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

Author

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

Subjects
Ageing, Antibiotics, Delirium, Direct oral anticoagulants management, Elderly, End of life, Frailty, Geriatric patient, Imaging, Laboratory test, Pain control, Palliative care, Resuscitation, Thrombo-prophylaxis, Trauma management, Trauma score, Vitamin K antagonists anticoagulants management, Humans, Wounds and Injuries, Aged, Frail Elderly, Frailty, Aged, 80 and over, Practice Guidelines as Topic, Geriatric Assessment
Abstract

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

Published
2024

6. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma.

Author

Sermonesi, Giacomo, Tian, Brian, Vallicelli, Carlo, Abu-Zidan, Fikri, Damaskos, Dimitris, Kelly, Michael, Leppäniemi, Ari, Galante, Joseph, Tan, Edward, Kirkpatrick, Andrew, Khokha, Vladimir, Romeo, Oreste, Chirica, Mircea, Pikoulis, Manos, Litvin, Andrey, Shelat, Vishal, Sakakushev, Boris, Wani, Imtiaz, Sall, Ibrahima, Fugazzola, Paola, Cicuttin, Enrico, Toro, Adriana, Amico, Francesco, Mas, Francesca, De Simone, Belinda, Sugrue, Michael, Bonavina, Luigi, Campanelli, Giampiero, Carcoforo, Paolo, Cobianchi, Lorenzo, Coccolini, Federico, Chiarugi, Massimo, Di Carlo, Isidoro, Di Saverio, Salomone, Podda, Mauro, Pisano, Michele, Sartelli, Massimo, Testini, Mario, Fette, Andreas, Rizoli, Sandro, Picetti, Edoardo, Weber, Dieter, Latifi, Rifat, Kluger, Yoram, Balogh, Zsolt, Biffl, Walter, Jeekel, Hans, Civil, Ian, Hecker, Andreas, Ansaloni, Luca, Bravi, Francesca, Agnoletti, Vanni, Beka, Solomon, Moore, Ernest, and Catena, Fausto

Subjects
Acute appendicitis, Acute care surgery, Acute cholecystitis, Acute diverticulitis, Acute pancreatitis, Acute peritonitis, Adhesive small bowel obstruction, Colo–rectal emergencies, Emergency general surgery, Guidelines, Incarcerated/complicated ventral/inguinal hernia, Laparoscopic approach, Laparoscopy, Mesenteric ischemia, Minimally invasive surgery/approach, Penetrating/blunt abdominal trauma, Perforated peptic ulcer, Recommendations, Trauma surgery hemodynamic stability, Humans, Emergencies, Retrospective Studies, Laparoscopy, Abdomen, Abdominal Injuries, Randomized Controlled Trials as Topic
Abstract

BACKGROUND: Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS: This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS: A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS: The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.

Published
2023

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

Author

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

Subjects
Humans, Perioperative Care, Elective Surgical Procedures
Abstract

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

Published
2023

11. ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings.

Author

Frassini, Simone, Cobianchi, Lorenzo, Fugazzola, Paola, Biffl, Walter, Coccolini, Federico, Damaskos, Dimitrios, Moore, Ernest, Kluger, Yoram, Ceresoli, Marco, Coimbra, Raul, Davies, Justin, Kirkpatrick, Andrew, Di Carlo, Isidoro, Hardcastle, Timothy, Isik, Arda, Chiarugi, Massimo, Gurusamy, Kurinchi, Maier, Ronald, Segovia Lohse, Helmut, Jeekel, Hans, Boermeester, Marja, Abu-Zidan, Fikri, Inaba, Kenji, Weber, Dieter, Augustin, Goran, Bonavina, Luigi, Velmahos, George, Sartelli, Massimo, Di Saverio, Salomone, Ten Broek, Richard, Granieri, Stefano, Dal Mas, Francesca, Farè, Camilla, Peverada, Jacopo, Zanghì, Simone, Viganò, Jacopo, Tomasoni, Matteo, Dominioni, Tommaso, Cicuttin, Enrico, Hecker, Andreas, Tebala, Giovanni, Galante, Joseph, Wani, Imtiaz, Khokha, Vladimir, Sugrue, Michael, Scalea, Thomas, Tan, Edward, Malangoni, Mark, Pararas, Nikolaos, Podda, Mauro, De Simone, Belinda, Ivatury, Rao, Cui, Yunfeng, Kashuk, Jeffry, Peitzman, Andrew, Kim, Fernando, Pikoulis, Emmanouil, Sganga, Gabriele, Chiara, Osvaldo, Kelly, Michael, Marzi, Ingo, Picetti, Edoardo, Agnoletti, Vanni, DeAngelis, Nicola, Campanelli, Giampiero, de Moya, Marc, Litvin, Andrey, Martínez-Pérez, Aleix, Sall, Ibrahima, Rizoli, Sandro, Tomadze, Gia, Sakakushev, Boris, Stahel, Philip, Civil, Ian, Shelat, Vishal, Costa, David, Chichom-Mefire, Alain, Latifi, Rifat, Chirica, Mircea, Amico, Francesco, Pardhan, Amyn, Seenarain, Vidya, Boyapati, Nikitha, Hatz, Basil, Ackermann, Travis, Abeyasundara, Sandun, Fenton, Linda, Plani, Frank, Sarvepalli, Rohit, Rouhbakhshfar, Omid, Caleo, Pamela, Ho-Ching Yau, Victor, Clement, Kristenne, Christou, Erasmia, Castillo, Ana, Gosal, Preet, Balasubramaniam, Sunder, Hsu, Jeremy, Banphawatanarak, Kamon, and Pisano, Michele

Subjects
Abdominal wall incision, Closure technique, Emergency, Incisional hernia, Laparotomy closure, Midline incision, Wound complications, Wound dehiscence, Humans, Laparotomy, Abdominal Wound Closure Techniques, Suture Techniques, Incisional Hernia, Reoperation
Abstract

Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.

Published
2023

12. Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper.

Author

Giuffrida, Mario, Perrone, Gennaro, Abu-Zidan, Fikri, Agnoletti, Vanni, Ansaloni, Luca, Baiocchi, Gian, Bendinelli, Cino, Biffl, Walter, Bonavina, Luigi, Bravi, Francesca, Carcoforo, Paolo, Ceresoli, Marco, Chichom-Mefire, Alain, Coccolini, Federico, Coimbra, Raul, deAngelis, Nicola, de Moya, Marc, De Simone, Belinda, Di Saverio, Salomone, Fraga, Gustavo, Ivatury, Rao, Kashuk, Jeffry, Kelly, Michael, Kirkpatrick, Andrew, Kluger, Yoram, Koike, Kaoru, Leppaniemi, Ari, Maier, Ronald, Moore, Ernest, Peitzmann, Andrew, Sakakushev, Boris, Sartelli, Massimo, Sugrue, Michael, Tian, Brian, Broek, Richard, Vallicelli, Carlo, Wani, Imtaz, Weber, Dieter, Docimo, Giovanni, Catena, Fausto, and Galante, Joseph

Subjects
Congenital, Diaphragm hernia, Emergency surgery, Guidelines, Rupture, Trauma, Humans, Diaphragm, Hernias, Diaphragmatic, Congenital, Tomography, X-Ray Computed, Thorax, Hernia, Hiatal, Thoracic Injuries
Abstract

BACKGROUND: Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. METHODS: A bibliographic search using major databases was performed using the terms emergency surgery diaphragmatic hernia, traumatic diaphragmatic rupture and congenital diaphragmatic hernia. GRADE methodology was used to evaluate the evidence and give recommendations. RESULTS: CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients. CONCLUSIONS: Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.

Published
2023

14. WSES consensus guidelines on sigmoid volvulus management.

Author

Tian, Brian, Vigutto, Gabriele, Tan, Edward, van Goor, Harry, Bendinelli, Cino, Abu-Zidan, Fikri, Ivatury, Rao, Sakakushev, Boris, Di Carlo, Isidoro, Sganga, Gabriele, Maier, Ronald, Coimbra, Raul, Leppäniemi, Ari, Litvin, Andrey, Damaskos, Dimitrios, Broek, Richard, Biffl, Walter, Di Saverio, Salomone, De Simone, Belinda, Ceresoli, Marco, Picetti, Edoardo, Tebala, Giovanni, Beka, Solomon, Bonavina, Luigi, Cui, Yunfeng, Khan, Jim, Cicuttin, Enrico, Amico, Francesco, Kenji, Inaba, Hecker, Andreas, Ansaloni, Luca, Sartelli, Massimo, Moore, Ernest, Kluger, Yoram, Testini, Mario, Weber, Dieter, Agnoletti, Vanni, Angelis, Nicola, Coccolini, Federico, Sall, Ibrahima, Catena, Fausto, and Galante, Joseph

Subjects
Humans, Aged, Intestinal Volvulus, Decompression, Surgical, Lumbar Vertebrae, Colonic Diseases
Abstract

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

Published
2023

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

Author

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

Subjects
Classification, Delay in surgery, Delphi method, Emergency surgery, Healthcare system, Operating room management, Priority, Time to surgery, Timing in acute care surgery (TACS), Triage, Humans, Delphi Technique, Triage, Consensus, Surgeons, Operating Rooms
Abstract

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

Published
2023

17. EAES Multidisciplinary Rapid Guideline: systematic review, meta-analysis, GRADE assessment and evidence-informed recommendations on the surgical management of paraesophageal hernias

Author

Markar, Sheraz R., Menon, Nainika, Guidozzi, Nadia, Kontouli, Katerina-Maria, Mavridis, Dimitrios, Andreou, Alexandros, Berlth, Felix, Bonavina, Luigi, Cushieri, Alfred, Fourie, Lana, Gossage, James, Gronnier, Caroline, Hazebroek, Eric J., Krishnadath, Sheila, Low, Donald E., McCord, Mimi, Pouw, Roos E., Watson, David I., Carrano, Francesco Maria, Ortenzi, Monica, and Antoniou, Stavros A.

Published
2023
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18. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery.

Author

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

Subjects
Bowel ischemia, Guidelines, Mesenteric arterial occlusion, Mesenteric artery stenting, Mesenteric ischemia, Recommendations, World Society of Emergency Surgery, Humans, Mesenteric Ischemia, Mesenteric Vascular Occlusion, Endovascular Procedures, Ischemia, Intestines
Abstract

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

Published
2022

19. Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document.

Author

Podda, Mauro, De Simone, Belinda, Ceresoli, Marco, Virdis, Francesco, Favi, Francesco, Wiik Larsen, Johannes, Coccolini, Federico, Sartelli, Massimo, Pararas, Nikolaos, Beka, Solomon, Bonavina, Luigi, Bova, Raffaele, Pisanu, Adolfo, Abu-Zidan, Fikri, Balogh, Zsolt, Chiara, Osvaldo, Wani, Imtiaz, Stahel, Philip, Di Saverio, Salomone, Scalea, Thomas, Soreide, Kjetil, Sakakushev, Boris, Amico, Francesco, Martino, Costanza, Hecker, Andreas, deAngelis, Nicola, Chirica, Mircea, Kirkpatrick, Andrew, Pikoulis, Emmanouil, Kluger, Yoram, Bensard, Denis, Ansaloni, Luca, Fraga, Gustavo, Civil, Ian, Tebala, Giovanni, Di Carlo, Isidoro, Cui, Yunfeng, Coimbra, Raul, Agnoletti, Vanni, Sall, Ibrahima, Tan, Edward, Picetti, Edoardo, Litvin, Andrey, Damaskos, Dimitrios, Inaba, Kenji, Leung, Jeffrey, Maier, Ronald, Biffl, Walt, Leppaniemi, Ari, Moore, Ernest, Gurusamy, Kurinchi, Catena, Fausto, and Galante, Joseph

Subjects
Consensus, Conservative treatment, Diagnostic imaging, Embolization, Follow-up, Nonoperative management, Spleen, Trauma, Abdominal Injuries, Adult, Child, Consensus, Follow-Up Studies, Hemoglobins, Heparin, Low-Molecular-Weight, Humans, Prospective Studies, Wounds, Nonpenetrating
Abstract

BACKGROUND: In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved. METHODS: Using a modified Delphi method, we sought to explore ongoing areas of controversy in the NOM of splenic trauma and reach a consensus among a group of 48 international experts from five continents (Africa, Europe, Asia, Oceania, America) concerning optimal follow-up strategies in patients with splenic injuries treated with NOM. RESULTS: Consensus was reached on eleven clinical research questions and 28 recommendations with an agreement rate ≥ 80%. Mobilization after 24 h in low-grade splenic trauma patients (WSES Class I, AAST Grades I-II) was suggested, while in patients with high-grade splenic injuries (WSES Classes II-III, AAST Grades III-V), if no other contraindications to early mobilization exist, safe mobilization of the patient when three successive hemoglobins 8 h apart after the first are within 10% of each other was considered safe according to the panel. The panel suggests adult patients to be admitted to hospital for 1 day (for low-grade splenic injuries-WSES Class I, AAST Grades I-II) to 3 days (for high-grade splenic injuries-WSES Classes II-III, AAST Grades III-V), with those with high-grade injuries requiring admission to a monitored setting. In the absence of specific complications, the panel suggests DVT and VTE prophylaxis with LMWH to be started within 48-72 h from hospital admission. The panel suggests splenic artery embolization (SAE) as the first-line intervention in patients with hemodynamic stability and arterial blush on CT scan, irrespective of injury grade. Regarding patients with WSES Class II blunt splenic injuries (AAST Grade III) without contrast extravasation, a low threshold for SAE has been suggested in the presence of risk factors for NOM failure. The panel also suggested angiography and eventual SAE in all hemodynamically stable adult patients with WSES Class III injuries (AAST Grades IV-V), even in the absence of CT blush, especially when concomitant surgery that requires change of position is needed. Follow-up imaging with contrast-enhanced ultrasound/CT scan in 48-72 h post-admission of trauma in splenic injuries WSES Class II (AAST Grade III) or higher treated with NOM was considered the best strategy for timely detection of vascular complications. CONCLUSION: This consensus document could help guide future prospective studies aiming at validating the suggested strategies through the implementation of prospective trauma databases and the subsequent production of internationally endorsed guidelines on the issue.

Published
2022

20. Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines.

Author

Coccolini, Federico, Corradi, Francesco, Sartelli, Massimo, Coimbra, Raul, Kryvoruchko, Igor, Leppaniemi, Ari, Doklestic, Krstina, Bignami, Elena, Biancofiore, Giandomenico, Bala, Miklosh, Marco, Ceresoli, Damaskos, Dimitris, Biffl, Walt, Fugazzola, Paola, Santonastaso, Domenico, Agnoletti, Vanni, Sbarbaro, Catia, Nacoti, Mirco, Hardcastle, Timothy, Mariani, Diego, De Simone, Belinda, Tolonen, Matti, Ball, Chad, Podda, Mauro, Di Carlo, Isidoro, Di Saverio, Salomone, Navsaria, Pradeep, Bonavina, Luigi, Abu-Zidan, Fikri, Soreide, Kjetil, Fraga, Gustavo, Carvalho, Vanessa, Batista, Sergio, Hecker, Andreas, Cucchetti, Alessandro, Ercolani, Giorgio, Tartaglia, Dario, Wani, Imtiaz, Kurihara, Hayato, Tan, Edward, Litvin, Andrey, Melotti, Rita, Sganga, Gabriele, Zoro, Tamara, Isirdi, Alessandro, DeAngelis, Nicola, Weber, Dieter, Hodonou, Adrien, tenBroek, Richard, Parini, Dario, Khan, Jim, Sbrana, Giovanni, Coniglio, Carlo, Giarratano, Antonino, Gratarola, Angelo, Zaghi, Claudia, Romeo, Oreste, Kelly, Michael, Forfori, Francesco, Chiarugi, Massimo, Moore, Ernest, Catena, Fausto, Malbrain, Manu, and Galante, Joseph

Subjects
Acute, Emergency, Morbidity, Pain, Surgery, Treatment, Abdomen, Analgesics, Anesthesia, Humans, Pain, Postoperative, Perioperative Care, United States
Abstract

BACKGROUND: Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. MATERIAL AND METHODS: An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. CONCLUSION: Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.

Published
2022

21. The LIFE TRIAD of emergency general surgery.

Author

Coccolini, Federico, Sartelli, Massimo, Kluger, Yoram, Osipov, Aleksei, Cui, Yunfeng, Beka, Solomon, Kirkpatrick, Andrew, Sall, Ibrahima, Moore, Ernest, Biffl, Walter, Litvin, Andrey, Pisano, Michele, Magnone, Stefano, Picetti, Edoardo, de Angelis, Nicola, Stahel, Philip, Ansaloni, Luca, Tan, Edward, Abu-Zidan, Fikri, Ceresoli, Marco, Hecker, Andreas, Chiara, Osvaldo, Sganga, Gabriele, Khokha, Vladimir, di Saverio, Salomone, Sakakushev, Boris, Campanelli, Giampiero, Fraga, Gustavo, Wani, Imtiaz, Broek, Richard, Cicuttin, Enrico, Cremonini, Camilla, Tartaglia, Dario, Soreide, Kjetil, de Moya, Marc, Koike, Kaoru, De Simone, Belinda, Balogh, Zsolt, Amico, Francesco, Shelat, Vishal, Pikoulis, Emmanouil, Di Carlo, Isidoro, Bonavina, Luigi, Leppaniemi, Ari, Marzi, Ingo, Ivatury, Rao, Khan, Jim, Maier, Ronald, Hardcastle, Timothy, Isik, Arda, Podda, Mauro, Tolonen, Matti, Rasa, Kemal, Navsaria, Pradeep, Demetrashvili, Zaza, Tarasconi, Antonio, Carcoforo, Paolo, Sibilla, Maria, Baiocchi, Gian, Pararas, Nikolaos, Weber, Dieter, Chiarugi, Massimo, Catena, Fausto, and Galante, Joseph

Subjects
Data, Effectiveness, Emergency General Surgery, Formation, Learning, Outcomes, Planning, Hospitals, Humans, Registries, Surgeons
Abstract

Emergency General Surgery (EGS) was identified as multidisciplinary surgery performed for traumatic and non-traumatic acute conditions during the same admission in the hospital by general emergency surgeons and other specialists. It is the most diffused surgical discipline in the world. To live and grow strong EGS necessitates three fundamental parts: emergency and elective continuous surgical practice, evidence generation through clinical registries and data accrual, and indications and guidelines production: the LIFE TRIAD.

Published
2022

22. Three-year survival and distribution of lymph node metastases in gastric cancer following neoadjuvant chemotherapy: results from a European randomized clinical trial

Author

van der Wielen, Nicole, Daams, Freek, Rosati, Riccardo, Parise, Paolo, Weitz, Jürgen, Reissfelder, Christoph, del Val, Ismael Diez, Loureiro, Carlos, Parada-González, Purificación, Pintos-Martínez, Elena, Vallejo, Francisco Mateo, Achirica, Carlos Medina, Sánchez-Pernaute, Andrés, Campos, Adriana Ruano, Bonavina, Luigi, Asti, Emanuele L. G., Poza, Alfredo Alonso, Gilsanz, Carlos, Nilsson, Magnus, Lindblad, Mats, Gisbertz, Suzanne S., van Berge Henegouwen, Mark I., Romario, Uberto Fumagalli, De Pascale, Stefano, Akhtar, Khurshid, Cuesta, Miguel A., van der Peet, Donald L., and Straatman, Jennifer

Published
2023
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24. Correction: ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

Author

Frassini, Simone, Cobianchi, Lorenzo, Fugazzola, Paola, Biffl, Walter L., Coccolini, Federico, Damaskos, Dimitrios, Moore, Ernest E., Kluger, Yoram, Ceresoli, Marco, Coimbra, Raul, Davies, Justin, Kirkpatrick, Andrew, Di Carlo, Isidoro, Hardcastle, Timothy C., Isik, Arda, Chiarugi, Massimo, Gurusamy, Kurinchi, Maier, Ronald V., Segovia Lohse, Helmut A., Jeekel, Hans, Boermeester, Marja A., Abu-Zidan, Fikri, Inaba, Kenji, Weber, Dieter G., Augustin, Goran, Bonavina, Luigi, Velmahos, George, Sartelli, Massimo, Di Saverio, Salomone, Ten Broek, Richard P. G., Granieri, Stefano, Dal Mas, Francesca, Farè, Camilla Nikita, Peverada, Jacopo, Zanghì, Simone, Viganò, Jacopo, Tomasoni, Matteo, Dominioni, Tommaso, Cicuttin, Enrico, Hecker, Andreas, Tebala, Giovanni D., Galante, Joseph M., Wani, Imtiaz, Khokha, Vladimir, Sugrue, Michael, Scalea, Thomas M., Tan, Edward, Malangoni, Mark A., Pararas, Nikolaos, Podda, Mauro, De Simone, Belinda, Ivatury, Rao, Cui, Yunfeng, Kashuk, Jeffry, Peitzman, Andrew, Kim, Fernando, Pikoulis, Emmanouil, Sganga, Gabriele, Chiara, Osvaldo, Kelly, Michael D., Marzi, Ingo, Picetti, Edoardo, Agnoletti, Vanni, De’Angelis, Nicola, Campanelli, Giampiero, de Moya, Marc, Litvin, Andrey, Martínez-Pérez, Aleix, Sall, Ibrahima, Rizoli, Sandro, Tomadze, Gia, Sakakushev, Boris, Stahel, Philip F., Civil, Ian, Shelat, Vishal, Costa, David, Chichom-Mefire, Alain, Latifi, Rifat, Chirica, Mircea, Amico, Francesco, Pardhan, Amyn, Seenarain, Vidya, Boyapati, Nikitha, Hatz, Basil, Ackermann, Travis, Abeyasundara, Sandun, Fenton, Linda, Plani, Frank, Sarvepalli, Rohit, Rouhbakhshfar, Omid, Caleo, Pamela, Ho-Ching Yau, Victor, Clement, Kristenne, Christou, Erasmia, Castillo, Ana María González, Gosal, Preet K. S., Balasubramaniam, Sunder, Hsu, Jeremy, Banphawatanarak, Kamon, Pisano, Michele, Toro, Adriana, Michele, Altomare, Cioffi, Stefano P. B., Spota, Andrea, Catena, Fausto, and Ansaloni, Luca

Published
2023
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25. Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines

Author

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

Published
2023
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26. The unrestricted global effort to complete the COOL trial

Author

Kirkpatrick, Andrew W., Coccolini, Federico, Tolonen, Matti, Minor, Samuel, Catena, Fausto, Gois, Jr., Emanuel, Doig, Christopher J., Hill, Michael D., Ansaloni, Luca, Chiarugi, Massimo, Tartaglia, Dario, Ioannidis, Orestis, Sugrue, Michael, Colak, Elif, Hameed, S. Morad, Lampela, Hanna, Agnoletti, Vanni, McKee, Jessica L., Garraway, Naisan, Sartelli, Massimo, Ball, Chad G., Parry, Neil G., Voght, Kelly, Julien, Lisa, Kroeker, Jenna, Roberts, Derek J., Faris, Peter, Tiruta, Corina, Moore, Ernest E., Ammons, Lee Anne, Anestiadou, Elissavet, Bendinelli, Cino, Bouliaris, Konstantinos, Carroll, Rosemarry, Ceresoli, Marco, Favi, Francesco, Gurrado, Angela, Rezende-Neto, Joao, Isik, Arda, Cremonini, Camilla, Strambi, Silivia, Koukoulis, Georgios, Testini, Mario, Trpcic, Sandy, Pasculli, Alessandro, Picariello, Erika, Abu-Zidan, Fikri, Adeyeye, Ademola, Augustin, Goran, Alconchel, Felipe, Altinel, Yuksel, Hernandez Amin, Luz Adriana, Aranda-Narváez, José Manuel, Baraket, Oussama, Biffl, Walter L., Baiocchi, Gian Luca, Bonavina, Luigi, Brisinda, Giuseppe, Cardinali, Luca, Celotti, Andrea, Chaouch, Mohamed, Chiarello, Maria, Costa, Gianluca, de’Angelis, Nicola, De Manzini, Nicolo, Delibegovic, Samir, Di Saverio, Salomone, De Simone, Belinda, Dubuisson, Vincent, Fransvea, Pietro, Garulli, Gianluca, Giordano, Alessio, Gomes, Carlos, Hayati, Firdaus, Huang, Jinjian, Ibrahim, Aini Fahriza, Huei, Tan Jih, Jailani, Ruhi Fadzlyana, Khan, Mansoor, Luna, Alfonso Palmieri, Malbrain, Manu L. N. G., Marwah, Sanjay, McBeth, Paul, Mihailescu, Andrei, Morello, Alessia, Mulita, Francesk, Murzi, Valentina, Mohammad, Ahmad Tarmizi, Parmar, Simran, Pak, Ajay, Wong, Michael Pak-Kai, Pantalone, Desire, Podda, Mauro, Puccioni, Caterina, Rasa, Kemal, Ren, Jianan, Roscio, Francesco, Gonzalez-Sanchez, Antonio, Sganga, Gabriele, Scheiterle, Maximilian, Slavchev, Mihail, Smirnov, Dmitry, Tosi, Lorenzo, Trivedi, Anand, Vega, Jaime Andres Gonzalez, Waledziak, Maciej, Xenaki, Sofia, Winter, Desmond, Wu, Xiuwen, Zakaria, Andee Dzulkarnean, and Zakaria, Zaidi

Published
2023
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28. Laparoscopic Total and Subtotal Gastrectomy

Author

Stopenski, Stephen, Bonavina, Luigi, Smith, Brian R., Nguyen, Ninh T., editor, Clarke, John O., editor, Lipham, John C., editor, Chang, Kenneth J., editor, Schnoll-Sussman, Felice, editor, Bell, Reginald C.W., editor, and Kahrilas, Peter J., editor

Published
2023
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37. Improving the Diagnostic Yield of High-Resolution Esophageal Manometry for GERD: The “Straight Leg-Raise” International Study

Author

Siboni, Stefano, Kristo, Ivan, Rogers, Benjamin D., De Bortoli, Nicola, Hobson, Anthony, Louie, Brian, Lee, Yeong Yeh, Tee, Vincent, Tolone, Salvatore, Marabotto, Elisa, Visaggi, Pierfrancesco, Haworth, Jordan, Ivy, Megan, Greenan, Garrett, Facchini, Chiara, Masuda, Takahiro, Yano, Fumiaki, Perry, Kyle, Balasubramanian, Gokulakrishnan, Theodorou, Dimitrios, Triantafyllou, Tania, Cusmai, Lorenzo, Boveri, Sara, Schoppmann, Sebastian F., Gyawali, C. Prakash, and Bonavina, Luigi

Published
2023
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40. Dysphagia aortica

Author

Grimaldi, Serena, Milito, Pamela, Lovece, Andrea, Asti, Emanuele, Secchi, Francesco, and Bonavina, Luigi

Published
2022
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41. Correction: Three-year survival and distribution of lymph node metastases in gastric cancer following neoadjuvant chemotherapy: results from a European randomized clinical trial

Author

van der Wielen, Nicole, Daams, Freek, Rosati, Riccardo, Parise, Paolo, Weitz, Jürgen, Reissfelder, Christoph, del Val, Ismael Diez, Loureiro, Carlos, Parada-González, Purificación, Pintos-Martínez, Elena, Vallejo, Francisco Mateo, Achirica, Carlos Medina, Sánchez-Pernaute, Andrés, Campos, Adriana Ruano, Bonavina, Luigi, Asti, Emanuele L. G., Poza, Alfredo Alonso, Gilsanz, Carlos, Nilsson, Magnus, Lindblad, Mats, Gisbertz, Suzanne S., van Berge Henegouwen, Mark I., Romario, Uberto Fumagalli, De Pascale, Stefano, Akhtar, Khurshid, Cuesta, Miguel A., van der Peet, Donald L., and Straatman, Jennifer

Published
2023
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46. Long-Term Impact of Severe Postoperative Complications after Esophagectomy for Cancer: Individual Patient Data Meta-Analysis

Author

Bona, Davide, primary, Manara, Michele, additional, Bonitta, Gianluca, additional, Guerrazzi, Guglielmo, additional, Guraj, Juxhin, additional, Lombardo, Francesca, additional, Biondi, Antonio, additional, Cavalli, Marta, additional, Bruni, Piero Giovanni, additional, Campanelli, Giampiero, additional, Bonavina, Luigi, additional, and Aiolfi, Alberto, additional

Published
2024
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