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

Author

Giuffrida, M, Perrone, G, Abu-Zidan, F, Agnoletti, V, Ansaloni, L, Baiocchi, G, Bendinelli, C, Biffl, W, Bonavina, L, Bravi, F, Carcoforo, P, Ceresoli, M, Chichom-Mefire, A, Coccolini, F, Coimbra, R, De'Angelis, N, de Moya, M, De Simone, B, Di Saverio, S, Fraga, G, Galante, J, Ivatury, R, Kashuk, J, Kelly, M, Kirkpatrick, A, Kluger, Y, Koike, K, Leppaniemi, A, Maier, R, Moore, E, Peitzmann, A, Sakakushev, B, Sartelli, M, Sugrue, M, Tian, B, Broek, R, Vallicelli, C, Wani, I, Weber, D, Docimo, G, Catena, F, Giuffrida M., Perrone G., Abu-Zidan F., Agnoletti V., Ansaloni L., Baiocchi G. L., Bendinelli C., Biffl W. L., Bonavina L., Bravi F., Carcoforo P., Ceresoli M., Chichom-Mefire A., Coccolini F., Coimbra R., de'Angelis N., de Moya M., De Simone B., Di Saverio S., Fraga G. P., Galante J., Ivatury R., Kashuk J., Kelly M. D., Kirkpatrick A. W., Kluger Y., Koike K., Leppaniemi A., Maier R. V., Moore E. E., Peitzmann A., Sakakushev B., Sartelli M., Sugrue M., Tian B. W. C. A., Broek R. T., Vallicelli C., Wani I., Weber D. G., Docimo G., Catena F., Giuffrida, M, Perrone, G, Abu-Zidan, F, Agnoletti, V, Ansaloni, L, Baiocchi, G, Bendinelli, C, Biffl, W, Bonavina, L, Bravi, F, Carcoforo, P, Ceresoli, M, Chichom-Mefire, A, Coccolini, F, Coimbra, R, De'Angelis, N, de Moya, M, De Simone, B, Di Saverio, S, Fraga, G, Galante, J, Ivatury, R, Kashuk, J, Kelly, M, Kirkpatrick, A, Kluger, Y, Koike, K, Leppaniemi, A, Maier, R, Moore, E, Peitzmann, A, Sakakushev, B, Sartelli, M, Sugrue, M, Tian, B, Broek, R, Vallicelli, C, Wani, I, Weber, D, Docimo, G, Catena, F, Giuffrida M., Perrone G., Abu-Zidan F., Agnoletti V., Ansaloni L., Baiocchi G. L., Bendinelli C., Biffl W. L., Bonavina L., Bravi F., Carcoforo P., Ceresoli M., Chichom-Mefire A., Coccolini F., Coimbra R., de'Angelis N., de Moya M., De Simone B., Di Saverio S., Fraga G. P., Galante J., Ivatury R., Kashuk J., Kelly M. D., Kirkpatrick A. W., Kluger Y., Koike K., Leppaniemi A., Maier R. V., Moore E. E., Peitzmann A., Sakakushev B., Sartelli M., Sugrue M., Tian B. W. C. A., Broek R. T., Vallicelli C., Wani I., Weber D. G., Docimo G., and Catena F.

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

2. WSES consensus guidelines on sigmoid volvulus management

Author

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

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

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

Author

De Simone, B, Kluger, Y, Moore, E, Sartelli, M, Abu-Zidan, F, Coccolini, F, Ansaloni, L, Tebala, G, Di Saverio, S, Di Carlo, I, Sakakushev, B, Bonavina, L, Sugrue, M, Galante, J, Ivatury, R, Picetti, E, Chirica, M, Wani, I, Bala, M, Sall, I, Kirkpatrick, A, Shelat, V, Pikoulis, E, Leppäniemi, A, Tan, E, Broek, R, Gurmu Beka, S, Litvin, A, Chouillard, E, Coimbra, R, Cui, Y, De’ Angelis, N, Sganga, G, Stahel, P, Agnoletti, V, Rampini, A, Damaskos, D, Carcoforo, P, Biffl, W, Hecker, A, Di Salomone, S, Balogh, Z, Beka, S, Velmahos, G, Ceresoli, M, Chiara, O, Leppaniemi, A, Marzi, I, Inaba, K, Khokha, V, Reva, V, Khan, M, Toro, A, de’ Angelis, N, Malangoni, M, Scozzafava, E, Civil, I, Maier, R, Weber, D, Chiarugi, M, Soreide, K, Testini, M, Bravi, F, Catena, F, De Simone B., Kluger Y., Moore E. E., Sartelli M., Abu-Zidan F. M., Coccolini F., Ansaloni L., Tebala G. D., Di Saverio S., Di Carlo I., Sakakushev B. E., Bonavina L., Sugrue M., Galante J. M., Ivatury R., Picetti E., Chirica M., Wani I., Bala M., Sall I., Kirkpatrick A. W., Shelat V. G., Pikoulis E., Leppäniemi A., Tan E., Broek R. P. G. t., Gurmu Beka S., Litvin A., Chouillard E., Coimbra R., Cui Y., De’ Angelis N., Sganga G., Stahel P. F., Agnoletti V., Rampini A., Shelat V., Damaskos D., Carcoforo P., Biffl W. L., Hecker A., Kirkpatrick A., Di Salomone S., Balogh Z., Beka S. G., Broek R. T., Velmahos G., Sakakushev B., Ceresoli M., Chiara O., Stahel P., Leppaniemi A., Marzi I., Inaba K., Khokha V., Reva V., Khan M., Toro A., de’ Angelis N., Malangoni M., Scozzafava E., Civil I., Maier R., Weber D., Chiarugi M., Soreide K., Testini M., Bravi F., Maier R. V., Catena F., De Simone, B, Kluger, Y, Moore, E, Sartelli, M, Abu-Zidan, F, Coccolini, F, Ansaloni, L, Tebala, G, Di Saverio, S, Di Carlo, I, Sakakushev, B, Bonavina, L, Sugrue, M, Galante, J, Ivatury, R, Picetti, E, Chirica, M, Wani, I, Bala, M, Sall, I, Kirkpatrick, A, Shelat, V, Pikoulis, E, Leppäniemi, A, Tan, E, Broek, R, Gurmu Beka, S, Litvin, A, Chouillard, E, Coimbra, R, Cui, Y, De’ Angelis, N, Sganga, G, Stahel, P, Agnoletti, V, Rampini, A, Damaskos, D, Carcoforo, P, Biffl, W, Hecker, A, Di Salomone, S, Balogh, Z, Beka, S, Velmahos, G, Ceresoli, M, Chiara, O, Leppaniemi, A, Marzi, I, Inaba, K, Khokha, V, Reva, V, Khan, M, Toro, A, de’ Angelis, N, Malangoni, M, Scozzafava, E, Civil, I, Maier, R, Weber, D, Chiarugi, M, Soreide, K, Testini, M, Bravi, F, Catena, F, De Simone B., Kluger Y., Moore E. E., Sartelli M., Abu-Zidan F. M., Coccolini F., Ansaloni L., Tebala G. D., Di Saverio S., Di Carlo I., Sakakushev B. E., Bonavina L., Sugrue M., Galante J. M., Ivatury R., Picetti E., Chirica M., Wani I., Bala M., Sall I., Kirkpatrick A. W., Shelat V. G., Pikoulis E., Leppäniemi A., Tan E., Broek R. P. G. t., Gurmu Beka S., Litvin A., Chouillard E., Coimbra R., Cui Y., De’ Angelis N., Sganga G., Stahel P. F., Agnoletti V., Rampini A., Shelat V., Damaskos D., Carcoforo P., Biffl W. L., Hecker A., Kirkpatrick A., Di Salomone S., Balogh Z., Beka S. G., Broek R. T., Velmahos G., Sakakushev B., Ceresoli M., Chiara O., Stahel P., Leppaniemi A., Marzi I., Inaba K., Khokha V., Reva V., Khan M., Toro A., de’ Angelis N., Malangoni M., Scozzafava E., Civil I., Maier R., Weber D., Chiarugi M., Soreide K., Testini M., Bravi F., Maier R. V., and Catena F.

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 classificat

Published
2023

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

Author

De Simone B., Kluger Y., Moore E. E., Sartelli M., Abu-Zidan F. M., Coccolini F., Ansaloni L., Tebala G. D., Di Saverio S., Di Carlo I., Sakakushev B. E., Bonavina L., Sugrue M., Galante J. M., Ivatury R., Picetti E., Chirica M., Wani I., Bala M., Sall I., Kirkpatrick A. W., Shelat V. G., Pikoulis E., Leppäniemi A., Tan E., Broek R. P. G. t., Gurmu Beka S., Litvin A., Chouillard E., Coimbra R., Cui Y., De’ Angelis N., Sganga G., Stahel P. F., Agnoletti V., Rampini A., Shelat V., Damaskos D., Carcoforo P., Biffl W. L., Hecker A., Kirkpatrick A., Di Salomone S., Balogh Z., Beka S. G., Broek R. T., Velmahos G., Sakakushev B., Ceresoli M., Chiara O., Stahel P., Leppaniemi A., Marzi I., Inaba K., Khokha V., Reva V., Khan M., Toro A., de’ Angelis N., Malangoni M., Scozzafava E., Civil I., Maier R., Weber D., Chiarugi M., Soreide K., Testini M., Bravi F., Maier R. V., Catena F., De Simone, B, Kluger, Y, Moore, E, Sartelli, M, Abu-Zidan, F, Coccolini, F, Ansaloni, L, Tebala, G, Di Saverio, S, Di Carlo, I, Sakakushev, B, Bonavina, L, Sugrue, M, Galante, J, Ivatury, R, Picetti, E, Chirica, M, Wani, I, Bala, M, Sall, I, Kirkpatrick, A, Shelat, V, Pikoulis, E, Leppäniemi, A, Tan, E, Broek, R, Gurmu Beka, S, Litvin, A, Chouillard, E, Coimbra, R, Cui, Y, De’ Angelis, N, Sganga, G, Stahel, P, Agnoletti, V, Rampini, A, Damaskos, D, Carcoforo, P, Biffl, W, Hecker, A, Di Salomone, S, Balogh, Z, Beka, S, Velmahos, G, Ceresoli, M, Chiara, O, Leppaniemi, A, Marzi, I, Inaba, K, Khokha, V, Reva, V, Khan, M, Toro, A, de’ Angelis, N, Malangoni, M, Scozzafava, E, Civil, I, Maier, R, Weber, D, Chiarugi, M, Soreide, K, Testini, M, Bravi, F, and Catena, F

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

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

Author

Fugazzola, P, Ceresoli, M, Coccolini, F, Gabrielli, F, Puzziello, A, Monzani, F, Amato, B, Sganga, G, Sartelli, M, Menichetti, F, Puglisi, G, Tartaglia, D, Carcoforo, P, Avenia, N, Kluger, Y, Paolillo, C, Zago, M, Leppaniemi, A, Tomasoni, M, Cobianchi, L, Dal Mas, F, Improta, M, Moore, E, Peitzman, A, Sugrue, M, Agnoletti, V, Fraga, G, Weber, D, Damaskos, D, Abu-Zidan, F, Wani, I, Kirkpatrick, A, Pikoulis, M, Pararas, N, Tan, E, Broek, R, Maier, R, Davies, R, Kashuk, J, Shelat, V, Mefire, A, Augustin, G, Magnone, S, Poiasina, E, De Simone, B, Chiarugi, M, Biffl, W, Baiocchi, G, Catena, F, Ansaloni, L, Fugazzola P., Ceresoli M., Coccolini F., Gabrielli F., Puzziello A., Monzani F., Amato B., Sganga G., Sartelli M., Menichetti F., Puglisi G. A., Tartaglia D., Carcoforo P., Avenia N., Kluger Y., Paolillo C., Zago M., Leppaniemi A., Tomasoni M., Cobianchi L., Dal Mas F., Improta M., Moore E. E., Peitzman A. B., Sugrue M., Agnoletti V., Fraga G. P., Weber D. G., Damaskos D., Abu-Zidan F. M., Wani I., Kirkpatrick A. W., Pikoulis M., Pararas N., Tan E., Broek R. T., Maier R. V., Davies R. J., Kashuk J., Shelat V. G., Mefire A. C., Augustin G., Magnone S., Poiasina E., De Simone B., Chiarugi M., Biffl W., Baiocchi G. L., Catena F., Ansaloni L., Fugazzola, P, Ceresoli, M, Coccolini, F, Gabrielli, F, Puzziello, A, Monzani, F, Amato, B, Sganga, G, Sartelli, M, Menichetti, F, Puglisi, G, Tartaglia, D, Carcoforo, P, Avenia, N, Kluger, Y, Paolillo, C, Zago, M, Leppaniemi, A, Tomasoni, M, Cobianchi, L, Dal Mas, F, Improta, M, Moore, E, Peitzman, A, Sugrue, M, Agnoletti, V, Fraga, G, Weber, D, Damaskos, D, Abu-Zidan, F, Wani, I, Kirkpatrick, A, Pikoulis, M, Pararas, N, Tan, E, Broek, R, Maier, R, Davies, R, Kashuk, J, Shelat, V, Mefire, A, Augustin, G, Magnone, S, Poiasina, E, De Simone, B, Chiarugi, M, Biffl, W, Baiocchi, G, Catena, F, Ansaloni, L, Fugazzola P., Ceresoli M., Coccolini F., Gabrielli F., Puzziello A., Monzani F., Amato B., Sganga G., Sartelli M., Menichetti F., Puglisi G. A., Tartaglia D., Carcoforo P., Avenia N., Kluger Y., Paolillo C., Zago M., Leppaniemi A., Tomasoni M., Cobianchi L., Dal Mas F., Improta M., Moore E. E., Peitzman A. B., Sugrue M., Agnoletti V., Fraga G. P., Weber D. G., Damaskos D., Abu-Zidan F. M., Wani I., Kirkpatrick A. W., Pikoulis M., Pararas N., Tan E., Broek R. T., Maier R. V., Davies R. J., Kashuk J., Shelat V. G., Mefire A. C., Augustin G., Magnone S., Poiasina E., De Simone B., Chiarugi M., Biffl W., Baiocchi G. L., Catena F., and Ansaloni L.

Abstract

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

Published
2022

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