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.
Subject(s)
Abdominal Wound Closure Techniques , Incisional Hernia , Humans , Laparotomy/adverse effects , Abdominal Wound Closure Techniques/adverse effects , Suture Techniques/adverse effects , Incisional Hernia/etiology , Reoperation/adverse effectsSubject(s)
Emergency Medicine/standards , Evidence-Based Medicine/standards , General Surgery/standards , Pancreatitis/therapy , Societies, Medical/standards , Anti-Bacterial Agents/therapeutic use , Cholangiopancreatography, Endoscopic Retrograde/standards , Cholecystectomy, Laparoscopic/standards , Clinical Deterioration , Critical Care/methods , Critical Care/standards , Emergency Medicine/methods , Evidence-Based Medicine/methods , Fluid Therapy/methods , Fluid Therapy/standards , Humans , Intensive Care Units/standards , Necrosis/diagnosis , Necrosis/therapy , Pancreas/diagnostic imaging , Pancreas/microbiology , Pancreas/pathology , Pancreas/surgery , Pancreatitis/diagnosis , Pancreatitis/microbiology , Pancreatitis/pathology , Severity of Illness Index , Tomography, X-Ray ComputedABSTRACT
BACKGROUND AND AIMS: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. METHODS: This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients. CONCLUSIONS: The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.
Subject(s)
Abdominal Pain/diagnosis , Abdominal Pain/surgery , Appendicitis/diagnosis , Appendicitis/surgery , Practice Guidelines as Topic , Acute Disease , Anti-Bacterial Agents/therapeutic use , Appendectomy , Evidence-Based Medicine , Humans , Laparoscopy/methodsABSTRACT
Diffuse peritonitis represents a life-threatening complication of acute appendicitis (AA). Whether laparoscopy is a safe procedure and presents similar results compared with laparotomy in case of complicated AA is still a matter of debate. The objective of this study is to compare laparoscopic (LA) and open appendectomy (OA) for the management of diffuse peritonitis caused by AA. This is a prospective multicenter cohort study, including 223 patients with diffuse peritonitis from perforated AA, enrolled in the Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) study from February to May 2018. Two groups were created: LA = 78 patients, mean age 42.51 ± 22.14 years and OA = 145 patients, mean age 38.44 ± 20.95 years. LA was employed in 34.98% of cases. There was no statically significant difference between LA and OA groups in terms of intra-abdominal abscess, postoperative peritonitis, rate of reoperation, and mortality. The wound infection rate was higher in the OA group (OR 21.63; 95% CI 3.46-895.47; P = 0.00). The mean postoperative hospital stay in the LA group was shorter than in the OA group (6.40 ± 4.29 days versus 7.8 ± 5.30 days; P = 0.032). Although LA was only used in one-third of cases, it is a safe procedure and should be considered in the management of patients with diffuse peritonitis caused by AA, respecting its indications.
Subject(s)
Appendectomy/methods , Appendicitis/complications , Appendicitis/surgery , Laparoscopy/methods , Laparotomy/methods , Peritonitis/etiology , Peritonitis/surgery , Abdomen, Acute , Adult , Aged , Appendicitis/mortality , Humans , Length of Stay , Middle Aged , Peritonitis/mortality , Postoperative Complications , Prognosis , Prospective Studies , Reoperation , Safety , Young AdultABSTRACT
Although most patients with acute pancreatitis have the mild form of the disease, about 20-30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27-30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen.
Subject(s)
Pancreatitis/therapy , Acute Disease/therapy , Amylases/analysis , Amylases/blood , Anti-Bacterial Agents/therapeutic use , C-Reactive Protein/analysis , Endoscopy/methods , Guidelines as Topic , Hematocrit/methods , Humans , Italy , Lipase/analysis , Lipase/blood , Pancreatitis/classification , Pancreatitis/diagnosis , Procalcitonin/analysis , Procalcitonin/blood , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography/methodsABSTRACT
Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections. SSTIs are a frequent clinical problem in surgical departments. In order to clarify key issues in the management of SSTIs, a task force of experts met in Bertinoro, Italy, on June 28, 2018, for a specialist multidisciplinary consensus conference under the auspices of the World Society of Emergency Surgery (WSES) and the Surgical Infection Society Europe (SIS-E). The multifaceted nature of these infections has led to a collaboration among general and emergency surgeons, intensivists, and infectious disease specialists, who have shared these clinical practice recommendations.
Subject(s)
Congresses as Topic/trends , Consensus , Soft Tissue Infections/therapy , Guidelines as Topic , Humans , ItalyABSTRACT
Computed tomography (CT) imaging is the most appropriate diagnostic tool to confirm suspected left colonic diverticulitis. However, the utility of CT imaging goes beyond accurate diagnosis of diverticulitis; the grade of severity on CT imaging may drive treatment planning of patients presenting with acute diverticulitis. The appropriate management of left colon acute diverticulitis remains still debated because of the vast spectrum of clinical presentations and different approaches to treatment proposed. The authors present a new simple classification system based on both CT scan results driving decisions making management of acute diverticulitis that may be universally accepted for day to day practice.
ABSTRACT
Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.
ABSTRACT
Se describen cinco casos de diverticulitis cecal: todos presentaban dolor leve a moderado en fosa iliaca derecha sin otros signos de toxicidad. Todos fueron intervenidos con diagnóstico inicial de apendicitis aguda. Tres casos no presentaron duda de ser diverticulitis cecal durante cirugía y se realizó diverticulectomía, en los otros dos se realizó colectomía derecha y anastomosis (por importante proceso inflamatorio y sospecha de cáncer). Uno de los casos con colectomía presentó dehiscencia, falla multiorgánica y óbito.
We describe five cases of cecal diverticulitis: all of them present with mild or moderate pain in right lower quadrant without other toxicity sign. In all of them the initial diagnosis was acute appendicitis. At the surgery, three cases present no doubt of cecal diverticulitis and diverticulectomy was made, in the two others right colectomy with anastomosis was perform (because of important inflammation and suspicious of cancer). One of the colectomy cases present dehiscence, organ failure and death.
Subject(s)
Male , Female , Humans , Adolescent , Adult , Middle Aged , Appendicitis/surgery , Diverticulitis/surgery , DiverticulumABSTRACT
Emergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications.A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergency Surgery with the goal of defining recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel.
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Introducción Se reporta la prevalencia y la edad de metaplasia, displasia y carcinoma de vesícula biliar y se trata de establecer una secuencia de progresión de las mismas, ya que diversos estudios la sugieren como vía de la carcinogénesis.Material y métodosEstudio descriptivo, retrospectivo de corte transverso con componente analítico, de 1.514 pacientes con colelitiasis en quienes se realizaron colecistectomías, en un periodo de 4 años.ResultadosEl 72% de los pacientes fueron mujeres, con un promedio general de edad de 46 años. La prevalencia (y promedio de edad) de metaplasia pilórica, metaplasia intestinal, displasia y carcinoma fue de 22,6 (47), 2,1 (46), 0,2 (54) y 0,6% (63 años), respectivamente. Hubo una asociación significativa entre metaplasia pilórica e intestinal (p < 0,001, chi2), y entre displasia y carcinoma (p < 0,005, Yates), no así entre metaplasia y displasia.ConclusiónSe deben realizar mejores estudios para la correcta interpretación de la patogénesis del cáncer de vesícula biliar (AU)
Introduction We report the frequency and age of metaplasia, dysplasia and carcinoma of the gallbladder, and seek to establish a sequence of progression of these, since several studies suggest that this is the carcinogenesis pathway.Material and methodsDescriptive retrospective cross-sectional study over a period of 4 years, with an analytical component of 1,514 patients with cholelithiasis, in whom cholecystectomy were performed.ResultsThe mean age of the sample was 46 years and 72% of patients were female. The prevalence (and mean age) of pyloric metaplasia, intestinal metaplasia, dysplasia and carcinoma was 22.6 (47), 2.1 (46), 0.2 (54) and 0.6% (63 years), respectively. There was a significant association between intestinal and pyloric metaplasia (P < .001, chi2) and between dysplasia and carcinoma (P < .005, Yates), but not between metaplasia and dysplasia.ConclusionImproved studies should be conducted for the correct interpretation of the pathogenesis of gallbladder cancer (AU)
Subject(s)
Humans , Metaplasia/pathology , Gallbladder Neoplasms/pathology , Carcinoma/pathology , Retrospective Studies , Cross-Sectional StudiesABSTRACT
INTRODUCTION: We report the frequency and age of metaplasia, dysplasia and carcinoma of the gallbladder, and seek to establish a sequence of progression of these, since several studies suggest that this is the carcinogenesis pathway. MATERIAL AND METHODS: Descriptive retrospective cross-sectional study over a period of 4 years, with an analytical component of 1,514 patients with cholelithiasis, in whom cholecystectomy were performed. RESULTS: The mean age of the sample was 46 years and 72% of patients were female. The prevalence (and mean age) of pyloric metaplasia, intestinal metaplasia, dysplasia and carcinoma was 22.6 (47), 2.1 (46), 0.2 (54) and 0.6% (63 years), respectively. There was a significant association between intestinal and pyloric metaplasia (P<.001, chi(2)) and between dysplasia and carcinoma (P<.005, Yates), but not between metaplasia and dysplasia. CONCLUSION: Improved studies should be conducted for the correct interpretation of the pathogenesis of gallbladder cancer.
Subject(s)
Carcinoma/epidemiology , Carcinoma/pathology , Gallbladder Neoplasms/epidemiology , Gallbladder Neoplasms/pathology , Cross-Sectional Studies , Female , Humans , Male , Metaplasia , Middle Aged , Prevalence , Retrospective StudiesABSTRACT
Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The World Society of Emergency Surgery (WSES) has designed the CIAOW study in order to describe the clinical, microbiological, and management-related profiles of both community- and healthcare-acquired complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated Intra-Abdominal infection Observational Worldwide Study) is a multicenter observational study currently underway in 57 medical institutions worldwide. The study includes patients undergoing surgery or interventional drainage to address complicated intra-abdominal infections. This preliminary report includes all data from almost the first two months of the six-month study period. Patients who met inclusion criteria with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 702 patients with a mean age of 49.2 years (range 18-98) were enrolled in the study. 272 patients (38.7%) were women and 430 (62.3%) were men. Among these patients, 615 (87.6%) were affected by community-acquired IAIs while the remaining 87 (12.4%) suffered from healthcare-associated infections. Generalized peritonitis was observed in 304 patients (43.3%), whereas localized peritonitis or abscesses was registered in 398 (57.7%) patients.The overall mortality rate was 10.1% (71/702). The final results of the CIAOW Study will be published following the conclusion of the study period in March 2013.
ABSTRACT
BACKGROUND: Intussuception is an uncommon condition in adults. It is usually secondary to an organic lesion that may be malignant. The most common clinical presentation is as a partial bowel obstruction that requires surgical management. Preoperative diagnosis remains difficult; therefore, this paper presents a case report and a brief review of adult intussusception. CLINICAL CASE: We present the case of a 24-year-old female with a 36-h evolution of lower abdominal pain with nausea, vomiting and diarrhea and a previous episode 8 days earlier. Pneumoperitoneum was observed on chest x-ray and surgery was decided upon. Peritonitis due to ileoileal intussusception was found, caused by an inflammatory fibroid polyp with microperforations. Small bowel resection with end-to-end anastomosis was performed and the patient had an uneventful recovery. CONCLUSIONS: Adult intussusception is an infrequent condition with nonspecific symptoms such as pain, nausea and vomiting. With more frequent use of tomography in patients with abdominal pain, correct diagnosis can be achieved. Treatment requires resection of the involved bowel without attempted reduction.
