., Mingoli, A., Mishra, T. S., Mohamedahmed, A. Y. Y., Mohan, R., Morales-Garcia, D., Mustafa, S. M. S., Naimzada, M. D., Negoi, I., Nidaw, M. K., Nigri, G., Ogundipe, H. D., Oliveri, C., Olmi, S., Pagani, L., Palomba, G., Pantalone, D., Panyko, A., Paolillo, C., Papis, D., Pararas, N., Pata, F., Pavone, G., Pecchini, F., Pellino, G., Pelloni, M., Peloso, A., Perea Del Pozo, E., Goncalves Pereira, R., Monteiro Pereira, B., Lizarazu Perez, A., Perrone, G., Pesce, A., Petracca, G., Piccoli, M., Picetti, E., Pikoulis, E., Pintar, T., Pirozzolo, G., Podda, M., Previtali, P., Privitera, F., Punzo, C., Quiodettis, M. A., Qvist, N., Rahim, R., Reinisch-Liese, A., Rodriguez-Luna, M. R., Roizblatt, D., Roscio, F. P. M., Rossi, S., Sakakushev, B. E., Salamea, J. C., Sall, I., Sammartano, F., Sanchez Arteaga, A., Sanchez-Cordero, S., Sasia, D., Sawyer, R. G., Seretis, C., Serradilla-Martin, M., Shelat, V. G., Shlyapnikov, S., Lages Simoes, R., Siribumrungwong, B., Slavchev, M., Solaini, L., Soldini, G., Soreide, K., Sydorchuk, L., Sydorchuk, R., Syed, A. M., Tallon-Aguilar, L., Tan, J. H., Tarasconi, A., Tartaglia, D., Tartaglia, N., Taylor, J., Tebala, G. D., Teuben, M., Tolonen, M., Tomasicchio, G., Triantafyllou, T., Trigiante, G., Turrado-Rodriguez, V., Tutino, R., Uccelli, M., Ugarte-Sierra, B., Ukkonen, M., Vassiliu, P. G., Verde, J. M., Veroux, M., Vilallonga, R., Visconti, D., Waledziak, M., Wannatoop, T., Widmer, L. W., Wilson, M. S. J., Wong, T. H., Xenaki, S., Yu, B., Zakaria, A. D., Zambrano, D. A., Zese, M., Cobianchi L., Dal Mas F., Massaro M., Fugazzola P., Coccolini F., Kluger Y., Leppaniemi A., Moore E.E., Sartelli M., Angelos P., Ansaloni L., Abdelmalik A., Abebe N.S., Abu-Zidan F.M., Adam Y.A.Y., Adamou H., Agrusa A., Akin E., Alexandrino H., Ali S.M., Almeida P.M., Amico F., Ammendola M., Andreuccetti J., Aparicio-Sanchez D., Ardito A., Argenio G., Askevold I.H., Atanasov B.T., Augustin G., Awad S.S., Bagnoli C., Bains L., Balalis D., Baldini E., Baraket O., Barone M., Barreras J.A., Bellanova G., Biancuzzi H., Bignell M.B., Bini R., Bissacco D., Boati P., Bottari A., Bouliaris K., Brillantino A., Buonomo L.A., Buscemi S., Calu V., Campo Dall'Orto R., Carvas J.M., Casoni Pattacini G., Catena F., Celentano V., Ceresoli M., Chirica M., Cianci P., Cillara N., Cimbanassi S., Cioffi S.P.B., Colak E., Conti L., Dantas Costa S., D'acapito F., Damaskos D., Das K., Davies R.J., De Beaux A.C., De Simone B., Demetrashvili Z., Demetriades A.K., Denicolai S., Di Buono G., Di Carlo I., Di Saverio S., Diaconescu B., Dibra R., Dios-Barbeito S., Dogjani A., Domanin M., D'Oria M., Duran Munoz-Cruzado V., East B., Ekwen G.T., Elbaih A.H., Escalera-Antezana J.P., Esposito G., Farre R., Ferrario di Tor Vajana A., Cordeiro Fonseca V., Forfori F., Fortuna L., Fradelos E., Fraga G.P., Fransvea P., Gachabayov M., Garcia Vazquez A., Ghannam W.M., Gioco R., Giraudo G., Giuffrida M., Giulii Capponi M., Gomes C.A., Teixeira Gonsaga R.A., Gonullu E., Goosen J., Goranovic T., Griffiths E.A., Haidar M.G., Hamid H.K.S., Harddastle T.C., Hecker M., Hernandez Garcia E.F., Cancio Huaman E., Hutan M., Ioannidis O., Isik A., Ismail A.M.H., Ismail N., Jang J.Y., Kalipershad S.N.R., Kaplan L.J., Kara Y., Karamagioli E., Karamarkovia A., Kavalakat A.J., Kechagias A., Kenig J., Khan J.S., Khokha V., Klappenbach R.F., Klappenbach R., Kobe Y., Kong V., Korkolis D., Kurihara H., Kuriyama A., Landaluce-Olavarria A., Licari L., Litvin A., Lohsiriwat V., Lopes Moreira C.C., Lostoridis E., Tovar Luna A., Luppi D., Machain G.M., Maegele M., Maggiore D., Maier R.V., Manangi M., Manetti A., Mantoglu B., Mariani F., Marinis A., Sbalcheiro Mariot E.A., Martines G., Martinez Perez A., Mascagni P., Massalou D., Bessa Melo R., Miceli L., Mingoli A., Mishra T.S., Mohamedahmed A.Y.Y., Mohan R., Morales-Garcia D., Mustafa S.M.S., Naimzada M.D., Negoi I., Nidaw M.K., Nigri G., Ogundipe H.D., Oliveri C., Olmi S., Pagani L., Palomba G., Pantalone D., Panyko A., Paolillo C., Papis D., Pararas N., Pata F., Pavone G., Pecchini F., Pellino G., Pelloni M., Peloso A., Perea Del Pozo E., Goncalves Pereira R., Monteiro Pereira B., Lizarazu Perez A., Perrone G., Pesce A., Petracca G., Piccoli M., Picetti E., Pikoulis E., Pintar T., Pirozzolo G., Podda M., Previtali P., Privitera F., Punzo C., Quiodettis M.A., Qvist N., Rahim R., Reinisch-Liese A., Rodriguez-Luna M.R., Roizblatt D., Roscio F.P.M., Rossi S., Sakakushev B.E., Salamea J.C., Sall I., Sammartano F., Sanchez Arteaga A., Sanchez-Cordero S., Sasia D., Sawyer R.G., Seretis C., Serradilla-Martin M., Shelat V.G., Shlyapnikov S., Lages Simoes R., Siribumrungwong B., Slavchev M., Solaini L., Soldini G., Soreide K., Sydorchuk L., Sydorchuk R., Syed A.M., Tallon-Aguilar L., Tan J.H., Tarasconi A., Tartaglia D., Tartaglia N., Taylor J., Tebala G.D., Teuben M., Tolonen M., Tomasicchio G., Triantafyllou T., Trigiante G., Turrado-Rodriguez V., Tutino R., Uccelli M., Ugarte-Sierra B., Ukkonen M., Vassiliu P.G., Verde J.M., Veroux M., Vilallonga R., Visconti D., Waledziak M., Wannatoop T., Widmer L.W., Wilson M.S.J., Wong T.H., Xenaki S., Yu B., Zakaria A.D., Zambrano D.A., Zese M., Cobianchi, L, Dal Mas, F, Massaro, M, Fugazzola, P, Coccolini, F, Kluger, Y, Leppaniemi, A, Moore, E, Sartelli, M, Angelos, P, Ansaloni, L, Abdelmalik, A, Abebe, N, Abu-Zidan, F, Adam, Y, Adamou, H, Agrusa, A, Akin, E, Alexandrino, H, Ali, S, Almeida, P, Amico, F, Ammendola, M, Andreuccetti, J, Aparicio-Sanchez, D, Ardito, A, Argenio, G, Askevold, I, Atanasov, B, Augustin, G, Awad, S, Bagnoli, C, Bains, L, Balalis, D, Baldini, E, Baraket, O, Barone, M, Barreras, J, Bellanova, G, Biancuzzi, H, Bignell, M, Bini, R, Bissacco, D, Boati, P, Bottari, A, Bouliaris, K, Brillantino, A, Buonomo, L, Buscemi, S, Calu, V, Campo Dall'Orto, R, Carvas, J, Casoni Pattacini, G, Catena, F, Celentano, V, Ceresoli, M, Chirica, M, Cianci, P, Cillara, N, Cimbanassi, S, Cioffi, S, Colak, E, Conti, L, Dantas Costa, S, D'Acapito, F, Damaskos, D, Das, K, Davies, R, De Beaux, A, De Simone, B, Demetrashvili, Z, Demetriades, A, Denicolai, S, Di Buono, G, Di Carlo, I, Di Saverio, S, Diaconescu, B, Dibra, R, Dios-Barbeito, S, Dogjani, A, Domanin, M, D'Oria, M, Duran Munoz-Cruzado, V, East, B, Ekwen, G, Elbaih, A, Escalera-Antezana, J, Esposito, G, Farre, R, Ferrario di Tor Vajana, A, Cordeiro Fonseca, V, Forfori, F, Fortuna, L, Fradelos, E, Fraga, G, Fransvea, P, Gachabayov, M, Garcia Vazquez, A, Ghannam, W, Gioco, R, Giraudo, G, Giuffrida, M, Giulii Capponi, M, Gomes, C, Teixeira Gonsaga, R, Gonullu, E, Goosen, J, Goranovic, T, Griffiths, E, Haidar, M, Hamid, H, Harddastle, T, Hecker, M, Hernandez Garcia, E, Cancio Huaman, E, Hutan, M, Ioannidis, O, Isik, A, Ismail, A, Ismail, N, Jang, J, Kalipershad, S, Kaplan, L, Kara, Y, Karamagioli, E, Karamarkovia, A, Kavalakat, A, Kechagias, A, Kenig, J, Khan, J, Khokha, V, Klappenbach, R, Kobe, Y, Kong, V, Korkolis, D, Kurihara, H, Kuriyama, A, Landaluce-Olavarria, A, Licari, L, Litvin, A, Lohsiriwat, V, Lopes Moreira, C, Lostoridis, E, Tovar Luna, A, Luppi, D, Machain, G, Maegele, M, Maggiore, D, Maier, R, Manangi, M, Manetti, A, Mantoglu, B, Mariani, F, Marinis, A, Sbalcheiro Mariot, E, Martines, G, Martinez Perez, A, Mascagni, P, Massalou, D, Bessa Melo, R, Miceli, L, Mingoli, A, Mishra, T, Mohamedahmed, A, Mohan, R, Morales-Garcia, D, Mustafa, S, Naimzada, M, Negoi, I, Nidaw, M, Nigri, G, Ogundipe, H, Oliveri, C, Olmi, S, Pagani, L, Palomba, G, Pantalone, D, Panyko, A, Paolillo, C, Papis, D, Pararas, N, Pata, F, Pavone, G, Pecchini, F, Pellino, G, Pelloni, M, Peloso, A, Perea Del Pozo, E, Goncalves Pereira, R, Monteiro Pereira, B, Lizarazu Perez, A, Perrone, G, Pesce, A, Petracca, G, Piccoli, M, Picetti, E, Pikoulis, E, Pintar, T, Pirozzolo, G, Podda, M, Previtali, P, Privitera, F, Punzo, C, Quiodettis, M, Qvist, N, Rahim, R, Reinisch-Liese, A, Rodriguez-Luna, M, Roizblatt, D, Roscio, F, Rossi, S, Sakakushev, B, Salamea, J, Sall, I, Sammartano, F, Sanchez Arteaga, A, Sanchez-Cordero, S, Sasia, D, Sawyer, R, Seretis, C, Serradilla-Martin, M, Shelat, V, Shlyapnikov, S, Lages Simoes, R, Siribumrungwong, B, Slavchev, M, Solaini, L, Soldini, G, Soreide, K, Sydorchuk, L, Sydorchuk, R, Syed, A, Tallon-Aguilar, L, Tan, J, Tarasconi, A, Tartaglia, D, Tartaglia, N, Taylor, J, Tebala, G, Teuben, M, Tolonen, M, Tomasicchio, G, Triantafyllou, T, Trigiante, G, Turrado-Rodriguez, V, Tutino, R, Uccelli, M, Ugarte-Sierra, B, Ukkonen, M, Vassiliu, P, Verde, J, Veroux, M, Vilallonga, R, Visconti, D, Waledziak, M, Wannatoop, T, Widmer, L, Wilson, M, Wong, T, Xenaki, S, Yu, B, Zakaria, A, Zambrano, D, and Zese, M

Subjects
RD1-811, media_common.quotation_subject, education, Trauma leaders, Context (language use), Knowledge translation, Trauma leader, Trauma teams, Knowledge translation, Team dynamics, Non-technical skills, Trauma leaders, Settore SECS-P/07 - Economia Aziendale, Multidisciplinary approach, Surveys and Questionnaires, Health care, Medicine, Humans, Non-technical skill, knowledge translation, non-technical skills, team dynamics, trauma leaders, trauma teams, humans, surveys and questionnaires, patient care team, Function (engineering), Trauma teams, Non-technical skills, media_common, Patient Care Team, Medical education, Teamwork, RC86-88.9, business.industry, Team dynamics, Correction, Medical emergencies. Critical care. Intensive care. First aid, Checklist, Emergency Medicine, Surgery, The Internet, Team dynamic, business, Trauma team, Research Article
Abstract

Background Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma’s causes or the patient’s personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients’ and stakeholders’ engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey’s participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions.

Published
2021

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

Author

Coccolini, F., Kluger, Y., Moore, E. E., Maier, R. V., Coimbra, R., Ordonez, C., Ivatury, R., Kirkpatrick, A. W., Biffl, W., Sartelli, M., Hecker, A., Ansaloni, L., Leppaniemi, A., Reva, V., Civil, I., Vega, F., Chiarugi, M., Chichom-Mefire, A., Sakakushev, B., Peitzman, A., Chiara, O., Abu-Zidan, F., Maegele, M., Miccoli, M., Chirica, M., Khokha, V., Sugrue, M., Fraga, G. P., Otomo, Y., Baiocchi, G. L., Catena, F., Kuliesius, Z., Conti, L., Dogjani, A., Lee, J. G., Consani, H., Russello, D., Bortul, M., Maurel, T. G., Kaf, H. S., Adamou, H., Alin, V., Robustelli, U., Sato, N., Seretis, C., Quiodettis, M., Gomes, C. A., Kong, V., Zakaria, A. D., Guner, A., Gachabayov, M., Chowdhury, S., Pata, F., Garcia, A., Rems, M., Das, K., Riedel, J. G., Lasithiotakis, K., Sydorchuk, R., Sydorchuk, L., Lostoridis, E., Buia, A., Mcfarlane, M., Ciani, R., Munoz-Cruzado, V. M. D., Tartaglia, D., Ioannidis, O., Muhrbeck, M., Reicher, M., Roscio, F., Ceresoli, M., Tsiftsis, D., Kavalakat, A., Pintar, T., Georgiou, G., Ricci, G., Mohan, R., Saar, S., Di Carlo, I., Isik, A., Ahmed, A. Y. Y. M., Gonsaga, R. A. T., Sammartano, F., Tallon-Aguilar, L., Shoko, T., Hsu, J., Kobe, Y., Romeo, C. G. L., Podda, M., Mingoli, A., Delgado, R. C., Ekwen, G., Aude, V., Olona, C., Boati, P., Magnone, S., Capaldi, M., Bala, M., Picetti, E., Negoi, I., Kok, K. Y. Y., Jusoh, A. C., Amato, B., Nita, G. E., de Beaux, A., Demetrashvili, Z., Davies, R. J., Kim, J. I., Pereira, A., Fattori, L., Paolillo, C., Ghannam, W., Rodriguez, F. M., Berardi, L., Florio, M. G., Hecker, M., Dubuisson, V., O'Connor, D. B., De'Angelis, N., Dobric, I., Massalou, D., Ortenwall, P., Pikoulis, E., Ugarte-Sierra, B., Zuidema, W. P., Kechagias, A., Marwah, S., Litvin, A., Nikolopoulos, I., Pesce, A., Uranues, S., Luppi, D., Flohe, S., Martinez-Perez, A., Lorenzo, M., Vergano, L. B., Manca, M., Malacarne, P., Kurihara, H., Widder, S., Pucciarelli, M., Monzani, F., Brambillasca, P., Corbella, D., Agresta, F., Moore, L., Buonomo, L. A., Adeleye, A. O., Kim, D., Veroux, M., Hardcastle, T. C., Di Saverio, S., Recordare, A., Rubio-Perez, I., Shlyapnikov, S., Rahim, R., Vega, G. M. M., Boris, K., Sawyer, R., Baraket, O., Soreide, K., Weber, C., Seak, C. -J., Herman, S., Gamberini, E., Costa, S., Mazzocconi, G., Lozada, E., Manatakis, D., Lohsiriwat, V., Ahmed, A., Elbery, B., Tiberio, G. A. M., Santini, M., Mellace, L., Enoksen, C. H., Major, P., Parini, D., Improta, M., Fugazzola, P., Pini, S., Liberti, G., Martino, C., Cobianchi, L., Canzi, G., Cicuttin, E., Kenig, J., Zago, M., Giannessi, S., Scaglione, M., Orsitto, E., Cioni, R., Ghiadoni, L., Menichetti, F., Agnoletti, V., Sganga, G., Prosperi, P., Roviello, F., De Paolis, P., Gordini, G., Forfori, F., Ruscelli, P., Gabrielli, F., Puglisi, A., Bertolucci, A., Marchi, S., Bellini, M., Casagli, S., De Simone, B., Carmassi, F., Marchetti, S., Accorsini, M., Cremonini, C., Morelli, F., Romeo, L., Coccolini F., Kluger Y., Moore E.E., Maier R.V., Coimbra R., Ordonez C., Ivatury R., Kirkpatrick A.W., Biffl W., Sartelli M., Hecker A., Ansaloni L., Leppaniemi A., Reva V., Civil I., Vega F., Chiarugi M., Chichom-Mefire A., Sakakushev B., Peitzman A., Chiara O., Abu-Zidan F., Maegele M., Miccoli M., Chirica M., Khokha V., Sugrue M., Fraga G.P., Otomo Y., Baiocchi G.L., Catena F., Kuliesius Z., Conti L., Dogjani A., Lee J.G., Consani H., Russello D., Bortul M., Maurel T.G., Kaf H.S., Adamou H., Alin V., Robustelli U., Sato N., Seretis C., Quiodettis M., Gomes C.A., Kong V., Zakaria A.D., Guner A., Gachabayov M., Chowdhury S., Pata F., Garcia A., Rems M., Das K., Riedel J.G., Lasithiotakis K., Sydorchuk R., Sydorchuk L., Lostoridis E., Buia A., McFarlane M., Ciani R., Munoz-Cruzado V.M.D., Tartaglia D., Ioannidis O., Muhrbeck M., Reicher M., Roscio F., Ceresoli M., Tsiftsis D., Kavalakat A., Pintar T., Georgiou G., Ricci G., Mohan R., Saar S., Di Carlo I., Isik A., Ahmed A.Y.Y.M., Gonsaga R.A.T., Sammartano F., Tallon-Aguilar L., Shoko T., Hsu J., Kobe Y., Romeo C.G.L., Podda M., Mingoli A., Delgado R.C., Ekwen G., Aude V., Olona C., Boati P., Magnone S., Capaldi M., Bala M., Picetti E., Negoi I., Kok K.Y.Y., Jusoh A.C., Amato B., Nita G.E., de Beaux A., Demetrashvili Z., Davies R.J., Kim J.I., Pereira A., Fattori L., Paolillo C., Ghannam W., Rodriguez F.M., Berardi L., Florio M.G., Hecker M., Dubuisson V., O'Connor D.B., De'Angelis N., Dobric I., Massalou D., Ortenwall P., Pikoulis E., Ugarte-Sierra B., Zuidema W.P., Kechagias A., Marwah S., Litvin A., Nikolopoulos I., Pesce A., Uranues S., Luppi D., Flohe S., Martinez-Perez A., Lorenzo M., Vergano L.B., Manca M., Malacarne P., Kurihara H., Widder S., Pucciarelli M., Monzani F., Brambillasca P., Corbella D., Agresta F., Moore L., Buonomo L.A., Adeleye A.O., Kim D., Veroux M., Hardcastle T.C., Di Saverio S., Recordare A., Rubio-Perez I., Shlyapnikov S., Rahim R., Vega G.M.M., Boris K., Sawyer R., Baraket O., Soreide K., Weber C., Seak C.-J., Herman S., Gamberini E., Costa S., Mazzocconi G., Lozada E., Manatakis D., Lohsiriwat V., Ahmed A., Elbery B., Tiberio G.A.M., Santini M., Mellace L., Enoksen C.H., Major P., Parini D., Improta M., Fugazzola P., Pini S., Liberti G., Martino C., Cobianchi L., Canzi G., Cicuttin E., Kenig J., Zago M., Giannessi S., Scaglione M., Orsitto E., Cioni R., Ghiadoni L., Menichetti F., Agnoletti V., Sganga G., Prosperi P., Roviello F., De Paolis P., Gordini G., Forfori F., Ruscelli P., Gabrielli F., Puglisi A., Bertolucci A., Marchi S., Bellini M., Casagli S., De Simone B., Carmassi F., Marchetti S., Accorsini M., Cremonini C., Morelli F., Romeo L., Coccolini, F, Kluger, Y, Moore, E, Maier, R, Coimbra, R, Ordonez, C, Ivatury, R, Kirkpatrick, A, Biffl, W, Sartelli, M, Hecker, A, Ansaloni, L, Leppaniemi, A, Reva, V, Civil, I, Vega, F, Chiarugi, M, Chichom-Mefire, A, Sakakushev, B, Peitzman, A, Chiara, O, Abu-Zidan, F, Maegele, M, Miccoli, M, Chirica, M, Khokha, V, Sugrue, M, Fraga, G, Otomo, Y, Baiocchi, G, Catena, F, Kuliesius, Z, Conti, L, Dogjani, A, Lee, J, Consani, H, Russello, D, Bortul, M, Maurel, T, Kaf, H, Adamou, H, Alin, V, Robustelli, U, Sato, N, Seretis, C, Quiodettis, M, Gomes, C, Kong, V, Zakaria, A, Guner, A, Gachabayov, M, Chowdhury, S, Pata, F, Garcia, A, Rems, M, Das, K, Riedel, J, Lasithiotakis, K, Sydorchuk, R, Sydorchuk, L, Lostoridis, E, Buia, A, Mcfarlane, M, Ciani, R, Munoz-Cruzado, V, Tartaglia, D, Ioannidis, O, Muhrbeck, M, Reicher, M, Roscio, F, Ceresoli, M, Tsiftsis, D, Kavalakat, A, Pintar, T, Georgiou, G, Ricci, G, Mohan, R, Saar, S, Di Carlo, I, Isik, A, Ahmed, A, Gonsaga, R, Sammartano, F, Tallon-Aguilar, L, Shoko, T, Hsu, J, Kobe, Y, Romeo, C, Podda, M, Mingoli, A, Delgado, R, Ekwen, G, Aude, V, Olona, C, Boati, P, Magnone, S, Capaldi, M, Bala, M, Picetti, E, Negoi, I, Kok, K, Jusoh, A, Amato, B, Nita, G, de Beaux, A, Demetrashvili, Z, Davies, R, Kim, J, Pereira, A, Fattori, L, Paolillo, C, Ghannam, W, Rodriguez, F, Berardi, L, Florio, M, Hecker, M, Dubuisson, V, O'Connor, D, De'Angelis, N, Dobric, I, Massalou, D, Ortenwall, P, Pikoulis, E, Ugarte-Sierra, B, Zuidema, W, Kechagias, A, Marwah, S, Litvin, A, Nikolopoulos, I, Pesce, A, Uranues, S, Luppi, D, Flohe, S, Martinez-Perez, A, Lorenzo, M, Vergano, L, Manca, M, Malacarne, P, Kurihara, H, Widder, S, Pucciarelli, M, Monzani, F, Brambillasca, P, Corbella, D, Agresta, F, Moore, L, Buonomo, L, Adeleye, A, Kim, D, Veroux, M, Hardcastle, T, Di Saverio, S, Recordare, A, Rubio-Perez, I, Shlyapnikov, S, Rahim, R, Vega, G, Boris, K, Sawyer, R, Baraket, O, Soreide, K, Weber, C, Seak, C, Herman, S, Gamberini, E, Costa, S, Mazzocconi, G, Lozada, E, Manatakis, D, Lohsiriwat, V, Elbery, B, Tiberio, G, Santini, M, Mellace, L, Enoksen, C, Major, P, Parini, D, Improta, M, Fugazzola, P, Pini, S, Liberti, G, Martino, C, Cobianchi, L, Canzi, G, Cicuttin, E, Kenig, J, Zago, M, Giannessi, S, Scaglione, M, Orsitto, E, Cioni, R, Ghiadoni, L, Menichetti, F, Agnoletti, V, Sganga, G, Prosperi, P, Roviello, F, De Paolis, P, Gordini, G, Forfori, F, Ruscelli, P, Gabrielli, F, Puglisi, A, Bertolucci, A, Marchi, S, Bellini, M, Casagli, S, De Simone, B, Carmassi, F, Marchetti, S, Accorsini, M, Cremonini, C, Morelli, F, Romeo, L, and HUS Abdominal Center

Subjects
System, Consensus, Internationality, Delphi Technique, Accrual, Process (engineering), media_common.quotation_subject, Performance, education, lcsh:Surgery, 030230 surgery, Analysis, Data, Morbidity, Mortality, Outcome, Planning, Product, World, 03 medical and health sciences, 0302 clinical medicine, Trauma management, Health care, Medicine, Humans, Operations management, Quality (business), Product (category theory), media_common, Quality Indicators, Health Care, Core set, business.industry, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Analysi, lcsh:RD1-811, lcsh:RC86-88.9, CARE, 3126 Surgery, anesthesiology, intensive care, radiology, Core (game theory), Traumatology, Emergency Medicine, Surgery, business, Research Article
Abstract

Introduction Quality in medical care must be measured in order to be improved. Trauma management is part of health care, and by definition, it must be checked constantly. The only way to measure quality and outcomes is to systematically accrue data and analyze them. Material and methods A systematic revision of the literature about quality indicators in trauma associated to an international consensus conference Results An internationally approved base core set of 82 trauma quality indicators was obtained: Indicators were divided into 6 fields: prevention, structure, process, outcome, post-traumatic management, and society integrational effects. Conclusion Present trauma quality indicator core set represents the result of an international effort aiming to provide a useful tool in quality evaluation and improvement. Further improvement may only be possible through international trauma registry development. This will allow for huge international data accrual permitting to evaluate results and compare outcomes.

Published
2021

4. Trends in open abdomen management in Italy: a subgroup analysis from the IROA project

Author

Cicuttin, E., Ansaloni, L., Ceresoli, M., Fugazzola, P., Tomasoni, M., Sartelli, M., Catena, F., Coccolini, F., Montori, G., Salvetti, F., Zese, M., Occhionorelli, S., Galatioto, C., Chiarugi, M., Dondossola, D., Novelli, G., Nacoti, M., Costa, S., Zoro, T., Trotta, F., Rausei, S., Bellanova, G., Costa, G., Porta, M., Mariani, F., Lora, F., Fattori, L., Jacopo, V., Lorenzo, C., Cicuttin, E, Ansaloni, L, Ceresoli, M, Fugazzola, P, Tomasoni, M, Sartelli, M, Catena, F, and Coccolini, F

Subjects
Male, Fistula, medicine.medical_treatment, Vascular emergency, Postoperative Complications, 0302 clinical medicine, Abdomen, Prospective Studies, Open abdomen, Univariate analysis, Evidence-Based Medicine, Peritoniti, Incidence (epidemiology), Age Factors, Abdominal Wound Closure Techniques, Middle Aged, Register, Management, IROA, medicine.anatomical_structure, Italy, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Complication, Fistula, IROA, Laparostomy, Management, Morbidity, Mortality, Open abdomen, Pancreatitis, Peritonitis, Register, Trauma, Vascular emergency, medicine.medical_specialty, Peritonitis, Subgroup analysis, Complication, Laparostomy, Morbidity, Mortality, Pancreatitis, Trauma, NO, 03 medical and health sciences, Negative-pressure wound therapy, Internal medicine, medicine, Humans, Aged, Open Abdomen Techniques, Pancreatiti, business.industry, medicine.disease, Surgery, business, Negative-Pressure Wound Therapy
Abstract

Use of open abdomen (OA) progressively acquired increasing importance with the diffusion of the damage control management of critical patients. The purpose of the present study is to identify the state of the art about the use of OA in Italy, focusing on techniques, critical issues and clinical outcomes. A prospective analysis of adult patients enrolled in the IROA, limited to the Italian participating centres was performed. 375 patients were enrolled. Mean age was 64 ± 16 years old, 56% of the patients were male, mean BMI was 26.9 ± 5.2. Main indications for using OA were secondary peritonitis (32.5%), post-operative peritonitis (22.9%) and trauma (11.7%). Main OA techniques used were commercial negative pressure wound therapy (49.6%) and Bogotà bag (27.7%). Definitive closure of the abdomen was reached in 82.4% of patients after 6 ± 7 days of OA. The primary fascia closure rate was 84.7%. Overall mortality was 29.1%. The complication rate was 50.8%, with an enteroatmospheric fistula incidence: 7.5%. A univariate analysis performed on complication type found the duration of OA treatment (p = 0.024) to be statistically significant. Univariate analysis on mortality risk identified as significant age, duration of OA (in days) and pancreatitis as indication; multivariate analysis confirmed age (p < 0.001) and pancreatitis (p = 0.002) as statistically significant. A large variety of behaviours towards the patient requiring OA exists. A strong acceptance of common, recognized and evidence-based guidelines is essential, to obtain more uniformity in patient management and coherence of collected data, thus leading to improvement in outcomes and reduction of costs.

Published
2019
Full Text
View/download PDF

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

Author

Ceresoli, M., Coccolini, F., Magnone, S., Lucianetti, A., Bisagni, P., Armao, T., Ansaloni, L., Zago, M., Chiarugi, M., Catena, F., Braga, M., Nizzardo, M., Nespoli, L., Fattori, L., Degrate, L., Perrone, S., Cereda, M., Pisano, M., Poiasina, E., Bertoli, P., Ballabio, M., Braga, S., Graziano, G., Tartaglia, D., Arces, F., Mariani, M., Tagliabue, F., Perrone, G., Annicchiarico, A., Giuffrida, M., Ferrari, G., Benedetti, A., Allievi, N., Ciocca, M., Pinotti, E., Montuori, M., Carlucci, M., Tomajer, V., Fugazzola, P., Ceresoli, M, Coccolini, F, Magnone, S, Lucianetti, A, Bisagni, P, Armao, T, Ansaloni, L, Zago, M, Chiarugi, M, Catena, F, Braga, M, Nizzardo, M, Nespoli, L, Fattori, L, Degrate, L, Perrone, S, Cereda, M, Pisano, M, Poiasina, E, Bertoli, P, Ballabio, M, Braga, S, Graziano, G, Tartaglia, D, Arces, F, Mariani, M, Tagliabue, F, Perrone, G, Annicchiarico, A, Giuffrida, M, Ferrari, G, Benedetti, A, Allievi, N, Ciocca, M, Pinotti, E, Montuori, M, Carlucci, M, Tomajer, V, and Fugazzola, P

Subjects
medicine.medical_specialty, Sports medicine, 030230 surgery, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Acute appendicitis, COVID-19, Non-complicated acute appendicitis, Internal medicine, Pandemic, medicine, Appendectomy, Humans, Orthopedics and Sports Medicine, Trial registration, Pandemics, Retrospective Studies, Control period, business.industry, SARS-CoV-2, Correction, Retrospective cohort study, Treatment rate, Length of Stay, Appendicitis, 030220 oncology & carcinogenesis, Hospital admission, Emergency Medicine, Surgery, Laparoscopy, Original Article, Acute appendiciti, business, Non-complicated acute appendiciti
Abstract

Background During pandemic, admissions for surgical emergencies dropped down dramatically. Also acute appendicitis decreased. The aim of the present study was to evaluate the change in volume and clinical presentation of patients with acute appendicitis during pandemic and the variation in treatment. Methods This is a retrospective study of patients admitted in 11 Italian hospital for acute appendicitis during the lockdown period (March–April 2020) compared with the same period of the previous 2 years (2018–2019). The number and the rate of complicated and non-complicated acute appendicitis were recorded and compared between the two study periods; non-operative vs operative treatment and negative appendectomy rate were also recorded. Results The study included 532 patients, 112 in the study period and 420 in the control period; Hospital admission for acute appendicitis dropped by 46% (OR 0.516 95% CI 0.411–0.648 p p = 0.1719), whereas the number of non-complicated acute appendicitis significantly decreased (− 56%, OR 0.424 95% CI 0.319–0.564 p p = 0.434). The negative appendectomy rate also significantly decreased (6.1% vs. 17.3%, p = 0.006). Conclusions The present study found a significant reduction of both admissions for non-complicated acute appendicitis and negative appendectomy rate during the pandemic period. Conversely, admissions for complicated acute appendicitis did not change. Trial registration: NCT04649996.

Published
2021

6. Liver trauma: WSES 2020 guidelines

Author

Coccolini F., Coimbra R., Ordonez C., Kluger Y., Vega F., Moore E. E., Biffl W., Peitzman A., Horer T., Abu-Zidan F. M., Sartelli M., Fraga G. P., Cicuttin E., Ansaloni L., Parra M. W., Millan M., Deangelis N., Inaba K., Velmahos G., Maier R., Khokha V., Sakakushev B., Augustin G., Di Saverio S., Pikoulis E., Chirica M., Reva V., Leppaniemi A., Manchev V., Chiarugi M., Damaskos D., Weber D., Parry N., Demetrashvili Z., Civil I., Napolitano L., Corbella D., Catena F., Bahouth H., Tolonen M., Fugazzola P., Serna J. J., Rodriguez F., Garcia A. F., Gonzalez A., Pino L. F., Guzman-Rodriguez M., Pereira B. M., Kirkpatrick A., Mefire A. C., Tarasconi A., Chiara O., Gomes C. A., Galante J., Bala M., Perfetti P., MacHado F., Romeo O., Salvetti F., Ghiadoni L., Forfori F., Malacarne P., Pini S., Pucciarelli M., Ceresoli M., Arvieux C., Khokha D., Spain D. A., Isik A., Coccolini, F, Coimbra, R, Ordonez, C, Kluger, Y, Vega, F, Moore, E, Biffl, W, Peitzman, A, Horer, T, Abu-Zidan, F, Sartelli, M, Fraga, G, Cicuttin, E, Ansaloni, L, Parra, M, Millan, M, Deangelis, N, Inaba, K, Velmahos, G, Maier, R, Khokha, V, Sakakushev, B, Augustin, G, Di Saverio, S, Pikoulis, E, Chirica, M, Reva, V, Leppaniemi, A, Manchev, V, Chiarugi, M, Damaskos, D, Weber, D, Parry, N, Demetrashvili, Z, Civil, I, Napolitano, L, Corbella, D, Catena, F, Bahouth, H, Tolonen, M, Fugazzola, P, Serna, J, Rodriguez, F, Garcia, A, Gonzalez, A, Pino, L, Guzman-Rodriguez, M, Pereira, B, Kirkpatrick, A, Mefire, A, Tarasconi, A, Chiara, O, Gomes, C, Galante, J, Bala, M, Perfetti, P, Machado, F, Romeo, O, Salvetti, F, Ghiadoni, L, Forfori, F, Malacarne, P, Pini, S, Pucciarelli, M, Ceresoli, M, Arvieux, C, Khokha, D, Spain, D, Isik, A, and Apollo - University of Cambridge Repository

Subjects
Non-operative management, Abdominal Injuries, Review, 030230 surgery, Guideline, Liver disease, 0302 clinical medicine, Injury Severity Score, Trauma management, Abdominal Injuries / surgery, Medicine, Pediatric, Evidence-Based Medicine, Interventional, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Classification, Optimal management, 3. Good health, Liver, Emergency Medicine, Patient Care Management / methods, Radiology, Adult, medicine.medical_specialty, Guidelines, Hemorrhage, Intensive care, Liver trauma, Minor, Moderate, Operative management, Severe, Surgery, Hemodynamics / physiology, lcsh:Surgery, 03 medical and health sciences, Patient safety, Emergency surgery, Humans, Intensive care medicine, business.industry, Hemodynamics, 030208 emergency & critical care medicine, Evidence-based medicine, lcsh:RD1-811, lcsh:RC86-88.9, medicine.disease, Patient Care Management, Liver / injuries, business
Abstract

Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.

Published
2020

7. Open abdomen and entero-atmospheric fistulae: An interim analysis from the International Register of Open Abdomen (IROA)

Author

Coccolini F, Register of Open Abdomen (IROA)., Ceresoli, M, Kluger, Y, Kirkpatrick, A, Montori, G, Salvetti, F, Fugazzola, P, Tomasoni, M, Sartelli, M, Ansaloni, L1, Catena, F, Nego, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, 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, Ardaisik, Yuan, Kc, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernández, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, Gp, Pereira, Bm, Gachabayov, M, Chagerben, Gp, Arellano, Ml, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Gianotti, L, Fattori, L, Ivatury, R, IROA study group, Coccolini, F, Ceresoli, M, Kluger, Y, Kirkpatrick, A, Montori, G, Salvetti, F, Fugazzola, P, Tomasoni, M, Sartelli, M, Ansaloni, L, Catena, F, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Galatioto, C, Chiarugi, 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, Hernández, 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, Gianotti, L, Fattori, L, and Ivatury, R

Subjects
Adult, Male, medicine.medical_specialty, Fistula, medicine.medical_treatment, Peritonitis, Entero-atmospheric fistula, NO, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Negative-pressure wound therapy, MED/18 - CHIRURGIA GENERALE, Intestinal Fistula, Humans, Medicine, Orthopedics and Sports Medicine, Prospective Studies, Young adult, Open abdomen, Prospective cohort study, Digestive System Surgical Procedures, General Environmental Science, 030222 orthopedics, business.industry, Mortality rate, Abdominal Cavity, Abdominal Wound Closure Techniques, 030208 emergency & critical care medicine, Middle Aged, Interim analysis, medicine.disease, Surgery, IROA, Treatment Outcome, Parenteral nutrition, Emergency Medicine, General Earth and Planetary Sciences, Female, business, Negative-Pressure Wound Therapy
Abstract

Introduction No definitive data describing associations between cases of Open Abdomen (OA) and Entero-atmospheric fistulae (EAF) exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) thus analyzed the International Register of Open Abdomen (IROA) to assess this question. Material and methods A prospective analysis of adult patients enrolled in the IROA. Results Among 649 adult patients with OA 58 (8.9%) developed EAF. Indications for OA were peritonitis (51.2%) and traumatic-injury (16.8%). The most frequently utilized temporary abdominal closure techniques were Commercial-NPWT (46.8%) and Bogota-bag (21.9%). Mean OA days were 7.9 ± 18.22. Overall mortality rate was 29.7%, with EAF having no impact on mortality. Multivariate analysis associated cancer (p = 0.018), days of OA (p = 0.003) and time to provision-of-nutrition (p = 0.016) with EAF occurrence. Conclusion Entero-atmospheric fistulas are influenced by the duration of open abdomen treatment and by the nutritional status of the patient. Peritonitis, intestinal anastomosis, negative pressure and oral or enteral nutrition were not risk factors for EAF during OA treatment.

Published
2019

8. Intra-operative gallbladder scoring predicts conversion of laparoscopic to open cholecystectomy : a WSES prospective collaborative study

Author

Sugrue M., Coccolini F., Bucholc M., Johnston A., Manatakis D., Ioannidis O., Bonilauri S., Gachabayov M., Isik A., Ghnnam W., Shelat V., Aremu M., Mohan R., Montori G., Waledziak M., Pisarska M., Kong V., Strzalka M., Fugazzola P., Nita G. E., Nardi M., Major P., Negoi I., Allegri A., Konstantoudakis G., Di Carlo I., Massalou D., D'Amico G., Solaini L., Ceresoli M., Bini R., Zielinski M., Tomasoni M., Litvin A., De Simone B., Lostoridis E., Hernandez F., Panyor G., Machain G. M. V., Pentara I., Baiocchi L., Ng K. C., Ansaloni L., Sartelli M., Arellano M. L., Savala N., Couse N., McBride S., Michael Sugrue, Federico Coccolini, Magda Bucholc, Alison Johnston, Contributors from WSES, Leonardo Solaini, Sugrue, M, Coccolini, F, Bucholc, M, Johnston, A, Manatakis, D, Ioannidis, O, Bonilauri, S, Gachabayov, M, Isik, A, Ghnnam, W, Shelat, V, Aremu, M, Mohan, R, Montori, G, Waledziak, M, Pisarska, M, Kong, V, Strzalka, M, Fugazzola, P, Nita, G, Nardi, M, Major, P, Negoi, I, Allegri, A, Konstantoudakis, G, Di Carlo, I, Massalou, D, D'Amico, G, Solaini, L, Ceresoli, M, Bini, R, Zielinski, M, Tomasoni, M, Litvin, A, De Simone, B, Lostoridis, E, Hernandez, F, Panyor, G, Machain, G, Pentara, I, Baiocchi, L, Ng, K, Ansaloni, L, Sartelli, M, Arellano, M, Savala, N, Couse, N, and Mcbride, S

Subjects
Male, Fistula, medicine.medical_treatment, Cholangiography, Cholecystitis, Conversion to open cholecystectomy, Index surgery, Operative severity scoring system, Surgical outcomes, Surgery, Emergency Medicine, 80 and over, Cholecystiti, Prospective Studies, Prospective cohort study, Aged, 80 and over, medicine.diagnostic_test, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Gallbladder, Middle Aged, Conversion to Open Surgery, medicine.anatomical_structure, Cholecystectomy, Laparoscopic, Research Design, Female, Research Article, Human, Adult, medicine.medical_specialty, Adolescent, Aged, Cholecystectomy, Humans, Open cholecystectomy, lcsh:Surgery, Laparoscopic, medicine, Laparoscopic cholecystectomy, Surgical outcome, business.industry, General surgery, lcsh:RD1-811, lcsh:RC86-88.9, medicine.disease, Prospective Studie, business
Abstract

Introduction: Laparoscopic cholecystectomy, the gold-standard approach for cholecystectomy, has surprisingly variable outcomes and conversion rates. Only recently has operative grading been reported to define disease severity and few have been validated. This multicentre, multinational study assessed an operative scoring system to assess its ability to predict the need for conversion from laparoscopic to open cholecystectomy. Methods: A prospective, web-based, ethically approved study was established by WSES with a 10-point gallbladder operative scoring system; enrolling patients undergoing elective or emergency laparoscopic cholecystectomy between January 2016 and December 2017. Gallbladder surgery was considered easy if the G10 score < 2, moderate (2 ≦ 4), difficult (5 ≦ 7) and extreme (8 ≦ 10). Demographics about the patients, surgeons and operative procedures, use of cholangiography and conversion rates were recorded. Results: Five hundred four patients, mean age 53.5 (range 18-89), were enrolled by 55 surgeons in 16 countries. Surgery was performed by consultants in 70% and was elective in (56%) with a mean operative time of 78.7 min (range 15-400). The mean G10 score was 3.21, with 22% deemed to have difficult or extreme surgical gallbladders, and 71/504 patients were converted. The G10 score was 2.98 in those completed laparoscopically and 4.65 in the 71/504 (14%) converted. (p < 0.0001; AUC 0.772 (CI 0.719-0.825). The optimal cut-off point of 0.067 (score of 3) was identified in G10 vs conversion to open cholecystectomy. Conversion occurred in 33% of patients with G10 scores of ≥ 5. The four variables statistically predictive of conversion were GB appearance - completely buried GB, impacted stone, bile or pus outside GB and fistula. Conclusion: The G10 operative scores provide simple grading of operative cholecystectomy and are predictive of the need to convert to open cholecystectomy. Broader adaptation and validation may provide a benchmark to understand and improve care and afford more standardisation in global comparisons of care for cholecystectomy.

Published
2019

9. The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition)

Author

Andrew W Kirkpatrick, Osvaldo Chiara, Daniele Marrelli, Massimo Sartelli, Pierluigi Viale, Ferdinando Agresta, Nazario Portolani, Angelo Guttadauro, Luca Petruzzelli, Mario Testini, Luca Ansaloni, Paolo Carcoforo, Vanni Agnoletti, Lorenzo Cobianchi, Salvatore Tolone, Angela Gurrado, Andrea Fabbri, Fausto Catena, Yoram Kluger, Paola Fugazzola, Federico Coccolini, Francesco Paolo Prete, Monica Zese, Francesco Gabrielli, Matteo Tomasoni, Bruno Amato, Marco Ceresoli, Alessandro De Troia, Alessandro Puzziello, Offir Ben Ishay, Salomone Di Saverio, Giorgio Soliani, Leonardo Leone, Massimo Chiarugi, Carlo V. Feo, Gregorio Tugnoli, Apollo - University of Cambridge Repository, Fugazzola, P., Ceresoli, M., Agnoletti, V., Agresta, F., Amato, B., Carcoforo, P., Catena, F., Chiara, O., Chiarugi, M., Cobianchi, L., Coccolini, F., De Troia, A., Di Saverio, S., Fabbri, A., Feo, C., Gabrielli, F., Gurrado, A., Guttadauro, A., Leone, L., Marrelli, D., Petruzzelli, L., Portolani, N., Prete, F. P., Puzziello, A., Sartelli, M., Soliani, G., Testini, M., Tolone, S., Tomasoni, M., Tugnoli, G., Viale, P., Zese, M., Ishay, O. B., Kluger, Y., Kirkpatrick, A., Ansaloni, L., Fugazzola, P, Ceresoli, M, Agnoletti, V, Agresta, F, Amato, B, Carcoforo, P, Catena, F, Chiara, O, Chiarugi, M, Cobianchi, L, Coccolini, F, De Troia, A, Di Saverio, S, Fabbri, A, Feo, C, Gabrielli, F, Gurrado, A, Guttadauro, A, Leone, L, Marrelli, D, Petruzzelli, L, Portolani, N, Prete, F, Puzziello, A, Sartelli, M, Soliani, G, Testini, M, Tolone, S, Tomasoni, M, Tugnoli, G, Viale, P, Zese, M, Ishay, O, Kluger, Y, Kirkpatrick, A, Ansaloni, L, Fugazzola P., Ceresoli M., Agnoletti V., Agresta F., Amato B., Carcoforo P., Catena F., Chiara O., Chiarugi M., Cobianchi L., Coccolini F., De Troia A., Di Saverio S., Fabbri A., Feo C., Gabrielli F., Gurrado A., Guttadauro A., Leone L., Marrelli D., Petruzzelli L., Portolani N., Prete F.P., Puzziello A., Sartelli M., Soliani G., Testini M., Tolone S., Tomasoni M., Tugnoli G., Viale P., Zese M., Ishay O.B., Kluger Y., Kirkpatrick A., and Ansaloni L.

Subjects
medicine.medical_specialty, Perforation (oil well), Population, lcsh:Surgery, Appendectomy, Appendicitis, Elderly, Surgery in elderly, Review, 030230 surgery, NO, 03 medical and health sciences, 0302 clinical medicine, Elderly, Emergency surgery, Epidemiology, Humans, Medicine, Appendectomy, Appendicitis, Surgery in elderly, Appendiciti, education, Aged, Aged, 80 and over, education.field_of_study, business.industry, General surgery, Age Factors, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Consensus conference, Postoperative complication, lcsh:RD1-811, lcsh:RC86-88.9, medicine.disease, 030220 oncology & carcinogenesis, Acute Disease, Acute appendicitis, Emergency Medicine, Surgery, business
Abstract

The epidemiology and the outcomes of acute appendicitis in elderly patients are very different from the younger population. Elderly patients with acute appendicitis showed higher mortality, higher perforation rate, lower diagnostic accuracy, longer delay from symptoms onset and admission, higher postoperative complication rate and higher risk of colonic and appendiceal cancer. The aim of the present work was to investigate age-related factors that could influence a different approach, compared to the 2016 WSES Jerusalem guidelines on general population, in terms of diagnosis and management of elderly patient with acute appendicitis. During the XXIX National Congress of the Italian Society of Surgical Pathophysiology (SIFIPAC) held in Cesena (Italy) in May 2019, in collaboration with the Italian Society of Geriatric Surgery (SICG), the World Society of Emergency Surgery (WSES) and the Italian Society of Emergency Medicine (SIMEU), a panel of experts participated to a Consensus Conference where eight panelists presented a number of statements, which were developed for each of the four topics about diagnosis and management of acute appendicitis in elderly patients, formulated according to the GRADE system. The statements were then voted, eventually modified and finally approved by the participants to the Consensus Conference. The current paper is reporting the definitive guidelines statements on each of the following topics: diagnosis, non-operative management, operative management and antibiotic therapy.

Published
2020
Full Text
View/download PDF

10. Neoadjuvant chemotherapy in advanced gastric and esophago-gastric cancer. Meta-analysis of randomized trials

Author

Luca Ansaloni, Matteo Tomasoni, Federico Coccolini, Marco Ceresoli, Andrea Celotti, Matteo Nardi, Giulia Montori, Fausto Catena, Yutaka Yonemura, Stefano Cascinu, Olivier Glehen, Paola Fugazzola, Coccolini, F, Nardi, M, Montori, G, Ceresoli, M, Celotti, A, Cascinu, S, Fugazzola, P, Tomasoni, M, Glehen, O, Catena, F, Yonemura, Y, Ansaloni, L, Coccolini, F., Nardi, M., Montori, G., Ceresoli, M., Celotti, A., Cascinu, S., Fugazzola, P., Tomasoni, M., Glehen, O., Catena, F., Yonemura, Y., and Ansaloni, L.

Subjects
Oncology, Male, Survival, Esophageal Neoplasms, medicine.medical_treatment, Esophago-gastric cancer, law.invention, Post-operative, 0302 clinical medicine, Randomized controlled trial, law, Recurrence, Perioperative, Neoadjuvant therapy, Adjuvant, Randomized Controlled Trials as Topic, Mortality rate, General Medicine, Neoadjuvant Therapy, Management, Treatment Outcome, Local, Gastric cancer, Morbidity, Mortality, Neoadjuvant chemotherapy, Treatment, Antineoplastic Agents, Chemotherapy, Adjuvant, Female, Gastrectomy, Humans, Neoplasm Recurrence, Local, Stomach Neoplasms, 030220 oncology & carcinogenesis, Meta-analysis, 030211 gastroenterology & hepatology, medicine.medical_specialty, 03 medical and health sciences, Internal medicine, medicine, Chemotherapy, business.industry, Cancer, medicine.disease, Neoplasm Recurrence, Surgery, business
Abstract

Introduction Even in after curative surgery and adequate linfoadenectomy the survival of advanced gastric cancer (AGC) remains poor. At present some data have been published on the effects of NACT and perioperative chemotherapy on AGC and Esophago-gastric cancer (EGC) but not definitive ones. The present meta-analysis aims to evaluate the effects of neoadjuvant chemotherapy (NACT) on the AGC and EGC. Material and methods A systematic review with meta-analysis of randomized controlled trials (RCTs) of NACT + surgery vs. Surgery in patients with AGC and EGC was performed. Results 15 RCTs have been included (2001 patients: 977 into NACT + surgery arm and 1024 into control arm). NACT + Surgery reduces the overall mortality at 1, 3 and 5-year in cumulative analysis (RR = 0.78; 0.81; 0.88 respectively), at 1, 2, 3 and 5-years in EGC (RR = 0.79; 0.83; 0.84; 0.91 respectively) and at 3 and 5-years in AGC (RR = 0.74; 0.82 respectively). Morbidity and perioperative mortality rate are not influenced by NACT. Recurrence rate is reduced by NACT + surgery in EGC (RR = 0.80). Conclusions NACT reduces the mortality in gastric and esophago-gastric cancer. Morbidity and perioperative mortality are not influenced by NACT. The overall recurrence rate is reduced by NACT in esophago-gastric cancer.

Published
2017

11. Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry

Author

Adam Bersztel, Camilla Cremonini, Endre Szarka, Fausto Catena, Maria Grazia Sibilla, Artai Pirouzram, Enrico Cicuttin, Eva-Corina Caragounis, Boris Kessel, Federico Coccolini, Yosuke Matsumura, Lauri Handolin, Viktor A. Reva, Emiliano Gamberini, Per Skoog, Sung Wook Chang, George Oosthuizen, David T. McGreevy, Miklosh Bala, Kristofer F. Nilsson, Yuri Kon, Luca Ansaloni, Vanni Agnoletti, Mariusz Maszkowski, Tongporn Wannatoop, Matteo Tomasoni, Marco Ceresoli, V Manchev, Tokiya Ishida, Mårten Falkenberg, Gad Shaked, Mitra Sadeghi, Massimo Chiarugi, Carlos A. Ordoñez, Paola Fugazzola, Junichi Matsumoto, Peter Hibert-Carius, Thomas Larzon, Dan Hebron, Claudia Zaghi, Koji Idoguchi, Asko Toivola, Tal M. Hörer, Coccolini, F, Ceresoli, M, Mcgreevy, D, Sadeghi, M, Pirouzram, A, Toivola, A, Skoog, P, Idoguchi, K, Kon, Y, Ishida, T, Matsumura, Y, Matsumoto, J, Reva, V, Maszkowski, M, Fugazzola, P, Tomasoni, M, Cicuttin, E, Ansaloni, L, Zaghi, C, Sibilla, M, Cremonini, C, Bersztel, A, Caragounis, E, Falkenberg, M, Handolin, L, Oosthuizen, G, Szarka, E, Manchev, V, Wannatoop, T, Chang, S, Kessel, B, Hebron, D, Shaked, G, Bala, M, Ordonez, C, Hibert-Carius, P, Chiarugi, M, Nilsson, K, Larzon, T, Gamberini, E, Agnoletti, V, Catena, F, and Horer, T

Subjects
Male, Hemodynamics, 0302 clinical medicine, Registries, Aorta, Univariate analysis, education.field_of_study, Trauma Severity Indices, ABO, EVTM, Hemodynamic, International, Morbidity, Mortality, Pelvis, REBOA, Registry, Trauma, Mortality rate, Hydrogen-Ion Concentration, Middle Aged, medicine.anatomical_structure, Blunt trauma, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Adult, medicine.medical_specialty, Adolescent, Systole, Pelvi, Population, Arterial Occlusive Diseases, Shock, Hemorrhagic, Young Adult, 03 medical and health sciences, medicine.artery, medicine, Humans, International Normalized Ratio, education, business.industry, Balloon Occlusion, Surgery, Blood pressure, business
Abstract

EndoVascular and Hybrid Trauma Management (EVTM) has been recently introduced in the treatment of severe pelvic ring injuries. This multimodal method of hemorrhage management counts on several strategies such as the REBOA (resuscitative endovascular balloon occlusion of the aorta). Few data exist on the use of REBOA in patients with a severely injured pelvic ring. The ABO (aortic balloon occlusion) Trauma Registry is designed to capture data for all trauma patients in hemorrhagic shock where management includes REBOA placement. Among all patients included in the ABO registry, 72 patients presented with severe pelvic injuries and were the population under exam. 66.7% were male. Mean and median ISS were respectively 43 and 41 (SD ± 13). Isolated pelvic injuries were observed in 12 patients (16.7%). Blunt trauma occurred in 68 patients (94.4%), penetrating in 2 (2.8%) and combined in 2 (2.8%). Type of injury: fall from height in 15 patients (23.1%), traffic accident in 49 patients (75.4%), and unspecified impact in 1 patient (1.5%). Femoral access was gained pre-hospital in 1 patient, in emergency room in 43, in operating room in 12 and in angio-suite in 16. REBOA was positioned in zone 1 in 59 patients (81,9%), in zone 2 in 1 (1,4%) and in zone 3 in 12 (16,7%). Aortic occlusion was partial/periodical in 35 patients (48,6%) and total occlusion in 37 patients (51,4%). REBOA associated morbidity rate: 11.1%. Overall mortality rate was 54.2% and early mortality rate (≤ 24 h) was 44.4%. In the univariate analysis, factors related to early mortality (≤ 24 h) are lower pH values (p = 0.03), higher base deficit (p = 0.021), longer INR (p = 0.012), minor increase in systolic blood pressure after the REBOA inflation (p = 0.03) and total aortic occlusion (p = 0.008). None of these values resulted significant in the multivariate analysis. In severe hemodynamically unstable pelvic trauma management, REBOA is a viable option when utilized in experienced centers as a bridge to other treatments; its use might be, however, accompanied with severe-to-lethal complications.

Published
2020
Full Text
View/download PDF

12. Improving splenic conservation rate after trauma by applying a protocol for non-operative management and follow-up: A propensity-score analysis

Author

Emanuela Giampalma, Paola Fugazzola, Dario Piazzalunga, Federico Coccolini, Emiliano Gamberini, Michele Pisano, Matteo Tomasoni, Marcello Bisulli, Vanni Agnoletti, Sofia Battisti, Luca Ansaloni, Stefano Magnone, Fugazzola P., Battisti S., Tomasoni M., Magnone S., Pisano M., Piazzalunga D., Bisulli M., Gamberini E., Agnoletti V., Coccolini F., Giampalma E., and Ansaloni L.

Subjects
medicine.medical_specialty, business.industry, Non-operative management, Trauma care, Retrospective cohort study, Spleen trauma, Critical Care and Intensive Care Medicine, Non-operative management failure, Blunt trauma, Internal medicine, Propensity score matching, Emergency Medicine, Medicine, Complication rate, In patient, business
Abstract

Background: There are shared guidelines about Non-Operative Management (NOM) of splenic injuries, but some unanswered questions remain. The aim of the present study is to establish the usefulness of a standardized protocol for management and follow-up of NOM patients with splenic injuries. Methods: Multicenter retrospective observational study including patients with major blunt trauma (ISS >15) with splenic injuries managed between January 1st 2014 and December 31st 2016 in two Italian I level Trauma Centers: one with a standardized management and follow-up protocol for NOM (Bufalini Hospital, Cesena, BH), and the other without it (ASST Papa Giovanni XXIII Hospital, Bergamo, PG23H). Comparison between patients’ outcomes were performed and a propensity score model was calculated. Results: 47 patients managed in BH and 49 patients in PG23H were included. In BH, a higher proportion of patients was treated with NOM (72.3 % vs. 53.1 %, p = 0.051). There was no difference in complication rate and mortality in patients treated with NOM in the two hospitals. A borderline significant trend to a higher NOM failure rate in PG23H was found (BH 0.0 % vs. PG23H 11.3 %, p = 0.076). The total splenic conservation rate was significantly higher in BH (BH 72.3 % vs. PG23H 46.9 %, p = 0.011). After the Propensity Score based matching, 72 patients were included and the total splenic conservation rate was significantly higher in BH (BH: 77.8 % vs. PG23H: 50.9 %, p = 0.014). Conclusions: The application of a protocol for in-hospital management and follow-up for NOM of patients with splenic injury could decrease the NOM failure rate and improve splenic conservation rate.

Published
2021
Full Text
View/download PDF

13. A pandemic recap: lessons we have learned

Author

Ugo Boggi, Julival Ribeiro, Luigi Bonavina, Mauro Pistello, Fikri M. Abu-Zidan, Massimo Sartelli, Dieter G. Weber, Vladimir Khokha, Pietro Brambillasca, Dario Tartaglia, Yoram Kluger, Lorenzo Cobianchi, Damien Massalou, Cristian Mesina, Arda Isik, Alessandro Cucchetti, Mutasim M. Elmangory, Xavier Guirao, Salomone Di Saverio, Ibrahima Sall, Emmanouil Pikoulis, Aleksei V. Osipov, Krstina Doklestic, Mahir Gachabayov, Maria Grazia Sibilla, Charalampos Seretis, Fabio Tumietto, M Chirica, Paola Fugazzola, Isidoro Di Carlo, Gian Luca Baiocchi, Chad G. Ball, Yunfeng Cui, Lorenzo Ghiadoni, Timothy Craig Hardcastle, Massimo Fantoni, Boun Kim Tan, Bruno Turri, Edoardo Picetti, Federico Coccolini, Jacek Czepiel, Jae Il Kim, Evgeni Dimitrov, R. V. Maier, Camilla Cremonini, Ali I. Yahya, I. A. Kryvoruchko, Akira Kuriyama, Wagih Ghannam, Shamshul Ansari, Fernando Machado, Enrico Cicuttin, Sumita A Jain, Ronald Kiguba, Doron Kopelman, Martha Quiodettis, Michele Pisano, Marco Ceresoli, Harry van Goor, Garima Kapoor, Andrew W. Kirkpatrick, Mauro Podda, Angelo Gemignani, Boris Sakakushev, Souha S. Kanj, Ernest E. Moore, Samir Delibegovic, Cinzia Monti, Massimo Girardis, Matti Tolonen, Mushira Enani, Massimo Chiarugi, Carlos A. Ordoñez, Zaza Demetrashvili, Leonardo Pagani, Ziad A. Memish, Pradeep H. Navsaria, Paolo Malacarne, Nicola de’Angelis, Giandomenico Luigi Biancofiore, Fulvio Basolo, Goran Augustin, Junichi Matsumoto, Fausto Catena, Ari Leppäniemi, Gabriel Rodrigues, W.P. Zuidema, Raul Coimbra, Manu Malbrain, Emilio Maseda, Suman Baral, Demetrios Demetriades, M. Hecker, Davide Corbella, András Vereczkei, Sanjay Marwah, Francesco Forfori, Donal B. O’Connor, Carlo Palombo, Vishal G Shelat, Michelangelo Scaglione, Walter L. Biffl, Andrey Litvin, Majdi N. Al-Hasan, Sameer Dhingra, Miklosh Bala, Oussama Baraket, Carlos Augusto Gomez, Offir Ben-Ishay, Gabriele Materazzi, Paolo Carcoforo, Rita Galeiras, Belinda De Simone, Ionut Negoi, Mirco Nacoti, Luca Ansaloni, Bruno Viaggi, Jose J. Diaz, Alessandro Puzziello, Bruno Amato, Lostoridis Eftychios, Cino Bendinelli, Mario Testini, Andreas Hecker, Martin Reichert, Francesco Corradi, Korey Das, Gustavo M. Machain Vega, Evika Karamagioli, Rao R. Ivatury, HUS Abdominal Center, II kirurgian klinikka, Coccolini, F, Cicuttin, E, Cremonini, C, Tartaglia, D, Viaggi, B, Kuriyama, A, Picetti, E, Ball, C, Abu-Zidan, F, Ceresoli, M, Turri, B, Jain, S, Palombo, C, Guirao, X, Rodrigues, G, Gachabayov, M, Machado, F, Eftychios, L, Kanj, S, Di Carlo, I, Di Saverio, S, Khokha, V, Kirkpatrick, A, Massalou, D, Forfori, F, Corradi, F, Delibegovic, S, Machain Vega, G, Fantoni, M, Demetriades, D, Kapoor, G, Kluger, Y, Ansari, S, Maier, R, Leppaniemi, A, Hardcastle, T, Vereczkei, A, Karamagioli, E, Pikoulis, E, Pistello, M, Sakakushev, B, Navsaria, P, Galeiras, R, Yahya, A, Osipov, A, Dimitrov, E, Doklestic, K, Pisano, M, Malacarne, P, Carcoforo, P, Sibilla, M, Kryvoruchko, I, Bonavina, L, Kim, J, Shelat, V, Czepiel, J, Maseda, E, Marwah, S, Chirica, M, Biancofiore, G, Podda, M, Cobianchi, L, Ansaloni, L, Fugazzola, P, Seretis, C, Gomez, C, Tumietto, F, Malbrain, M, Reichert, M, Augustin, G, Amato, B, Puzziello, A, Hecker, A, Gemignani, A, Isik, A, Cucchetti, A, Nacoti, M, Kopelman, D, Mesina, C, Ghannam, W, Ben-Ishay, O, Dhingra, S, Coimbra, R, Moore, E, Cui, Y, Quiodettis, M, Bala, M, Testini, M, Diaz, J, Girardis, M, Biffl, W, Hecker, M, Sall, I, Boggi, U, Materazzi, G, Ghiadoni, L, Matsumoto, J, Zuidema, W, Ivatury, R, Enani, M, Litvin, A, Al-Hasan, M, Demetrashvili, Z, Baraket, O, Ordonez, C, Negoi, I, Kiguba, R, Memish, Z, Elmangory, M, Tolonen, M, Das, K, Ribeiro, J, O'Connor, D, Tan, B, Van Goor, H, Baral, S, De Simone, B, Corbella, D, Brambillasca, P, Scaglione, M, Basolo, F, De'Angelis, N, Bendinelli, C, Weber, D, Pagani, L, Monti, C, Baiocchi, G, Chiarugi, M, Catena, F, Sartelli, M, Surgery, Other Research, APH - Quality of Care, Department of Surgery, and Faculty of Health Sciences

Subjects
Biomedical Research, Pandemics / prevention & control, Delivery of Health Care / organization & administration, International Cooperation, Reflection, 030230 surgery, Global Health, Health Services Accessibility, COVID-19 / epidemiology, 0302 clinical medicine, White paper, Telemedicine / organization & administration, Multidisciplinary approach, Pandemic, Health care, Global health, 030212 general & internal medicine, Letter to the Editor, Health Policy, Politics, Medical emergencies. Critical care. Intensive care. First aid, COVID-19 / therapy, Public relations, Telemedicine, Primary Health Care / organization & administration, 3. Good health, Policy, International, Emergency Medicine, Thought, medicine.medical_specialty, COVID-19 Vaccines, RD1-811, Thoughts, Mass Vaccination, Mass Vaccination / organization & administration, NO, 03 medical and health sciences, medicine, Politic, Humans, Ethic, Healthcare Disparities, Biology, Pandemics, Health policy, LS7_4, Ethics, Pandemia, Primary Health Care, RC86-88.9, business.industry, Public health, COVID-19, Health Status Disparities, 3126 Surgery, anesthesiology, intensive care, radiology, Delivery of Health Care, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Surgery, business, COVID-19 / diagnosis
Abstract

Contains fulltext : 238976.pdf (Publisher’s version ) (Open Access) 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
Full Text
View/download PDF

14. 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

15. From intensive care to step-down units: Managing patients throughput in response to COVID-19

Author

Agnoletti, Vanni, Russo, Emanuele, Circelli, Alessandro, Benni, Marco, Bolondi, Giuliano, Martino, Costanza, Domenico, P, Santonastas, O, Brogi, Etrusca, Praticò, Beniamino, Coccolini, Federico, Fugazzola, Paola, Ansaloni, Luca, Gamberini, Emiliano, Agnoletti V., Russo E., Circelli A., Benni M., Bolondi G., Martino C., Santonastaso D.P., Brogi E., Pratico B., Coccolini F., Fugazzola P., Ansaloni L., and Gamberini E.

Subjects
Waiting time, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Critical Illness, Coronaviru, Intensivist, intensive care unit, law.invention, 03 medical and health sciences, 0302 clinical medicine, length of stay, law, Intensive care, Epidemiology, medicine, Humans, Mass Casualty Incidents, AcademicSubjects/MED00860, 030212 general & internal medicine, mass casualty incident, Personal protective equipment, Pandemics, Coronavirus, Hospital Bed Capacity, Intensive Care Units, Length of Stay, Step Down Units, Bed Occupancy, business.industry, SARS-CoV-2, 030503 health policy & services, Health Policy, Public Health, Environmental and Occupational Health, COVID-19, General Medicine, medicine.disease, Intensive care unit, hospital bed capacity, Mass-casualty incident, Italy, Quality in Practice, Medical emergency, step-down units, 0305 other medical science, business, Intermediate Care Facilities
Abstract

Quality problem or issue The on-going COVID-19 pandemic may cause the collapse of healthcare systems because of unprecedented hospitalization rates. Initial assessment A total of 8.2 individuals per 1000 inhabitants have been diagnosed with COVID-19 in our province. The hospital predisposed 110 beds for COVID-19 patients: on the day of the local peak, 90% of them were occupied and intensive care unit (ICU) faced unprecedented admission rates, fearing system collapse. Choice of solution Instead of increasing the number of ICU beds, the creation of a step-down unit (SDU) close to the ICU was preferred: the aim was to safely improve the transfer of patients and to relieve ICU from the risk of overload. Implementation A nine-bed SDU was created next to the ICU, led by intensivists and ICU nurses, with adequate personal protective equipment, monitoring systems and ventilators for respiratory support when needed. A second six-bed SDU was also created. Evaluation Patients were clinically comparable to those of most reports from Western Countries now available in the literature. ICU never needed supernumerary beds, no patient died in the SDU, and there was no waiting time for ICU admission of critical patients. SDU has been affordable from human resources, safety and economic points of view. Lessons learned COVID-19 is like an enduring mass casualty incident. Solutions tailored on local epidemiology and available resources should be implemented to preserve the efficiency and adaptability of our institutions and provide the adequate sanitary response.

Published
2021

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

Author

Federico Coccolini, Enrico Cicuttin, E Pikoulis, Belinda De Simone, Ugo Boggi, Antonio Tarasconi, Luigi Bonavina, Bruno Viaggi, Camilla Cremonini, Robert G. Sawyer, Gennaro Perrone, Jean Louis Vincent, Ines Rubio, Paola Fugazzola, Itani Kamal, Arda Isik, Fikri M. Abu-Zidan, Massimo Sartelli, Philippe Montravers, Timothy Craig Hardcastle, Vishal G Shelat, Francesco Corradi, Ramiro Manzano Nunez, Goran Augustin, Ernest E. Moore, Richard P. G. ten Broek, Andrew B. Peitzman, Matti Tolonen, Marco Ceresoli, Fausto Catena, Stefano Gitto, Raul Coimbra, Sameer Dhingra, Miklosh Bala, Yoram Kluger, Manu L N G Malbrain, Andreas Hecker, Boris Sakakushev, Francesco Di Marzo, Dario Tartaglia, Salomone Di Saverio, Edward C.T.H. Tan, Imitiaz Wani, Carlos Augusto Gomes, Therese M. Duane, Francesco Forfori, Mauro Podda, Zaza Demetrashvili, Nicola de’Angelis, Mario Improta, Francesco M. Labricciosa, Yunfeng Cui, Kemal Rasa, Andrey Litvin, Luca Ansaloni, Mircea Chirica, Ari Leppäniemi, Michael Sugrue, Walter L. Biffl, Oreste Romeo, Marja A. Boermeester, Massimo Chiarugi, Carlos A. Ordoñez, Anastasia Pikoulis, Coccolini, F, Improta, M, Sartelli, M, Rasa, K, Sawyer, R, Coimbra, R, Chiarugi, M, Litvin, A, Hardcastle, T, Forfori, F, Vincent, J, Hecker, A, Ten Broek, R, Bonavina, L, Chirica, M, Boggi, U, Pikoulis, E, Di Saverio, S, Montravers, P, Augustin, G, Tartaglia, D, Cicuttin, E, Cremonini, C, Viaggi, B, De Simone, B, Malbrain, M, Shelat, V, Fugazzola, P, Ansaloni, L, Isik, A, Rubio, I, Kamal, I, Corradi, F, Tarasconi, A, Gitto, S, Podda, M, Pikoulis, A, Leppaniemi, A, Ceresoli, M, Romeo, O, Moore, E, Demetrashvili, Z, Biffl, W, Wani, I, Tolonen, M, Duane, T, Dhingra, S, Deangelis, N, Tan, E, Abu-Zidan, F, Ordonez, C, Cui, Y, Labricciosa, F, Perrone, G, Di Marzo, F, Peitzman, A, Sakakushev, B, Sugrue, M, Boermeester, M, Nunez, R, Gomes, C, Bala, M, Kluger, Y, and Catena, F

Subjects
Oncologic, Lymphoma, Cytomegalovirus, Review, Postoperative Complications, Cholecystitis, Medicine, Cholecystiti, Anesthesia, Appendiciti, Perioperative, Diverticuliti, Cancer, Abdomen, Acute, education.field_of_study, Leukemia, Perforation, Peritoniti, Medical emergencies. Critical care. Intensive care. First aid, Diverticulitis, Transplanted, Acute abdomen, Emergency Medicine, medicine.symptom, Emergency Service, Hospital, Infection, Immunocompetence, medicine.medical_specialty, RD1-811, Appendicitis, Hematologic, Immunocompromise, Immunosuppression, Infections, Intra-abdominal, Peritonitis, Tuberculosis, Tuberculosi, Perforation (oil well), Population, Immunocompromised Host, Humans, education, RC86-88.9, business.industry, General surgery, Cytomegaloviru, Pseudomembranous colitis, Emergency department, medicine.disease, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Surgery, business
Abstract

Contains fulltext : 245653.pdf (Publisher’s version ) (Open Access) 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

17. Case Report: Cytoreductive Surgery and HIPEC Associated With Liver Electrochemotherapy in a Cholangiocarcinoma Patient With Peritoneal Carcinomatosis and Liver Metastasis Case Report

Author

Costantino Mastronardi, Alessandro Palladino, Luca Ansaloni, Vanni Agnoletti, Mauro Stefano, Beatrice Benini, Paola Fugazzola, Marcello Bisulli, Federico Coccolini, Matteo Tomasoni, Enrico Prosperi, Emanuela Giampalma, Stefano M., Prosperi E., Fugazzola P., Benini B., Bisulli M., Coccolini F., Mastronardi C., Palladino A., Tomasoni M., Agnoletti V., Giampalma E., and Ansaloni L.

Subjects
medicine.medical_specialty, Electrochemotherapy, cholangiocarcinoma, debulking, electrochemotherapy, heated intraperitoneal chemotherapy, peritoneal metastases, Tare weight, medicine.medical_treatment, lcsh:Surgery, Hilum (biology), Case Report, Metastasis, 03 medical and health sciences, 0302 clinical medicine, Medicine, Embolization, business.industry, lcsh:RD1-811, medicine.disease, Debulking, Primary tumor, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Surgery, Hyperthermic intraperitoneal chemotherapy, Radiology, business
Abstract

Introduction: Cholangiocarcinoma (CCA) is the second most common primary tumor of the liver, and the recurrence after hepatic resection (HR), the only curative therapy, is linked with a worse prognosis. Systemic chemotherapy (SC) and liver loco-regional treatments, like trans-arterial chemoembolization (TACE) or radio embolization (TARE), have been employed for the treatment of unresectable intrahepatic metastasis (IM) with benefit on overall survival (OS), but SC has a limited effect on peritoneal metastasis (PM). In the last years, novel treatments like electrochemotherapy (ECT) with bleomycine (BLM) for IM and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS and HIPEC) for PM have been applied in small series but with encouraging results. We hereby describe the first synchronous application of ECT and CRS and HIPEC for the treatment of a patient with IM and PM from CCA.Case Description: A 47-year-old male patient with CCA underwent HR followed by adjuvant SC. After 14 months, for the occurrence of IM, the patient underwent a second HR and SC. Nonetheless, a new recurrence occurred and a third attempt of HR was proposed. Due to the intraoperative finding of unresectable IM with PM, no resective procedure was performed and the patient was referred to our center. CRS and HIPEC with cisplatin and mitomycin for PM and ECT with BLM on a bulky metastasis of the hepatic hilum were performed after 38 months from the first HR. The length of hospital stay was 19 days. At the computed tomography (CT) performed 11 days after treatment complete necrosis of the treated IM was detected.Results: CT scan after 3 and 6 months and magnetic resonance after 9 months were performed. Necrosis of the treated IM nor PM but progression of the residual liver lesions was observed. After 3 months, the patient received SC and underwent TACE after 8 months and TARE after 9 months for the residual liver metastases. At 14 months from CRS and HIPEC, the patient is alive, in good condition, and with stability of the disease.Conclusions: The association of ECT and CRS and HIPEC could be safe and effective for the treatment of unresectable recurrent intrahepatic CCA with PM.

Published
2021

18. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

Author

Nicola De Angelis, Ciro Paolillo, Djamila Boerna, Kurinchi Selvan Gurusamy, Andrea Tufo, Ari Leppäniemi, Ronald V. Maier, Marcello Di Martino, Boris Sakakushev, Dieter G. Weber, Stefania Cimbanassi, Federico Coccolini, Luca Ansaloni, Belinda De Simone, Walter L. Biffl, Osvaldo Chiara, Imitaz Wani, Yoram Kluger, Paola Fugazzola, Elia Poiasina, Stefano Magnone, Michele Pisano, Jeffrey Leung, Fausto Catena, Ernest E. Moore, Fikri M. Abu-Zidan, Marco Ceresoli, Giuseppe Borzellino, Raul Coimbra, Gustavo Pereira Fraga, Niccolò Allievi, Massimo Sartelli, Andrew W. Kirkpatrick, Salomone Di Saverio, Alessandro Lucianetti, Pisano, M, Allievi, N, Gurusamy, K, Borzellino, G, Cimbanassi, S, Boerna, D, Coccolini, F, Tufo, A, Di Martino, M, Leung, J, Sartelli, M, Ceresoli, M, Maier, R, Poiasina, E, De Angelis, N, Magnone, S, Fugazzola, P, Paolillo, C, Coimbra, R, Di Saverio, S, De Simone, B, Weber, D, Sakakushev, B, Lucianetti, A, Kirkpatrick, A, Fraga, G, Wani, I, Biffl, W, Chiara, O, Abu-Zidan, F, Moore, E, Leppaniemi, A, Kluger, Y, Catena, F, and Ansaloni, L

Subjects
Population, Cholecystitis, Acute, lcsh:Surgery, Disease, Computer-assisted web interviewing, Review, 030230 surgery, Guideline, Guidelines, Acute cholecystiti, Scientific evidence, Early and delayed cholecystectomy, 03 medical and health sciences, 0302 clinical medicine, Acute cholecystitis, Early and delayed cholecystectomy, Surgery, Antibiotics, Gallbladder Drainage, Highrisk patients, Guidelines, Highrisk patients, Emergency surgery, Antibiotics, medicine, Calculus, High-risk patient, Humans, Cholecystectomy, education, Grading (education), Gallbladder Drainage, education.field_of_study, business.industry, Antibiotic, lcsh:Medical emergencies. Critical care. Intensive care. First aid, High-risk patients, lcsh:RD1-811, lcsh:RC86-88.9, Acute cholecystitis, Surgery, medicine.disease, Subtotal cholecystectomy, 3. Good health, Cholecystectomy, Laparoscopic, Emergency Medicine, Cholecystitis, Drainage, 030211 gastroenterology & hepatology, business
Abstract

BackgroundAcute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC.Materials and methodsThe WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (seehttps://www.gradeworkinggroup.org/). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached.ResultsThe pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal.Conclusions, knowledge gaps and research recommendationsELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.

Published
2020

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

Author

Stefano Rausei, Vincenzo Pappalardo, Marco Ceresoli, Fausto Catena, Massimo Sartelli, Massimo Chiarugi, Yoram Kluger, Andrew Kirkpatrick, Luca Ansaloni, Federico Coccolini, Giulia Montori, Fracensco Salvetti, Paola Fugazzola, Ionut Negoi, Monica Zese, Savino Occhionorelli, Sergei Shlyapnikov, 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, 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, Federico Lora, Ivan Sahderov, Boyko Atanasov, Sergio Zegarra, Luca Fattori, Rao Ivatury, Jimmy Xiao, Andrea Lippi, Mario Improta, Francesca Gubbiotti, Andrey Zharikov, Vincent Dubuisson, Michael Sugrue, Rausei, S, Pappalardo, V, Ceresoli, M, Catena, F, Sartelli, M, Chiarugi, M, Kluger, Y, Kirkpatrick, A, Ansaloni, L, Coccolini, F, Montori, G, Salvetti, F, Fugazzola, P, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, 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, 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, Lippi, A, Improta, M, Gubbiotti, F, Zharikov, A, Dubuisson, V, and Sugrue, M

Subjects
Male, medicine.medical_specialty, Sepsi, Peritonitis, NO, Sepsis, 03 medical and health sciences, Elderly, Intra-abdominal infection, Open abdomen management, Source control, 0302 clinical medicine, Postoperative Complications, Abdomen, Medicine, Humans, Prospective Studies, Registries, Open abdomen, Aged, Aged, 80 and over, Univariate analysis, business.industry, Potential risk, Age Factors, Mean age, General Medicine, medicine.disease, Surgery, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Observational study, Female, business, Cohort study
Abstract

Background Analyzing the data of the International Register of Open Abdomen (IROA), the feasibility of open abdomen treatment has been demonstrated at every age. This new analysis on the IROA database investigates the risk factors for mortality in elderly patients treated with open abdomen for intra-abdominal infection. Methods Data were derived from the IROA, a prospective observational international cohort study that enrolled patients treated with open abdomen worldwide. A univariate analysis of potential risk factors was performed. Inclusion criteria were patients older than 65 years and treated with open abdomen for intra-abdominal infection. End point was overall mortality, calculated within 30 days after open abdomen management, after 1-month and 1-year follow-up. Results A total of 116 patients was analyzed with mean age of 76 ± 7 years. Definitive closure was achieved in 93 patients (93/116, 80.2%) for a mean open abdomen duration of 5.0 ± 5.0 days. Complicated patients were 101 (101/116, 87.1%) for a total of 201 complications. Overall, 62 out of 116 patients (53.4%) died: 23 patients (23/62, 37.1%) during open abdomen management, 29 patients (46.8%) within 30 days after abdominal closure, 9 patients (14.5%) after 1-month follow-up, and 1 patient (1.6%) after 1-year follow-up. Age did not affect mortality (75 ± 6 years in alive patients versus 77 ± 7 years in dead patients, p = 0.773). Definitive abdominal closure was the most important factor to prevent mortality. Conclusions This study confirmed that age alone cannot be considered a determinant for death, even in elderly patients managed with open abdomen for severe intra-abdominal infection.

Published
2020

20. Risk Factors for Infections in Trauma Patients

Author

Emanuele Rausa, Massimo Sartelli, Marco Ceresoli, Giulia Montori, Federico Coccolini, Fausto Catena, Paola Fugazzola, Luca Ansaloni, Coccolini, F, Rausa, E, Montori, G, Fugazzola, P, Ceresoli, M, Sartelli, M, Catena, F, and Ansaloni, L

Subjects
medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Antibiotics, 030230 surgery, Trauma, Sepsis, 03 medical and health sciences, Nosocomial infection, 0302 clinical medicine, Health care, medicine, Risk of mortality, Infection control, Orthopedics and Sports Medicine, Intensive care medicine, Rehabilitation, business.industry, 030208 emergency & critical care medicine, Surgical infection, medicine.disease, Social function, Emergency medicine, Surgery, Functional status, business
Abstract

Purpose of Review: This review aims to investigate the pattern of factors, which contribute to trigger and/or aggravate nosocomial infections in trauma patients in order to better prevent and treat such complications in those frail patients. Recent Findings: Trauma-related deaths have a tri-modal distribution, the third spike is commonly defined as the “late deaths” occurring after days or weeks and is due to sepsis and multiple organ failure. Hospitalized trauma patients with at least a single infection have a higher risk of mortality. Infections lead to a worse functional status and, in elderly patients, lower scores in social function, vitality, emotional, and general health. In those patients, the need for health care services and costs grows. Infection prevention in trauma patients represents a fundamental factor in improving outcomes. Every effort in preventing and treating them should be done. Summary: The reduction of unnecessary invasive devices use and the close monitoring of the patient’s vital parameters are the cornerstones of prevention and treatment in order to promptly treat the infection before the progression toward systemic symptoms and sepsis. The knowledge of both the risk factors and the potential pathogens may help physicians in preventing both the nosocomial post-traumatic infections and the antibiotic overuse, which induces harmful drug resistances by selecting multidrug-resistant micro-organisms.

Published
2017
Full Text
View/download PDF

21. 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

22. The World Society of Emergency Surgery (WSES) spleen trauma classification: A useful tool in the management of splenic trauma

Author

Giulia Montori, Yoram Kluger, Savino Occhionorelli, Federico Coccolini, Stefano Maccatrozzo, Stefano Magnone, Fausto Catena, Luca Ansaloni, Lucia Morganti, Matteo Tomasoni, Marco Ceresoli, Gian Luca Baiocchi, Niccolò Allievi, Massimo Sartelli, Paola Fugazzola, Coccolini, F, Fugazzola, P, Morganti, L, Ceresoli, M, Magnone, S, Montori, G, Tomasoni, M, Maccatrozzo, S, Allievi, N, Occhionorelli, S, Kluger, Y, Sartelli, M, Baiocchi, G, Ansaloni, L, and Catena, F

Subjects
Male, medicine.medical_treatment, Classification, Non-operative management, Outcome, Practice, Quality, Spleen trauma, Surgery, Validation, Adolescent, Adult, Aged, Aged, 80 and over, Disease Management, Female, Humans, Injury Severity Score, Middle Aged, Prospective Studies, Risk Factors, Spleen, Splenectomy, Surgeons, Wounds and Injuries, 80 and over, Medicine, Disease management (health), Prospective cohort study, lcsh:Medical emergencies. Critical care. Intensive care. First aid, medicine.anatomical_structure, Emergency Medicine, Human, Research Article, medicine.medical_specialty, lcsh:Surgery, Blunt splenic trauma, NO, Surgeon, Risk factor, business.industry, General surgery, Risk Factor, lcsh:RD1-811, lcsh:RC86-88.9, medicine.disease, Prospective Studie, Observational study, business
Abstract

Background The World Society of Emergency Surgery (WSES) spleen trauma classification meets the need of an evolution of the current anatomical spleen injury scale considering both the anatomical lesions and their physiologic effect. The aim of the present study is to evaluate the efficacy and trustfulness of the WSES classification as a tool in the decision-making process during spleen trauma management. Methods Multicenter prospective observational study on adult patients with blunt splenic trauma managed between 2014 and 2016 in two Italian trauma centers (ASST Papa Giovanni XXIII in Bergamo and Sant’Anna University Hospital in Ferrara). Risk factors for operative management at the arrival of the patient and as a definitive treatment were analyzed. Moreover, the association between the different WSES grades of injury and the definitive management was analyzed. Results One hundred twenty-four patients were included. At multivariate analysis, a WSES splenic injury grade IV is a risk factor for the operative management both at the arrival of the patients and as a definitive treatment. WSES splenic injury grade III is a risk factor for angioembolization. Conclusions The WSES classification is a good and reliable tool in the decision-making process in splenic trauma management.

Published
2019

23. Suicidal fall from heights trauma: difficult management and poor results

Author

Dario Piazzalunga, Luca Ansaloni, Federico Coccolini, Stefano Magnone, Niccolò Allievi, Michele Pisano, Giulia Montori, Francesca Rubertà, Paola Fugazzola, Matteo Tomasoni, Marco Ceresoli, Piazzalunga, D, Rubertà, F, Fugazzola, P, Allievi, N, Ceresoli, M, Magnone, S, Pisano, M, Coccolini, F, Tomasoni, M, Montori, G, and Ansaloni, L

Subjects
Male, Multivariate analysis, Sports medicine, Fall from heights, Fallers, Jumpers, Suicidal fall from heights, Suicide, Poison control, Suicide, Attempted, Abdominal Injuries, Critical Care and Intensive Care Medicine, Suicide prevention, 0302 clinical medicine, Injury Severity Score, Medicine, Craniocerebral Trauma, Orthopedics and Sports Medicine, Hospital Mortality, Facial Injuries, 030222 orthopedics, education.field_of_study, Accidental Injuries, Mortality rate, Middle Aged, Intensive Care Units, Italy, Abbreviated Injury Scale, Emergency Medicine, Female, Adult, medicine.medical_specialty, Thoracic Injuries, Faller, Jumper, Population, 03 medical and health sciences, Age Distribution, Internal medicine, Injury prevention, Humans, Glasgow Coma Scale, Mortality, Sex Distribution, education, Aged, Retrospective Studies, business.industry, Suicidal fall from height, 030208 emergency & critical care medicine, Fall from height, Extremities, Length of Stay, Blood pressure, Case-Control Studies, Surgery, Accidental Falls, business, human activities
Abstract

Background: Self-inflicted injuries represent a consistent cause of trauma and falls from heights (FFH) represent a common dynamic used for suicidal attempts. The aim of the current report is to compare, among FFH patients, unintentional fallers and intentional jumpers in terms of demographical characteristics, clinical-pathological parameters and mortality, describing the population at risk for suicide by jumping and the particular patterns of injury of FFH patients. Materials and methods: The present study is a retrospective analysis of prospectively collected data regarding FFH patients, extracted from the Trauma Registry of the Papa Giovanni XXIII Hospital in Bergamo, Italy. Demographic characteristics, clinical-pathological parameters, patterns of injury, outcomes including mortality rates of jumpers and fallers were analyzed and compared. Results: The FFH trauma group included 299 patients between April 2014 and July 2016: 259 of them (86.6%) were fallers and 40 (13.4%) were jumpers. At multivariate analysis both young age (p = 0.01) and female sex (p < 0.001) were statistical significant risk factors for suicidal attempt with FFH. Systolic blood pressure (SBP) at the arrival was lower and ISS was higher in the self-inflicted injury group (SBP 133.35 ± 23.46 in fallers vs 109.89 ± 29.93 in jumpers, p < 0.001; ISS in fallers 12.61 ± 10.65 vs 18.88 ± 11.80 in jumpers, p = 0.001). Jumpers reported higher AIS score than fallers for injuries to: face (p = 0.023), abdomen (p < 0.001) and extremities (p = 0.004). The global percentage of patients who required advanced or definitive airway control was significantly higher in the jumper group (35.0% vs 16.2%, p = 0.005). In total, 75% of jumpers and the 34% of fallers received surgical intervention (p < 0.001). A higher number of jumpers needed ICU admission, as compared to fallers (57.5% vs 23.6%, p < 0.001); jumpers showed longer total length of stay (26.00 ± 24.34 vs 14.89 ± 13.04, p = 0.007) and higher early mortality than fallers (7.5% vs 1.2%, p = 0.008). Conclusions: In Northern Italy, the population at highest risk of suicide by jumping and requiring Trauma Team activation is greatly composed by middle-aged women. Furthermore, FFH is the most common suicidal method. Jumpers show tendency to “feet-first landing” and seem to have more severe injuries, worse outcome and a higher early mortality rate, as compared to fallers. The Trauma Registry can be a useful tool to describe clusters of patients at high risk for suicidal attempts and to plan preventive and clinical actions, with the aim of optimizing hospital care for FFH trauma patients.

Published
2019

24. Never put equipoise in appendix! Final results of ASAA (antibiotics vs. surgery for uncomplicated acute appendicitis in adults) randomized controlled trial

Author

Niccolò Allievi, Luca Ansaloni, Paola Fugazzola, Michele Pisano, Federico Coccolini, Marco Ceresoli, Giulia Montori, Elia Poiasina, Ceresoli, M, Pisano, M, Allievi, N, Poiasina, E, Coccolini, F, Montori, G, Fugazzola, P, and Ansaloni, L

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, medicine.drug_class, Antibiotics, Uncomplicated acute appendicitis, law.invention, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Randomized controlled trial, law, Recurrence, Antibiotic therapy, Anti-Bacterial Agent, medicine, Humans, Appendectomy, Appendiciti, Surgical emergency, Equipoise, Aged, Acute appendicitis, business.industry, Antibiotic, Middle Aged, Appendicitis, Conservative treatment, Randomized trial, Appendix, Anti-Bacterial Agents, Surgery, medicine.anatomical_structure, Treatment Outcome, 030220 oncology & carcinogenesis, Acute Disease, Etiology, 030211 gastroenterology & hepatology, Female, Acute appendiciti, business, Uncomplicated acute appendiciti, Human
Abstract

Acute appendicitis is the most common surgical emergency; however, its etiology and diagnosis are still discussed with a considerable proportion of wrong diagnosis resulting in appendectomies for non inflamed appendix. Moreover, the biologic function of the appendix is still unclear. For uncomplicated acute appendicitis the conservative treatment with antibiotics has been proposed with interesting results. The aim of this study was to compare surgical treatment vs. antibiotics in uncomplicated acute appendicitis. This is a monocentric randomized controlled trial comparing surgery with antibiotic therapy in adults with uncomplicated acute appendicitis. The primary outcome was the success rate (resolution of symptoms within 2weeks and no need for further treatments); secondary outcomes were complication rate; negative appendectomy rate (only in surgical arm); and long-term outcomes within a year as recurrence. The study was designed as a non-inferiority trial. From September 2011 to December 2014, 224 patients fulfilled the eligibility criteria and 45 patients were randomized. Twenty four patients (53.3%) were randomly assigned to surgery and 21 (46.6%) to antibiotic therapy. In surgical group primary outcome was reached for all the patients; secondary negative outcomes were recorded in five patients (22.7%): two cases of negative appendectomies, three wound infections. In antibiotics group treatment fails in 16.8% of cases; secondary negative outcomes were recorded in one patient who experienced relapse of AA at 30days No further events or complications were observed at 1-year follow-up. Due to the poor patients’ accrual the study had no enough statistical power to demonstrate the non-inferiority of conservative treatment and results were inconclusive. Due to the poor patient’s accrual rate the study failed to demonstrate the non-inferiority of conservative treatment in uncomplicated acute appendicitis. On the other hand the study demonstrates the difficulty in performing randomized trials in emergency surgery and focus on the ethical aspects.

Published
2019

25. Routine prophylactic ureteral stenting before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Safety and usefulness from a single-center experience

Author

Federico Coccolini, Maria Grazia Sibilla, Paola Fugazzola, Giulia Montori, Enrico Cicuttin, Mario Improta, Michele Pisano, Francesca Gubbiotti, Matteo Tomasoni, Luca Ansaloni, Marco Ceresoli, Andrea Lippi, Fugazzola, P, Coccolini, F, Tomasoni, M, Cicuttin, E, Sibilla, M, Gubbiotti, F, Lippi, A, Improta, M, Montori, G, Ceresoli, M, Pisano, M, and Ansaloni, L

Subjects
General Urology, medicine.medical_specialty, HIPEC, Hydronephrosi, business.industry, Urinary system, Renal function, Hydronephrosis, Cytoreductive surgery, Peritoneal carcinomatosis, Prophylactic ureteral stenting, urologic and male genital diseases, medicine.disease, Single Center, Surgery, Sepsis, Peritoneal carcinomatosi, Peritonectomy, medicine, Rifle, Hyperthermic intraperitoneal chemotherapy, business
Abstract

Objective There are very few evidences about safety and usefulness of routine prophylactic ureteral stenting (PUS) before cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Material and methods An analysis of prospectively collected data about patients who underwent CRS and HIPEC for different sites of primary disease was carried out focusing on ureteral complications. Results A total of 138 patients who underwent CRS and HIPEC between December 2010 and June 2017 were considered. All patients underwent PUS before CRS and HIPEC. Of them, 91 (66.4%) patients received pelvic peritonectomy, 49 (35.8%) pelvic lymphadenectomy, 31 (22.6%) left hemicolectomy, 44 (32.4%) right hemicolectomy, 46 (33.6%) rectal resection, 56 (40.9%) hysteroannessiectomy, and 39 (28.5%) appendectomy. There was one (0.7%) postoperative ureteral fistula. The cumulative risk of ureteral stent-related major complications was 4.3% (two patients (1.4%) had protracted gross hematuria, two patients (1.4%) had urinary sepsis, and three patients (2.9%) developed hydronephrosis after a period from removing ureteral stents and required restenting. Morbidity due to ureteral stenting was associated with a longer length of stay (LOS) (p=0.053). A total of 52 patients (44.1%) developed renal dysfunction according to the RIFLE (Risk, Injury, Failure, Loss of kidney function, End-stage kidney-disease) criteria: 19.5% were in risk class, 10.2% in acute renal injury class, and 14.4% in acute renal failure class. Conclusion PUS could be a useful tool for reducing iatrogenic ureteral injury, but it is associated with a non-negligible morbidity, which implies longer LOS. A more accurate patient selection for PUS is necessary.

Published
2019

26. Kidney and uro-trauma: WSES-AAST guidelines

Author

Niccolò Allievi, Alain Chicom Mefire, Fernando Machado, A. Pikoulis, Tomasoni M, Giulia Montori, Emmanouil Pikoulis, Raul Coimbra, Fracensco Salvetti, Andreas Hecker, Gustavo Pereira Fraga, C. A. Gomez, Vladimir Khokha, Andrew B. Peitzman, Bruno M. Pereira, Imtiaz Wani, I. Di Carlo, Neil Parry, E. Picariello, Marco Ceresoli, M Chirica, R. Ten-Broek, Yoram Kluger, Viktor Reva, Fausto Catena, Goran Augustin, Federico Coccolini, W.L. Biffl, Dieter G. Weber, Oreste Romeo, Joseph M. Galante, Hany Bahouth, Ofir Ben-Ishay, M. Bala, Lena M. Napolitano, P. Fugazzola, Massimo Chiarugi, Carlos A. Ordoñez, Stefania Cimbanassi, Sandro Rizoli, Ernest E. Moore, Ari Leppäniemi, Matti Tolonen, Rao R Ivatury, V. Manchev, Osvaldo Chiara, Leonardo Solaini, M. Stommel, Tal M. Hörer, Nicola de’Angelis, Yosuke Matsumura, Paula Ferrada, P. Perfetti, M. Larrea, Luca Ansaloni, Fikri M. Abu-Zidan, Megan Brenner, Andrew W. Kirkpatrick, Antonio Tarasconi, Catherine Arvieux, J. Matsumoto, Fernando J. Kim, Ron Maier, M. Rajashekar, R. Bertelli, Boris Sakakushev, Massimo Sartelli, J. Bado, Gian Luca Baiocchi, Edward C.T.H. Tan, Coccolini, F, Moore, E, Kluger, Y, Biffl, W, Leppaniemi, A, Matsumura, Y, Kim, F, Peitzman, A, Fraga, G, Sartelli, M, Ansaloni, L, Augustin, G, Kirkpatrick, A, Abu-Zidan, F, Wani, I, Weber, D, Pikoulis, E, Larrea, M, Arvieux, C, Manchev, V, Reva, V, Coimbra, R, Khokha, V, Mefire, A, Ordonez, C, Chiarugi, M, Machado, F, Sakakushev, B, Matsumoto, J, Maier, R, Di Carlo, I, Catena, F, Fugazzola, P, Stommel, M, Rajashekar, M, Tan, E, Tolonen, M, Ceresoli, M, Gomez, C, Allievi, N, Chirica, M, Salvetti, F, Bertelli, R, Ben-Ishay, O, Bahouth, H, Baiocchi, G, Tarasconi, A, Cimbanassi, S, Chiara, O, Ten-Broek, R, Montori, G, Picariello, E, Solaini, L, Hecker, A, Tomasoni, M, Perfetti, P, Parry, N, Deangelis, N, Pereira, B, Bado, J, Romeo, O, Pikoulis, A, Bala, M, Napolitano, L, Galante, J, Rizoli, S, Ferrada, P, Horer, T, Brenner, M, Ivatury, R, and Federico Coccolini, Ernest E. Moore, Yoram Kluger, Walter Biffl, Ari Leppaniemi, Yosuke Matsumura, Fernando Kim, Andrew B. Peitzman, Gustavo P. Fraga, Massimo Sartelli, Luca Ansaloni, Goran Augustin, Andrew Kirkpatrick, Fikri Abu-Zidan, Imitiaz Wani, Dieter Weber, Emmanouil Pikoulis, Martha Larrea, Catherine Arvieux, Vassil Manchev, Viktor Reva, Raul Coimbra, Vladimir Khokha, Alain Chichom Mefire, Carlos Ordonez, Massimo Chiarugi, Fernando Machado, Boris Sakakushev, Junichi Matsumoto, Ron Maier, Isidoro di Carlo, Fausto Catena, WSES-AAST Expert Panel, Leonardo Solaini

Subjects
Stenting, medicine.medical_treatment, 030232 urology & nephrology, Review, Guideline, Kidney, Adult, Bladder, Classification, Conservative, Embolization, Endovascular trauma management, Flow chart, Guidelines, Non-operative, Operative, Pediatric, Surgery, Trauma, Ureter, Urethra, Urogenital, Urological, Injury Severity Score, 0302 clinical medicine, Urinary Tract, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Acute Kidney Injury, 3. Good health, medicine.anatomical_structure, Emergency Medicine, Pelvic fracture, Human, medicine.medical_specialty, lcsh:Surgery, Guidelines as Topic, 03 medical and health sciences, medicine, Humans, Hemodynamic, business.industry, Genitourinary system, General surgery, Gold standard, Hemodynamics, 030208 emergency & critical care medicine, lcsh:RD1-811, lcsh:RC86-88.9, medicine.disease, Review article, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Abdominal trauma, General Surgery, Triage, business
Abstract

Contains fulltext : 215819.pdf (Publisher’s version ) (Open Access) Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.

Published
2019

27. The open abdomen in trauma and non-trauma patients: WSES guidelines

Author

Osvaldo Chiara, Matteo Tomasoni, Peter T. Masiakos, Marco Ceresoli, Tino Martino Valetti, Viktor Reva, Kaoru Kike, Mircea Chirica, Fausto Catena, Stefania Cimbanassi, Lena M. Napolitano, Gustavo Pereira Fraga, Carlos A. Ordoñez, Yuan Kuo-Ching, Ingo Martzi, Federico Coccolini, Marc de Moya, Emiliano Gamberini, Walter L. Biffl, Zaza Demetrashvili, Kenneth D. Boffard, Paola Fugazzola, Martha Larrea, Andrew B. Peitzman, Nicola de’Angelis, Ernest E. Moore, Giulia Montori, Miklosh Bala, Paula Ferrada, Neil Parry, Zsolt J. Balogh, Manu L N G Malbrain, Matti Tolonen, Catherine Arvieux, Yoram Kluger, Fikri M. Abu-Zidan, Salomone Di Saverio, Luca Ansaloni, Alain Chichom Mefire, Carlos Augusto Gomes, Vanni Agnoletti, Francesco Salvetti, Dieter G. Weber, Rifat Latifi, Massimo Sartelli, Camilla Bing, Philippe Montravers, R. V. Maier, Jeffry L. Kashuk, Rita Maria Melotti, Raul Coimbra, Joseph M. Galante, Kenji Inaba, Tal M. Hörer, Belinda De Simone, Andreas Hecker, Sandro Rizoli, Rao R. Ivatury, Juan Alberto Martinez Hernandez, Michael Sugrue, Thomas M. Scalea, Noel Naidoo, Heng Fu Lin, Ari Leppäniemi, Kjetil Søreide, Andrew W. Kirkpatrick, George C. Velmahos, Vladimir Khokha, Bruno M. Pereira, Imtiaz Wani, Derek J. Roberts, Boris Sakakushev, Tarek Razek, Lauri Handolin, Coccolini, F, Roberts, D, Ansaloni, L, Ivatury, R, Gamberini, E, Kluger, Y, Moore, E, Coimbra, R, Kirkpatrick, A, Pereira, B, Montori, G, Ceresoli, M, Abu-Zidan, F, Sartelli, M, Velmahos, G, Fraga, G, Leppaniemi, A, Tolonen, M, Galante, J, Razek, T, Maier, R, Bala, M, Sakakushev, B, Khokha, V, Malbrain, M, Agnoletti, V, Peitzman, A, Demetrashvili, Z, Sugrue, M, Di Saverio, S, Martzi, I, Soreide, K, Biffl, W, Ferrada, P, Parry, N, Montravers, P, Melotti, R, Salvetti, F, Valetti, T, Scalea, T, Chiara, O, Cimbanassi, S, Kashuk, J, Larrea, M, Hernandez, J, Lin, H, Chirica, M, Arvieux, C, Bing, C, Horer, T, De Simone, B, Masiakos, P, Reva, V, Deangelis, N, Kike, K, Balogh, Z, Fugazzola, P, Tomasoni, M, Latifi, R, Naidoo, N, Weber, D, Handolin, L, Inaba, K, Hecker, A, Kuo-Ching, Y, Ordonez, C, Rizoli, S, Gomes, C, De Moya, M, Wani, I, Mefire, A, Boffard, K, Napolitano, L, Catena, F, Coccolini, Federico, Roberts, Derek, Ansaloni, Luca, Ivatury, Rao, Gamberini, Emiliano, Kluger, Yoram, Moore, Ernest E., Coimbra, Raul, Kirkpatrick, Andrew W., Pereira, Bruno M., Montori, Giulia, Ceresoli, Marco, Abu-Zidan, Fikri M., Sartelli, Massimo, Velmahos, George, Fraga, Gustavo Pereira, Leppaniemi, Ari, Tolonen, Matti, Galante, Joseph, Razek, Tarek, Maier, Ron, Bala, Miklosh, Sakakushev, Bori, Khokha, Vladimir, Malbrain, Manu, Agnoletti, Vanni, Peitzman, Andrew, Demetrashvili, Zaza, Sugrue, Michael, Di Saverio, Salomone, Martzi, Ingo, Soreide, Kjetil, Biffl, Walter, Ferrada, Paula, Parry, Neil, Montravers, Philippe, Melotti, Rita Maria, Salvetti, Francesco, Valetti, Tino M., Scalea, Thoma, Chiara, Osvaldo, Cimbanassi, Stefania, Kashuk, Jeffry L., Larrea, Martha, Hernandez, Juan Alberto Martinez, Lin, Heng-Fu, Chirica, Mircea, Arvieux, Catherine, Bing, Camilla, Horer, Tal, De Simone, Belinda, Masiakos, Peter, Reva, Viktor, DeAngelis, Nicola, Kike, Kaoru, Balogh, Zsolt J., Fugazzola, Paola, Tomasoni, Matteo, Latifi, Rifat, Naidoo, Noel, Weber, Dieter, Handolin, Lauri, Inaba, Kenji, Hecker, Andrea, Kuo-Ching, Yuan, Ordoñez, Carlos A., Rizoli, Sandro, Gomes, Carlos Augusto, De Moya, Marc, Wani, Imtiaz, Mefire, Alain Chichom, Boffard, Ken, Napolitano, Lena, Catena, Fausto, Supporting clinical sciences, Intensive Care, II kirurgian klinikka, Clinicum, Department of Surgery, I kirurgian klinikka (Töölö), HUS Abdominal Center, and HUS Musculoskeletal and Plastic Surgery

Subjects
Fistula, Abdominal Wound Closure Techniques, Abdominal compartment syndrome, medicine.medical_treatment, SEVERE ACUTE-PANCREATITIS, Review, Guideline, 030230 surgery, Cardiovascular, Abdominal wall, Postoperative Complications, 0302 clinical medicine, ACELLULAR DERMAL MATRIX, Laparotomy, Abdomen, Open abdomen, NEGATIVE-PRESSURE THERAPY, Medicine(all), DAMAGE CONTROL SURGERY, Peritoniti, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Abdominal Wound Closure Technique, Abdominal Cavity, VENTRAL HERNIA REPAIR, Prophylactic Surgical Procedures, 3. Good health, Vascular emergencie, medicine.anatomical_structure, Emergency Medicine, Technique, Re-exploration, ABDOMINAL COMPARTMENT SYNDROME, Intra-Abdominal Hypertension, ACUTE MESENTERIC ISCHEMIA, Human, medicine.medical_specialty, Physical Injury - Accidents and Adverse Effects, Closure, Resuscitation, PRIMARY FASCIAL CLOSURE, lcsh:Surgery, Non-trauma, Peritonitis, Guidelines as Topic, Reintervention, Guidelines, Trauma, Prophylactic Surgical Procedure, 03 medical and health sciences, LONG-TERM COMPLICATIONS, Intra-abdominal infection, Rare Diseases, Clinical Research, medicine, Humans, ddc:610, Timing, Intensive care medicine, Nutrition, Mesh, Pancreatiti, Laparostomy, business.industry, Synthetic, Vascular emergencies, 030208 emergency & critical care medicine, lcsh:RD1-811, lcsh:RC86-88.9, 3126 Surgery, anesthesiology, intensive care, radiology, Biological, medicine.disease, Pancreatitis, Negative-Pressure Wound Therapy, RANDOMIZED-CONTROLLED-TRIAL, Surgery, Postoperative Complication, business
Abstract

Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a "planned second-look" laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.

Published
2018
Full Text
View/download PDF

28. The need for red blood cell transfusions in the emergency department as a risk factor for failure of non-operative management of splenic trauma: a multicenter prospective study

Author

Giulia Montori, Federico Coccolini, Luca Ansaloni, Lucia Morganti, Matteo Tomasoni, Savino Occhionorelli, Marco Ceresoli, Stefano Magnone, Dario Piazzalunga, Stefano Maccatrozzo, Paola Fugazzola, Niccolò Allievi, Fugazzola, P, Morganti, L, Coccolini, F, Magnone, S, Montori, G, Ceresoli, M, Tomasoni, M, Piazzalunga, D, Maccatrozzo, S, Allievi, N, Occhionorelli, S, and Ansaloni, L

Subjects
Male, Non-operative management, Hemodynamics, Abdominal Injuries, Conservative Treatment, Wounds, Nonpenetrating, Critical Care and Intensive Care Medicine, Non-operative management failure, Spleen trauma, Trauma care, Injury Severity Score, 0302 clinical medicine, Risk Factors, Shock, Traumatic, Orthopedics and Sports Medicine, Prospective Studies, Treatment Failure, Prospective cohort study, Aged, 80 and over, 030222 orthopedics, Univariate analysis, Middle Aged, Embolization, Therapeutic, Italy, Splenectomy, Emergency Medicine, Female, Emergency Service, Hospital, Erythrocyte Transfusion, Adult, medicine.medical_specialty, Adolescent, Blunt splenic trauma, NO, Young Adult, 03 medical and health sciences, medicine, Humans, Risk factor, Contraindication, Aged, business.industry, 030208 emergency & critical care medicine, Emergency department, medicine.disease, Hemostasis, Surgical, Emergency medicine, Surgery, Observational study, business, Spleen
Abstract

Introduction: The majority of patients with splenic trauma undergo non-operative management (NOM); around 15% of these cases fail NOM and require surgery. The aim of the current study is to assess whether the hemodynamic status of the patient represents a risk factor for failure of NOM (fNOM) and if this may be considered a relevant factor in the decision-making process, especially in Centers where AE (angioembolization), intensive monitoring and 24-h-operating room are not available. Furthermore, the presence of additional risk factors for fNOM was investigated. Materials and methods: This is a multicentre prospective observational study, including patients presenting with blunt splenic trauma older than 17 years, managed between 2014 and 2016 in two Italian trauma centres (ASST Papa Giovanni XXIII in Bergamo and Sant’Anna University Hospital in Ferrara—Italy). The risk factors for fNOM were analyzed with univariate and multivariate analyses. Results: In total, 124 patients were included in the study. In univariate analysis, the risk factors for fNOM were AAST grade > 3 (fNOM 37.5% vs 9.1%, p = 0.024), and the need of red blood cell (RBC) transfusion in the emergency department (ED) (fNOM 42.9% vs 8.9%, p = 0.011). Multivariate analysis showed that the only significant risk factor for fNOM was the need for RBC transfusion in the ED (p = 0.049). Conclusions: The current study confirms the contraindication to NOM in case of hemodynamically instability in case of splenic trauma, as indicated by the most recent guidelines; attention should be paid to patients with transient hemodynamic stability, including patients who require transfusion of RBC in the ED. These patients could benefit from AE; in centers where AE, intensive monitoring and an 24-h-operating room are not available, this particular subgroup of patients should probably be treated with operative management.

Published
2018

29. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in ovarian and gastrointestinal peritoneal carcinomatosis: Results from a 7-year experience

Author

Giulia Montori, Luigi Frigerio, Michele Colledan, Stefano Raimondo, Domenico Pinelli, Matteo Tomasoni, Carolina Rubicondo, Luca Ansaloni, Marco Ceresoli, Federico Coccolini, Paola Fugazzola, Montori, G, Coccolini, F, Fugazzola, P, Ceresoli, M, Tomasoni, M, Rubicondo, C, Raimondo, S, Pinelli, D, Colledan, M, Frigerio, L, and Ansaloni, L

Subjects
0301 basic medicine, Hyperthermic intraperitoneal chemotherapy (HIPEC), medicine.medical_specialty, Colorectal cancer, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Appendiceal cancer (AC), Cytoreductive surgery (CRS), Gastric cancer (GC), Others tumors, Ovarian cancer (OC), Peritoneal carcinosis (PC), Others tumor, business.industry, Mortality rate, Cancer, Common Terminology Criteria for Adverse Events, Perioperative, medicine.disease, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, Hyperthermic intraperitoneal chemotherapy, Original Article, business, Ovarian cancer, Cytoreductive surgery
Abstract

Background: An increasing promising evidence and increasing long-term oncologic outcomes support the use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) as locoregional treatment for peritoneal carcinosis (PC) especially from ovarian and gastrointestinal tumors, but also for others cancers. Methods: A prospective monocentric study was performed in Papa Giovanni XXIII Hospital, Bergamo (Italy). Patients and tumor characteristics were analyzed. Overall survival (OS), disease free survival (DFS) and morbidity were analyzed with Kaplan-Meier curves and log-rank testing. Results: A total of 150 patients undergone CRS + HIPEC were analyzed from January 2011 to June 2017. The principal origins of PC were: gastric cancer (GC) (n=40), colon cancer (n=31), appendiceal cancer (AC) (n=18), ovarian cancer (OC) (n=49), others (n=12). Major morbidity [≥3 Common Terminology Criteria for Adverse Events (CTCAE)] and perioperative mortality rates were 38% and 2.7% respectively. Re-operation rate was 15.3%. Median OS is 9, 35, 47, 51, 82 months (29% 3-year OS; 27% 5-year OS; 48% 5-year OS; 40% 5-year OS; 67% 5-year OS respectively) in GC, colorectal cancer (CRC), OC, others tumors and AC respectively. Median DFS is 4, 14, 17, 19, 82 months (32% 3-year DFS; 22% 5-year DFS; 29% 5-year DFS; 11% 5-year DFS; 67% 5-year DFS respectively) in GC, CRC, others tumors, OC and AC respectively. Conclusions: A therapeutic approach that combined CRS + HIPEC could achieve long-term survival in selected groups of patients with PC from gastrointestinal, gynecological and others tumors with acceptable morbidity and mortality. A good expertise and a high volume of patients are necessary to manage PC and to further improve results.

Published
2018

30. Long-term oncologic outcomes of stent as a bridge to surgery versus emergency surgery in malignant left side colonic obstructions: A meta-analysis

Author

Luca Ansaloni, Fausto Catena, Marco Ceresoli, Michele Pisano, Niccolò Allievi, Massimo Sartelli, Giulia Montori, Federico Coccolini, Paola Fugazzola, Ceresoli, M, Allievi, N, Coccolini, F, Montori, G, Fugazzola, P, Pisano, M, Sartelli, M, Catena, F, and Ansaloni, L

Subjects
medicine.medical_specialty, medicine.medical_treatment, 030230 surgery, Colonic obstruction, Colonic stent, Emergency surgery (ES), Long-term outcomes, 03 medical and health sciences, 0302 clinical medicine, Emergency surgery, medicine, Bridge to surgery, business.industry, Gastroenterology, Stent, Long-term outcome, Confidence interval, Surgery, Oncology, 030220 oncology & carcinogenesis, Meta-analysis, Relative risk, Original Article, Observational study, business
Abstract

Background: The placement of a metallic stent as a bridge to surgery (SBTS) could represents an option for the treatment of left-sided malignant colonic obstruction in centres with adequate skills. Several meta-analyses demonstrated better short-term outcomes after SBTS when compared with emergency surgery (ES); however, some studies reported a higher local recurrence rate. The aim of the present review is to investigate the long-term outcomes of stent bridge to surgery as compared to ES. Methods: A systematic review was performed to retrieve studies comparing long-term oncologic outcomes of SBTS and ES. Local and overall recurrence rate, overall and disease-free survival were retrieved and results were expressed as risk ratios. Results: Seventeen studies and a total of 1,333 patients were included in the analysis. No significant differences were reported in recurrence rate [risk ratio (RR) =1.11; 95% confidence interval (95% CI): 0.84–1.47, P=0.47], 3-year mortality (RR =0.90; 95% CI: 0.73–1.12, P=0.34) and 5-year mortality (RR =1.00; 95% CI: 0.82–1.22, P=0.99). There were no differences among randomized and observational studies. Conclusions: SBTS has similar long-term oncologic outcomes to ES and in centres with appropriate skill should be considered the best treatment option for left-sided malignant colonic obstructions.

Published
2017

31. IROA: International Register of Open Abdomen, preliminary results

Author

Arda Isik, Luca Ansaloni, Tugan Tezcaner, Fausto Catena, Rao R. Ivatury, Federico Coccolini, András Vereczkei, Giulia Montori, Guillermo Perez Chagerben, Francesco Salvetti, Fernando Hernández, Sergei Shlyapnikov, Torsten Kaussen, Mahir Gachabayov, Kuo-Ching Yuan, Boris Sakakushev, Francesco Trotta, Martha Quiodettis, Paola Fugazzola, Zaza Demetrashvili, Rafael L. Curado, Stefano Rausei, Christian Galatioto, Marco Ceresoli, Athanasios Marinis, Ionut Negoi, Desmond Khor, Dimitrios Damaskos, Yovcho Yovtchev, Sefa Ozyazici, Giovanni Bellanova, Aleix Martínez-Pérez, Massimo Chiarugi, Monica Zese, Gianluca Costa, Giuseppe Novelli, Michael Sugrue, Davide Corbella, Miguel Leon Arellano, Gustavo Pereira Fraga, Ohad Guetta, Stefano Costa, Bruno M. Pereira, Demetrios Demetriades, Asri Che Jusoh, Savino Occhionorelli, Orestis Ioannidis, Daniele Dondossola, Wagih Ghannam, Miklosh Bala, Wellington Fernandes, Kenji Inaba, Vinicius Cordeiro Fonseca, Agron Dogjani, Sandeep Singh, Stefano Maccatrozzo, Massimo Sartelli, Mirco Nacoti, 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, 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, and Ansaloni, L

Subjects
Male, Internationality, Fistula, Kaplan-Meier Estimate, 030230 surgery, Barker, Cohort Studies, 0302 clinical medicine, Ischemia, Abdomen, Epidemiology, Prospective Studies, Registries, Bogotà bag, Commercial, Compartment, IROA, Negative pressure, Non-commercial, Open abdomen, Peritonitis, Register, Skin, Trauma, Vascular emergencies, Witmann, Child, Digestive System Surgical Procedures, Peritoniti, Abdominal Wound Closure Techniques, Middle Aged, Bogota bag, Vascular emergencie, Child, Preschool, 030220 oncology & carcinogenesis, Emergency Medicine, Female, Erratum, Cohort study, Adult, medicine.medical_specialty, NO, 03 medical and health sciences, Emergency surgery, medicine, Humans, Aged, Adult patients, business.industry, medicine.disease, Surgery, Wounds and Injuries, Pancreatitis, business
Abstract

Background: No definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA). Methods: A prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers (R)) through a dedicated website: www.clinicalregisters.org. Results: Four hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39 +/- 18.37; 56% male; Mean BMI: 36 +/- 5.6. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%), Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(+/- 4.83) days; Mean number of dressing changes: 0.88(+/- 0.88). After-closure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p

Published
2017

32. Endoscopic Stenting as Bridge to Surgery versus Emergency Resection for Left-Sided Malignant Colorectal Obstruction: An Updated Meta-Analysis

Author

Niccolò Allievi, Luca Ansaloni, Federico Coccolini, P. Fugazzola, Marco Ceresoli, Giulia Montori, Allievi, N, Ceresoli, M, Fugazzola, P, Montori, G, Coccolini, F, and Ansaloni, L

Subjects
medicine.medical_specialty, medicine.medical_treatment, Review Article, Colectomy, Colorectal Neoplasms, Emergencies, Endoscopy, Digestive System, Humans, Intestinal Obstruction, Prosthesis Implantation, Randomized Controlled Trials as Topic, Stents, lcsh:RC254-282, law.invention, Stoma, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, medicine, Endoscopic stenting, colonic obstruction, medicine.diagnostic_test, business.industry, General surgery, Mortality rate, Postoperative complication, Stent, Endoscopy, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Surgery, Oncology, 030220 oncology & carcinogenesis, SEMS, 030211 gastroenterology & hepatology, business, Digestive System
Abstract

Introduction. Emergency resection represents the traditional treatment for left-sided malignant obstruction. However, the placement of self-expanding metallic stents and delayed surgery has been proposed as an alternative approach. The aim of the current meta-analysis was to review the available evidence, with particular interest for the short-term outcomes, including a recent multicentre RCT. Methods. We considered randomized controlled trials comparing stenting as a bridge to surgery and emergency surgery for the management of left-sided malignant large bowel obstruction, performing a systematic review in MEDLINE, PubMed database, and the Cochrane libraries. Results. We initially identified a total of 2543 studies. After the elimination of duplicates and the screening of titles and abstracts, seven studies, for a total of 448 patients, were considered. The current meta-analysis revealed no difference in the mortality rate between the stent group and the emergency surgery group; the postoperative complication rate (37.84% versus 54.87%, P=0.02), the stoma rate (28.8% versus 46.02%, P<0.0001), and the incidence of wound infection (8.11% versus 15.49%, P=0.01) were reduced after stent as a bridge to surgery. Conclusion. Colonic stenting as a bridge to surgery appears to be a safe approach to malignant large bowel obstruction. Possible advantages of this treatment can be identified in a reduced incidence of postoperative complications and a lower stoma rate. Further RCTs considering long-term outcomes and cost-effectiveness analysis are needed.

Published
2017

33. Splenic trauma: WSES classification and guidelines for adult and pediatric patients

Author

Sandro Rizoli, Vladimir Khokha, Andrew B. Peitzman, Luca Ansaloni, Giulia Montori, Emiliano Gamberini, Paola Fugazzola, Catherine Arvieux, Rao R. Ivatury, Frederick A. Moore, Bruno M. Pereira, Francesco Salvetti, Carlos Augusto Gomes, Joseph M. Galante, Fausto Catena, Matteo Tomasoni, Neil Parry, Hany Bahouth, Kenji Inaba, Tal M. Hörer, Michele Pisano, Yoram Kluger, Camilla Bing, Noel Naidoo, David Costa Navarro, Viktor Reva, Marco Ceresoli, Federico Coccolini, Ronald V. Maier, Paula Ferrada, Boris Sakakushev, Richard P. G. ten Broek, Joseph Kashuk, Simone Vasilij Benatti, Osvaldo Chiara, Ingo Marzi, Andrea Celotti, Kjetil Søreide, Yashuiro Otomo, Lauri Handolin, Ernest E. Moore, Andrew W. Kirkpatrick, Peter T. Masiakos, Antonio Costanzo, Leonardo Solaini, Ari Leppäniemi, Raul Coimbra, Massimo Sartelli, Dieter G. Weber, Rifat Latifi, Gustavo Pereira Fraga, Fikri M. Abu-Zidan, Stefania Cimbanassi, Alain Chichom Mefire, David A. Spain, Marc de Moya, Liban Wehlie, Vanni Agnoletti, Walter L. Biffl, George C. Velmahos, Miklosh Bala, Stefano Maccatrozzo, Salomone Di Saverio, Lena M. Napolitano, Kimberly A. Davis, Nicola De Angelis, Stefano Magnone, Konstantinos S. Mylonas, Coccolini, F, Montori, G, Catena, F, Kluger, Y, Biffl, W, Moore, E, Reva, V, Bing, C, Bala, M, Fugazzola, P, Bahouth, H, Marzi, I, Velmahos, G, Ivatury, R, Soreide, K, Horer, T, ten Broek, R, Pereira, B, Fraga, G, Inaba, K, Kashuk, J, Parry, N, Masiakos, P, Mylonas, K, Kirkpatrick, A, Abu-Zidan, F, Gomes, C, Benatti, S, Naidoo, N, Salvetti, F, Maccatrozzo, S, Agnoletti, V, Gamberini, E, Solaini, L, Costanzo, A, Celotti, A, Tomasoni, M, Khokha, V, Arvieux, C, Napolitano, L, Handolin, L, Pisano, M, Magnone, S, Spain, D, de Moya, M, Davis, K, De Angelis, N, Leppaniemi, A, Ferrada, P, Latifi, R, Navarro, D, Otomo, Y, Coimbra, R, Maier, R, Moore, F, Rizoli, S, Sakakushev, B, Galante, J, Chiara, O, Cimbanassi, S, Mefire, A, Weber, D, Ceresoli, M, Peitzman, A, Wehlie, L, Sartelli, M, Di Saverio, S, Ansaloni, L, and DIPARTIMENTO DI SCIENZE MEDICHE E CHIRURGICHE

Subjects
Adult, medicine.medical_specialty, Splenic trauma, medicine.medical_treatment, lcsh:Surgery, Classification, Conservative, Embolization, Guidelines, Non-operative, Pediatric, Spleen, Surgery, Trauma, Abdominal Injuries, Conservative Treatment, Hemodynamics, Humans, Wounds and Injuries, Guidelines as Topic, Computed tomography, Review, Guideline, Blunt splenic trauma, 03 medical and health sciences, 0302 clinical medicine, Emergency surgery, medicine, ddc:610, Intensive care medicine, Liver injury, medicine.diagnostic_test, business.industry, Optimal treatment, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RD1-811, lcsh:RC86-88.9, medicine.disease, 3. Good health, 030220 oncology & carcinogenesis, Emergency Medicine, business, Pediatric trauma
Abstract

none 68 si Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines. open Coccolini, Federico; Montori, G; Catena, F; Kluger, Y; Biffl, W; Moore, Ee; Reva, V; Bing, C; Bala, M; Fugazzola, P; Bahouth, H; Marzi, I; Velmahos, G; Ivatury, R; Soreide, K; Horer, T; Nullr, nullTen Broek; Pereira, Bm; Fraga, Gp; Inaba, K; Kashuk, J; Parry, N; Masiakos, Pt; Mylonas, Ks; Kirkpatrick, A; Abu zidan, F; Gomes, Ca; Benatti, Sv; Naidoo, N; Salvetti, F; Maccatrozzo, S; Agnoletti, V; Gamberini, E; Solaini, Leonardo; Costanzo, A; Celotti, A; Tomasoni, M; Khokha, V; Arvieux, C; Napolitano, L; Handolin, L; Pisano, M; Magnone, S; Spain, Da; Nullm, nullDe Moya; Davis, Ka; Nulln, nullDe Angelis; Leppaniemi, A; Ferrada, P; Latifi, R; Navarro, Dc; Otomo, Y; Coimbra, R; Maier, Rv; Moore, F; Rizoli, S; Sakakushev, B; Galante, Jm; Chiara, O; Cimbanassi, S; Mefire, Ac; Weber, D; Ceresoli, M; Peitzman, Ab; Wehlie, L; Sartelli, M; Nulls, nullDi Saverio; Ansaloni, L. Coccolini, Federico; Montori, G; Catena, F; Kluger, Y; Biffl, W; Moore, Ee; Reva, V; Bing, C; Bala, M; Fugazzola, P; Bahouth, H; Marzi, I; Velmahos, G; Ivatury, R; Soreide, K; Horer, T; Nullr, nullTen Broek; Pereira, Bm; Fraga, Gp; Inaba, K; Kashuk, J; Parry, N; Masiakos, Pt; Mylonas, Ks; Kirkpatrick, A; Abu zidan, F; Gomes, Ca; Benatti, Sv; Naidoo, N; Salvetti, F; Maccatrozzo, S; Agnoletti, V; Gamberini, E; Solaini, Leonardo; Costanzo, A; Celotti, A; Tomasoni, M; Khokha, V; Arvieux, C; Napolitano, L; Handolin, L; Pisano, M; Magnone, S; Spain, Da; Nullm, nullDe Moya; Davis, Ka; Nulln, nullDe Angelis; Leppaniemi, A; Ferrada, P; Latifi, R; Navarro, Dc; Otomo, Y; Coimbra, R; Maier, Rv; Moore, F; Rizoli, S; Sakakushev, B; Galante, Jm; Chiara, O; Cimbanassi, S; Mefire, Ac; Weber, D; Ceresoli, M; Peitzman, Ab; Wehlie, L; Sartelli, M; Nulls, nullDi Saverio; Ansaloni, L.

Published
2017

34. Negative Pressure Wound Therapy versus modified Barker Vacuum Pack as temporary abdominal closure technique for Open Abdomen management: a four-year experience

Author

Giulia Montori, Federico Coccolini, Matteo Tomasoni, Marco Ceresoli, Luca Ansaloni, Leonardo Solaini, Luca Campanati, Roberto Manfredi, Stefano Magnone, Paola Fugazzola, Niccolò Allievi, Montori, G, Allievi, N, Coccolini, F, Solaini, L, Campanati, L, Ceresoli, M, Fugazzola, P, Manfredi, R, Magnone, S, Tomasoni, M, Ansaloni, L, Montori, Giulia, Allievi, Niccolò, Coccolini, Federico, Solaini, Leonardo, Campanati, Luca, Ceresoli, Marco, Fugazzola, Paola, Manfredi, Roberto, Magnone, Stefano, Tomasoni, Matteo, and Ansaloni, Luca

Subjects
Adult, Male, medicine.medical_specialty, Abdominal Wound Closure Techniques, Fistula, Vacuum, Open Abdomen, medicine.medical_treatment, Barker Vacuum Pack, lcsh:Surgery, Peritonitis, Abdominal Injuries, Trauma, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Negative-pressure wound therapy, Abdomen, medicine, Humans, Temporary abdominal closure, Aged, Retrospective Studies, business.industry, 030208 emergency & critical care medicine, Retrospective cohort study, General Medicine, lcsh:RD1-811, Negative Pressure Wound Therapy, Length of Stay, Middle Aged, medicine.disease, Emergency surgery, Female, Negative-Pressure Wound Therapy, Surgery, medicine.anatomical_structure, Abdominal trauma, 030220 oncology & carcinogenesis, Anesthesia, business, Research Article
Abstract

Background We reviewed our experience with patients presenting with trauma and peritonitis who underwent an open abdomen (OA) procedure, and compared outcomes between Negative Pressure Wound Therapy (NPWT) and a modified Barker Vacuum Pack (mBVP) technique. Methods In this descriptive study, we retrospectively analyzed data regarding all patients who underwent OA for intra-abdominal sepsis or abdominal trauma at our Centre from January 2012 to December 2015. Demographic data, co-morbidities, indications to surgery, intra-operative details and Björck classification grade were considered. Outcomes included were: time to closure in days, fascial closure rates, ICU and hospital stay, in-hospital and overall mortality, and entero-atmospheric fistula rate. Results A total of 83 cases were considered. Mean closure time was 6 days versus 6.5 days (p = 0.71) in NPWT and mBVP groups, respectively; the fascial closure rate was 75.4% versus 93.8% (p = 0.10). At multivariate analysis, in-hospital and overall mortality were significantly higher within the mBVP, as compared to NPWT (OR 3.8, 95% CI 1.1 to 13.1, p = 0.02 – OR 4.2, 95% CI 1.2 to 14.1, p = 0.01). Entero-atmospheric fistula rate was 2.6% in the two groups. Conclusions NPWT as a temporary abdominal closure technique, as compared to mBVP, appears to be associated with better outcomes in terms of mortality. Electronic supplementary material The online version of this article (doi:10.1186/s12893-017-0281-3) contains supplementary material, which is available to authorized users.

Published
2016

Catalog

Books, media, physical & digital resources
See catalog results