Browsing by Author "Di Saverio, Salomone"
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Item Open Access 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation(2018-01-24) de’Angelis, Nicola; Di Saverio, Salomone; Chiara, Osvaldo; Sartelli, Massimo; Martínez-Pérez, Aleix; Patrizi, Franca; Weber, Dieter G; Ansaloni, Luca; Biffl, Walter; Ben-Ishay, Offir; Bala, Miklosh; Brunetti, Francesco; Gaiani, Federica; Abdalla, Solafah; Amiot, Aurelien; Bahouth, Hany; Bianchi, Giorgio; Casanova, Daniel; Coccolini, Federico; Coimbra, Raul; de’Angelis, Gian Luigi; De Simone, Belinda; Fraga, Gustavo P; Genova, Pietro; Ivatury, Rao; Kashuk, Jeffry L; Kirkpatrick, Andrew W; Le Baleur, Yann; Machado, Fernando; Machain, Gustavo M; Maier, Ronald V; Chichom-Mefire, Alain; Memeo, Riccardo; Mesquita, Carlos; Salamea Molina, Juan C; Mutignani, Massimiliano; Manzano-Núñez, Ramiro; Ordoñez, Carlos; Peitzman, Andrew B; Pereira, Bruno M; Picetti, Edoardo; Pisano, Michele; Puyana, Juan C; Rizoli, Sandro; Siddiqui, Mohammed; Sobhani, Iradj; ten Broek, Richard P; Zorcolo, Luigi; Carra, Maria C; Kluger, Yoram; Catena, FaustoAbstract Iatrogenic colonoscopy perforation (ICP) is a severe complication that can occur during both diagnostic and therapeutic procedures. Although 45–60% of ICPs are diagnosed by the endoscopist while performing the colonoscopy, many ICPs are not immediately recognized but are instead suspected on the basis of clinical signs and symptoms that occur after the endoscopic procedure. There are three main therapeutic options for ICPs: endoscopic repair, conservative therapy, and surgery. The therapeutic approach must vary based on the setting of the diagnosis (intra- or post-colonoscopy), the type of ICP, the characteristics and general status of the patient, the operator’s level of experience, and surgical device availability. Although ICPs have been the focus of numerous publications, no guidelines have been created to standardize the management of ICPs. The aim of this article is to present the World Society of Emergency Surgery (WSES) guidelines for the management of ICP, which are intended to be used as a tool to promote global standards of care in case of ICP. These guidelines are not meant to substitute providers’ clinical judgment for individual patients, and they may need to be modified based on the medical team’s level of experience and the availability of local resources.Item Open Access 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting(2020-05-07) Sartelli, Massimo; Weber, Dieter G; Kluger, Yoram; Ansaloni, Luca; Coccolini, Federico; Abu-Zidan, Fikri; Augustin, Goran; Ben-Ishay, Offir; Biffl, Walter L; Bouliaris, Konstantinos; Catena, Rodolfo; Ceresoli, Marco; Chiara, Osvaldo; Chiarugi, Massimo; Coimbra, Raul; Cortese, Francesco; Cui, Yunfeng; Damaskos, Dimitris; de’ Angelis, Gian L; Delibegovic, Samir; Demetrashvili, Zaza; De Simone, Belinda; Di Marzo, Francesco; Di Saverio, Salomone; Duane, Therese M; Faro, Mario P; Fraga, Gustavo P; Gkiokas, George; Gomes, Carlos A; Hardcastle, Timothy C; Hecker, Andreas; Karamarkovic, Aleksandar; Kashuk, Jeffry; Khokha, Vladimir; Kirkpatrick, Andrew W; Kok, Kenneth Y Y; Inaba, Kenji; Isik, Arda; Labricciosa, Francesco M; Latifi, Rifat; Leppäniemi, Ari; Litvin, Andrey; Mazuski, John E; Maier, Ronald V; Marwah, Sanjay; McFarlane, Michael; Moore, Ernest E; Moore, Frederick A; Negoi, Ionut; Pagani, Leonardo; Rasa, Kemal; Rubio-Perez, Ines; Sakakushev, Boris; Sato, Norio; Sganga, Gabriele; Siquini, Walter; Tarasconi, Antonio; Tolonen, Matti; Ulrych, Jan; Zachariah, Sannop K; Catena, FaustoAbstract Acute colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of acute left-sided colonic diverticulitis (ALCD) according to the most recent available literature. The update includes recent changes introduced in the management of ALCD. The new update has been further integrated with advances in acute right-sided colonic diverticulitis (ARCD) that is more common than ALCD in select regions of the world.Item Open Access 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy(2021-06-10) de’Angelis, Nicola; Catena, Fausto; Memeo, Riccardo; Coccolini, Federico; Martínez-Pérez, Aleix; Romeo, Oreste M.; De Simone, Belinda; Di Saverio, Salomone; Brustia, Raffaele; Rhaiem, Rami; Piardi, Tullio; Conticchio, Maria; Marchegiani, Francesco; Beghdadi, Nassiba; Abu-Zidan, Fikri M.; Alikhanov, Ruslan; Allard, Marc-Antoine; Allievi, Niccolò; Amaddeo, Giuliana; Ansaloni, Luca; Andersson, Roland; Andolfi, Enrico; Azfar, Mohammad; Bala, Miklosh; Benkabbou, Amine; Ben-Ishay, Offir; Bianchi, Giorgio; Biffl, Walter L.; Brunetti, Francesco; Carra, Maria C.; Casanova, Daniel; Celentano, Valerio; Ceresoli, Marco; Chiara, Osvaldo; Cimbanassi, Stefania; Bini, Roberto; Coimbra, Raul; Luigi de’Angelis, Gian; Decembrino, Francesco; De Palma, Andrea; de Reuver, Philip R.; Domingo, Carlos; Cotsoglou, Christian; Ferrero, Alessandro; Fraga, Gustavo P.; Gaiani, Federica; Gheza, Federico; Gurrado, Angela; Harrison, Ewen; Henriquez, Angel; Hofmeyr, Stefan; Iadarola, Roberta; Kashuk, Jeffry L.; Kianmanesh, Reza; Kirkpatrick, Andrew W.; Kluger, Yoram; Landi, Filippo; Langella, Serena; Lapointe, Real; Le Roy, Bertrand; Luciani, Alain; Machado, Fernando; Maggi, Umberto; Maier, Ronald V.; Mefire, Alain C.; Hiramatsu, Kazuhiro; Ordoñez, Carlos; Patrizi, Franca; Planells, Manuel; Peitzman, Andrew B.; Pekolj, Juan; Perdigao, Fabiano; Pereira, Bruno M.; Pessaux, Patrick; Pisano, Michele; Puyana, Juan C.; Rizoli, Sandro; Portigliotti, Luca; Romito, Raffaele; Sakakushev, Boris; Sanei, Behnam; Scatton, Olivier; Serradilla-Martin, Mario; Schneck, Anne-Sophie; Sissoko, Mohammed L.; Sobhani, Iradj; ten Broek, Richard P.; Testini, Mario; Valinas, Roberto; Veloudis, Giorgos; Vitali, Giulio C.; Weber, Dieter; Zorcolo, Luigi; Giuliante, Felice; Gavriilidis, Paschalis; Fuks, David; Sommacale, DanieleAbstract Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.Item Open Access 2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery(2023-09-09) de’Angelis, Nicola; Schena, Carlo A.; Marchegiani, Francesco; Reitano, Elisa; De Simone, Belinda; Wong, Geoffrey Y. M.; Martínez-Pérez, Aleix; Abu-Zidan, Fikri M.; Agnoletti, Vanni; Aisoni, Filippo; Ammendola, Michele; Ansaloni, Luca; Bala, Miklosh; Biffl, Walter; Ceccarelli, Graziano; Ceresoli, Marco; Chiara, Osvaldo; Chiarugi, Massimo; Cimbanassi, Stefania; Coccolini, Federico; Coimbra, Raul; Di Saverio, Salomone; Diana, Michele; Dioguardi Burgio, Marco; Fraga, Gustavo; Gavriilidis, Paschalis; Gurrado, Angela; Inchingolo, Riccardo; Ingels, Alexandre; Ivatury, Rao; Kashuk, Jeffry L.; Khan, Jim; Kirkpatrick, Andrew W.; Kim, Fernando J.; Kluger, Yoram; Lakkis, Zaher; Leppäniemi, Ari; Maier, Ronald V.; Memeo, Riccardo; Moore, Ernest E.; Ordoñez, Carlos A.; Peitzman, Andrew B.; Pellino, Gianluca; Picetti, Edoardo; Pikoulis, Manos; Pisano, Michele; Podda, Mauro; Romeo, Oreste; Rosa, Fausto; Tan, Edward; Ten Broek, Richard P.; Testini, Mario; Tian Wei Cheng, Brian A.; Weber, Dieter; Sacco, Emilio; Sartelli, Massimo; Tonsi, Alfredo; Dal Moro, Fabrizio; Catena, FaustoAbstract Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.Item Open Access A pandemic recap: lessons we have learned(2021-09-10) Coccolini, Federico; Cicuttin, Enrico; Cremonini, Camilla; Tartaglia, Dario; Viaggi, Bruno; Kuriyama, Akira; Picetti, Edoardo; Ball, Chad; Abu-Zidan, Fikri; Ceresoli, Marco; Turri, Bruno; Jain, Sumita; Palombo, Carlo; Guirao, Xavier; Rodrigues, Gabriel; Gachabayov, Mahir; Machado, Fernando; Eftychios, Lostoridis; Kanj, Souha S.; Di Carlo, Isidoro; Di Saverio, Salomone; Khokha, Vladimir; Kirkpatrick, Andrew; Massalou, Damien; Forfori, Francesco; Corradi, Francesco; Delibegovic, Samir; Machain Vega, Gustavo M.; Fantoni, Massimo; Demetriades, Demetrios; Kapoor, Garima; Kluger, Yoram; Ansari, Shamshul; Maier, Ron; Leppaniemi, Ari; Hardcastle, Timothy; Vereczkei, Andras; Karamagioli, Evika; Pikoulis, Emmanouil; Pistello, Mauro; Sakakushev, Boris E.; Navsaria, Pradeep H.; Galeiras, Rita; Yahya, Ali I.; Osipov, Aleksei V.; Dimitrov, Evgeni; Doklestić, Krstina; Pisano, Michele; Malacarne, Paolo; Carcoforo, Paolo; Sibilla, Maria G.; Kryvoruchko, Igor A.; Bonavina, Luigi; Kim, Jae I.; Shelat, Vishal G.; Czepiel, Jacek; Maseda, Emilio; Marwah, Sanjay; Chirica, Mircea; Biancofiore, Giandomenico; Podda, Mauro; Cobianchi, Lorenzo; Ansaloni, Luca; Fugazzola, Paola; Seretis, Charalampos; Gomez, Carlos A.; Tumietto, Fabio; Malbrain, Manu; Reichert, Martin; Augustin, Goran; Amato, Bruno; Puzziello, Alessandro; Hecker, Andreas; Gemignani, Angelo; Isik, Arda; Cucchetti, Alessandro; Nacoti, Mirco; Kopelman, Doron; Mesina, Cristian; Ghannam, Wagih; Ben-Ishay, Offir; Dhingra, Sameer; Coimbra, Raul; Moore, Ernest E.; Cui, Yunfeng; Quiodettis, Martha A.; Bala, Miklosh; Testini, Mario; Diaz, Jose; Girardis, Massimo; Biffl, Walter L.; Hecker, Matthias; Sall, Ibrahima; Boggi, Ugo; Materazzi, Gabriele; Ghiadoni, Lorenzo; Matsumoto, Junichi; Zuidema, Wietse P.; Ivatury, Rao; Enani, Mushira A.; Litvin, Andrey; Al-Hasan, Majdi N.; Demetrashvili, Zaza; Baraket, Oussama; Ordoñez, Carlos A.; Negoi, Ionut; Kiguba, Ronald; Memish, Ziad A.; Elmangory, Mutasim M.; Tolonen, Matti; Das, Korey; Ribeiro, Julival; O’Connor, Donal B.; Tan, Boun K.; Van Goor, Harry; Baral, Suman; De Simone, Belinda; Corbella, Davide; Brambillasca, Pietro; Scaglione, Michelangelo; Basolo, Fulvio; De’Angelis, Nicola; Bendinelli, Cino; Weber, Dieter; Pagani, Leonardo; Monti, Cinzia; Baiocchi, Gianluca; Chiarugi, Massimo; Catena, Fausto; Sartelli, MassimoAbstract 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.Item Open Access Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group(2018-06-19) ten Broek, Richard P G; Krielen, Pepijn; Di Saverio, Salomone; Coccolini, Federico; Biffl, Walter L; Ansaloni, Luca; Velmahos, George C; Sartelli, Massimo; Fraga, Gustavo P; Kelly, Michael D; Moore, Frederick A; Peitzman, Andrew B; Leppaniemi, Ari; Moore, Ernest E; Jeekel, Johannes; Kluger, Yoram; Sugrue, Michael; Balogh, Zsolt J; Bendinelli, Cino; Civil, Ian; Coimbra, Raul; De Moya, Mark; Ferrada, Paula; Inaba, Kenji; Ivatury, Rao; Latifi, Rifat; Kashuk, Jeffry L; Kirkpatrick, Andrew W; Maier, Ron; Rizoli, Sandro; Sakakushev, Boris; Scalea, Thomas; Søreide, Kjetil; Weber, Dieter; Wani, Imtiaz; Abu-Zidan, Fikri M; De’Angelis, Nicola; Piscioneri, Frank; Galante, Joseph M; Catena, Fausto; van Goor, HarryAbstract Background Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups. Methods The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion. Recommendations Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO. Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention. Discussion This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.Item Open Access Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (the COOL trial): study protocol for a randomized controlled trial(2018-06-22) Kirkpatrick, Andrew W; Coccolini, Federico; Ansaloni, Luca; Roberts, Derek J; Tolonen, Matti; McKee, Jessica L; Leppaniemi, Ari; Faris, Peter; Doig, Christopher J; Catena, Fausto; Fabian, Timothy; Jenne, Craig N; Chiara, Osvaldo; Kubes, Paul; Manns, Braden; Kluger, Yoram; Fraga, Gustavo P; Pereira, Bruno M; Diaz, Jose J; Sugrue, Michael; Moore, Ernest E; Ren, Jianan; Ball, Chad G; Coimbra, Raul; Balogh, Zsolt J; Abu-Zidan, Fikri M; Dixon, Elijah; Biffl, Walter; MacLean, Anthony; Ball, Ian; Drover, John; McBeth, Paul B; Posadas-Calleja, Juan G; Parry, Neil G; Di Saverio, Salomone; Ordonez, Carlos A; Xiao, Jimmy; Sartelli, MassimoAbstract Background Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. Principles of treatment include early antibiotic administration and operative source control. A further therapeutic option may be open abdomen (OA) management with active negative peritoneal pressure therapy (ANPPT) to remove inflammatory ascites and ameliorate the systemic damage from SCIAS. Although there is now a biologic rationale for such an intervention as well as non-standardized and erratic clinical utilization, this remains a novel therapy with potential side effects and clinical equipoise. Methods The Closed Or Open after Laparotomy (COOL) study will constitute a prospective randomized controlled trial that will randomly allocate eligible surgical patients intra-operatively to either formal closure of the fascia or use of the OA with application of an ANPTT dressing. Patients will be eligible if they have free uncontained intra-peritoneal contamination and physiologic derangements exemplified by septic shock OR a Predisposition-Infection-Response-Organ Dysfunction Score ≥ 3 or a World-Society-of-Emergency-Surgery-Sepsis-Severity-Score ≥ 8. The primary outcome will be 90-day survival. Secondary outcomes will be logistical, physiologic, safety, bio-mediators, microbiological, quality of life, and health-care costs. Secondary outcomes will include days free of ICU, ventilation, renal replacement therapy, and hospital at 30 days from the index laparotomy. Physiologic secondary outcomes will include changes in intensive care unit illness severity scores after laparotomy. Bio-mediator outcomes for participating centers will involve measurement of interleukin (IL)-6 and IL-10, procalcitonin, activated protein C (APC), high-mobility group box protein-1, complement factors, and mitochondrial DNA. Economic outcomes will comprise standard costing for utilization of health-care resources. Discussion Although facial closure after SCIAS is considered the current standard of care, many reports are suggesting that OA management may improve outcomes in these patients. This trial will be powered to demonstrate a mortality difference in this highly lethal and morbid condition to ensure critically ill patients are receiving the best care possible and not being harmed by inappropriate therapies based on opinion only. Trial registration ClinicalTrials.gov , NCT03163095 .Item Open Access Correction: ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings(2023-11-27) 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 N.; 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 M. G.; Gosal, Preet K. S.; Balasubramaniam, Sunder; Hsu, Jeremy; Banphawatanarak, Kamon; Pisano, Michele; Toro, Adriana; Michele, Altomare; Cioffi, Stefano P. B.; Spota, Andrea; Catena, Fausto; Ansaloni, LucaItem Open Access COVID-19 the showdown for mass casualty preparedness and management: the Cassandra Syndrome(2020-04-09) Coccolini, Federico; Sartelli, Massimo; Kluger, Yoram; Pikoulis, Emmanouil; Karamagioli, Evika; Moore, Ernest E; Biffl, Walter L; Peitzman, Andrew; Hecker, Andreas; Chirica, Mircea; Damaskos, Dimitrios; Ordonez, Carlos; Vega, Felipe; Fraga, Gustavo P; Chiarugi, Massimo; Di Saverio, Salomone; Kirkpatrick, Andrew W; Abu-Zidan, Fikri; Mefire, Alain C; Leppaniemi, Ari; Khokha, Vladimir; Sakakushev, Boris; Catena, Rodolfo; Coimbra, Raul; Ansaloni, Luca; Corbella, Davide; Catena, FaustoAbstract Since December 2019, the world is potentially facing one of the most difficult infectious situations of the last decades. COVID-19 epidemic warrants consideration as a mass casualty incident (MCI) of the highest nature. An optimal MCI/disaster management should consider all four phases of the so-called disaster cycle: mitigation, planning, response, and recovery. COVID-19 outbreak has demonstrated the worldwide unpreparedness to face a global MCI. This present paper thus represents a call for action to solicitate governments and the Global Community to actively start effective plans to promote and improve MCI management preparedness in general, and with an obvious current focus on COVID-19.Item Open Access ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings(2023-07-26) 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 N.; 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 M. G.; Gosal, Preet K. S.; Balasubramaniam, Sunder; Hsu, Jeremy; Banphawatanarak, Kamon; Pisano, Michele; Adriana, Toro; Michele, Altomare; Cioffi, Stefano P. B.; Spota, Andrea; Catena, Fausto; Ansaloni, LucaAbstract 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.Item Open Access Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document(2022-10-12) Podda, Mauro; De Simone, Belinda; Ceresoli, Marco; Virdis, Francesco; Favi, Francesco; Wiik Larsen, Johannes; Coccolini, Federico; Sartelli, Massimo; Pararas, Nikolaos; Beka, Solomon G.; 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; de’Angelis, Nicola; Chirica, Mircea; Galante, Joseph; Kirkpatrick, Andrew; Pikoulis, Emmanouil; Kluger, Yoram; Bensard, Denis; Ansaloni, Luca; Fraga, Gustavo; Civil, Ian; Tebala, Giovanni D.; 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, FaustoAbstract 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.Item Open Access Getting the invite list right: a discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteria(2018-04-06) Tolonen, Matti; Coccolini, Federico; Ansaloni, Luca; Sartelli, Massimo; Roberts, Derek J; McKee, Jessica L; Leppaniemi, Ari; Doig, Christopher J; Catena, Fausto; Fabian, Timothy; Jenne, Craig N; Chiara, Osvaldo; Kubes, Paul; Kluger, Yoram; Fraga, Gustavo P; Pereira, Bruno M; Diaz, Jose J; Sugrue, Michael; Moore, Ernest E; Ren, Jianan; Ball, Chad G; Coimbra, Raul; Dixon, Elijah; Biffl, Walter; MacLean, Anthony; McBeth, Paul B; Posadas-Calleja, Juan G; Di Saverio, Salomone; Xiao, Jimmy; Kirkpatrick, Andrew WAbstract Background Severe complicated intra-abdominal sepsis (SCIAS) is a worldwide challenge with increasing incidence. Open abdomen management with enhanced clearance of fluid and biomediators from the peritoneum is a potential therapy requiring prospective evaluation. Given the complexity of powering multi-center trials, it is essential to recruit an inception cohort sick enough to benefit from the intervention; otherwise, no effect of a potentially beneficial therapy may be apparent. An evaluation of abilities of recognized predictive systems to recognize SCIAS patients was conducted using an existing intra-abdominal sepsis (IAS) database. Methods All consecutive adult patients with a diffuse secondary peritonitis between 2012 and 2013 were collected from a quaternary care hospital in Finland, excluding appendicitis/cholecystitis. From this retrospectively collected database, a target population (93) of those with either ICU admission or mortality were selected. The performance metrics of the Third Consensus Definitions for Sepsis and Septic Shock based on both SOFA and quick SOFA, the World Society of Emergency Surgery Sepsis Severity Score (WSESSSS), the APACHE II score, Manheim Peritonitis Index (MPI), and the Calgary Predisposition, Infection, Response, and Organ dysfunction (CPIRO) score were all tested for their discriminant ability to identify this subgroup with SCIAS and to predict mortality. Results Predictive systems with an area under-the-receiving-operating characteristic (AUC) curve > 0.8 included SOFA, Sepsis-3 definitions, APACHE II, WSESSSS, and CPIRO scores with the overall best for CPIRO. The highest identification rates were SOFA score ≥ 2 (78.4%), followed by the WSESSSS score ≥ 8 (73.1%), SOFA ≥ 3 (75.2%), and APACHE II ≥ 14 (68.8%) identification. Combining the Sepsis-3 septic-shock definition and WSESSS ≥ 8 increased detection to 80%. Including CPIRO score ≥ 3 increased this to 82.8% (Sensitivity-SN; 83% Specificity-SP; 74%. Comparatively, SOFA ≥ 4 and WSESSSS ≥ 8 with or without septic-shock had 83.9% detection (SN; 84%, SP; 75%, 25% mortality). Conclusions No one scoring system behaves perfectly, and all are largely dominated by organ dysfunction. Utilizing combinations of SOFA, CPIRO, and WSESSSS scores in addition to the Sepsis-3 septic shock definition appears to offer the widest “inclusion-criteria” to recognize patients with a high chance of mortality and ICU admission. Trial registration https://clinicaltrials.gov/ct2/show/NCT03163095 ; Registered on May 22, 2017.Item Open Access Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines(2020-02-10) De Simone, Belinda; Sartelli, Massimo; Coccolini, Federico; Ball, Chad G; Brambillasca, Pietro; Chiarugi, Massimo; Campanile, Fabio C; Nita, Gabriela; Corbella, Davide; Leppaniemi, Ari; Boschini, Elena; Moore, Ernest E; Biffl, Walter; Peitzmann, Andrew; Kluger, Yoram; Sugrue, Michael; Fraga, Gustavo; Di Saverio, Salomone; Weber, Dieter; Sakakushev, Boris; Chiara, Osvaldo; Abu-Zidan, Fikri M; ten Broek, Richard; Kirkpatrick, Andrew W; Wani, Imtiaz; Coimbra, Raul; Baiocchi, Gian L; Kelly, Micheal D; Ansaloni, Luca; Catena, FaustoAbstract Background Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections. Methods The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES. Results Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI. Conclusions The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.Item Open Access Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference(2017-05-04) Sartelli, Massimo; Catena, Fausto; Abu-Zidan, Fikri M; Ansaloni, Luca; Biffl, Walter L; Boermeester, Marja A; Ceresoli, Marco; Chiara, Osvaldo; Coccolini, Federico; De Waele, Jan J; Di Saverio, Salomone; Eckmann, Christian; Fraga, Gustavo P; Giannella, Maddalena; Girardis, Massimo; Griffiths, Ewen A; Kashuk, Jeffry; Kirkpatrick, Andrew W; Khokha, Vladimir; Kluger, Yoram; Labricciosa, Francesco M; Leppaniemi, Ari; Maier, Ronald V; May, Addison K; Malangoni, Mark; Martin-Loeches, Ignacio; Mazuski, John; Montravers, Philippe; Peitzman, Andrew; Pereira, Bruno M; Reis, Tarcisio; Sakakushev, Boris; Sganga, Gabriele; Soreide, Kjetil; Sugrue, Michael; Ulrych, Jan; Vincent, Jean-Louis; Viale, Pierluigi; Moore, Ernest EAbstract This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.Item Open Access Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines(2023-07-21) 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 t.; Baiocchi, Gian L.; 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 G.; 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; Kirkpatrick, Andrew W.Abstract Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.Item Open Access Splenic trauma: WSES classification and guidelines for adult and pediatric patients(2017-08-18) Coccolini, Federico; Montori, Giulia; Catena, Fausto; Kluger, Yoram; Biffl, Walter; Moore, Ernest E; Reva, Viktor; Bing, Camilla; Bala, Miklosh; Fugazzola, Paola; Bahouth, Hany; Marzi, Ingo; Velmahos, George; Ivatury, Rao; Soreide, Kjetil; Horer, Tal; ten Broek, Richard; Pereira, Bruno M; Fraga, Gustavo P; Inaba, Kenji; Kashuk, Joseph; Parry, Neil; Masiakos, Peter T; Mylonas, Konstantinos S; Kirkpatrick, Andrew; Abu-Zidan, Fikri; Gomes, Carlos A; Benatti, Simone V; Naidoo, Noel; Salvetti, Francesco; Maccatrozzo, Stefano; Agnoletti, Vanni; Gamberini, Emiliano; Solaini, Leonardo; Costanzo, Antonio; Celotti, Andrea; Tomasoni, Matteo; Khokha, Vladimir; Arvieux, Catherine; Napolitano, Lena; Handolin, Lauri; Pisano, Michele; Magnone, Stefano; Spain, David A; de Moya, Marc; Davis, Kimberly A; De Angelis, Nicola; Leppaniemi, Ari; Ferrada, Paula; Latifi, Rifat; Navarro, David C; Otomo, Yashuiro; Coimbra, Raul; Maier, Ronald V; Moore, Frederick; Rizoli, Sandro; Sakakushev, Boris; Galante, Joseph M; Chiara, Osvaldo; Cimbanassi, Stefania; Mefire, Alain C; Weber, Dieter; Ceresoli, Marco; Peitzman, Andrew B; Wehlie, Liban; Sartelli, Massimo; Di Saverio, Salomone; Ansaloni, LucaAbstract 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.Item Open Access Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper(2024-10-18) Sermonesi, Giacomo; Bertelli, Riccardo; Pieracci, Fredric M.; Balogh, Zsolt J.; Coimbra, Raul; Galante, Joseph M.; Hecker, Andreas; Weber, Dieter; Bauman, Zachary M.; Kartiko, Susan; Patel, Bhavik; Whitbeck, SarahAnn S.; White, Thomas W.; Harrell, Kevin N.; Perrina, Daniele; Rampini, Alessia; Tian, Brian; Amico, Francesco; Beka, Solomon G.; Bonavina, Luigi; Ceresoli, Marco; Cobianchi, Lorenzo; Coccolini, Federico; Cui, Yunfeng; Dal Mas, Francesca; De Simone, Belinda; Di Carlo, Isidoro; Di Saverio, Salomone; Dogjani, Agron; Fette, Andreas; Fraga, Gustavo P.; Gomes, Carlos A.; Khan, Jim S.; Kirkpatrick, Andrew W.; Kruger, Vitor F.; Leppäniemi, Ari; Litvin, Andrey; Mingoli, Andrea; Navarro, David C.; Passera, Eliseo; Pisano, Michele; Podda, Mauro; Russo, Emanuele; Sakakushev, Boris; Santonastaso, Domenico; Sartelli, Massimo; Shelat, Vishal G.; Tan, Edward; Wani, Imtiaz; Abu-Zidan, Fikri M.; Biffl, Walter L.; Civil, Ian; Latifi, Rifat; Marzi, Ingo; Picetti, Edoardo; Pikoulis, Manos; Agnoletti, Vanni; Bravi, Francesca; Vallicelli, Carlo; Ansaloni, Luca; Moore, Ernest E.; Catena, FaustoAbstract Background Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF. 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 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements. Results A total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection. Conclusion This consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research.Item Open Access The 2023 WSES guidelines on the management of trauma in elderly and frail patients(2024-05-31) De Simone, Belinda; Chouillard, Elie; Podda, Mauro; Pararas, Nikolaos; de Carvalho Duarte, Gustavo; Fugazzola, Paola; Birindelli, Arianna; Coccolini, Federico; Polistena, Andrea; Sibilla, Maria G.; Kruger, Vitor; Fraga, Gustavo P.; 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 E.; Romeo, Oreste M.; Abu-Zidan, Fikri M.; Beka, Solomon G.; Weber, Dieter G.; Tan, Edward C. T. H.; Paolillo, Ciro; Cui, Yunfeng; Kim, Fernando; Picetti, Edoardo; Di Carlo, Isidoro; Toro, Adriana; Sganga, Gabriele; Sganga, Federica; Testini, Mario; Di Meo, Giovanna; Kirkpatrick, Andrew W.; Marzi, Ingo; déAngelis, Nicola; Kelly, Michael D.; Wani, Imtiaz; Sakakushev, Boris; Bala, Miklosh; Bonavina, Luigi; Galante, Joseph M.; Shelat, Vishal G.; Cobianchi, Lorenzo; Mas, Francesca D.; Pikoulis, Manos; Damaskos, Dimitrios; Coimbra, Raul; Dhesi, Jugdeep; Hoffman, Melissa R.; Stahel, Philip F.; Maier, Ronald V.; Litvin, Andrey; Latifi, Rifat; Biffl, Walter L.; Catena, FaustoAbstract 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 patient’s 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. Graphical abstractItem Open Access The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?(2022-12-16) De Simone, Belinda; Abu-Zidan, Fikri M.; Chouillard, Elie; Di Saverio, Salomone; Sartelli, Massimo; Podda, Mauro; Gomes, Carlos A.; Moore, Ernest E.; Moug, Susan J.; Ansaloni, Luca; Kluger, Yoram; Coccolini, Federico; Landaluce-Olavarria, Aitor; Estraviz-Mateos, Begoña; Uriguen-Etxeberria, Ana; Giordano, Alessio; Luna, Alfonso P.; Amín, Luz A. H.; Hernández, Adriana M. P.; Shabana, Amanda; Dzulkarnaen, Zakaria A.; Othman, Muhammad A.; Sani, Mohamad I.; Balla, Andrea; Scaramuzzo, Rosa; Lepiane, Pasquale; Bottari, Andrea; Staderini, Fabio; Cianchi, Fabio; Cavallaro, Andrea; Zanghì, Antonio; Cappellani, Alessandro; Campagnacci, Roberto; Maurizi, Angela; Martinotti, Mario; Ruggieri, Annamaria; Jusoh, Asri C.; Rahman, Karim A.; Zulkifli, Anis S. M.; Petronio, Barbara; Matías-García, Belén; Quiroga-Valcárcel, Ana; Mendoza-Moreno, Fernando; Atanasov, Boyko; Campanile, Fabio C.; Vecchioni, Ilaria; Cardinali, Luca; Travaglini, Grazia; Sebastiani, Elisa; Chooklin, Serge; Chuklin, Serhii; Cianci, Pasquale; Restini, Enrico; Capuzzolo, Sabino; Currò, Giuseppe; Filippo, Rosalinda; Rispoli, Michele; Aparicio-Sánchez, Daniel; Muñóz-Cruzado, Virginia D.; Barbeito, Sandra D.; Delibegovic, Samir; Kesetovic, Amar; Sasia, Diego; Borghi, Felice; Giraudo, Giorgio; Visconti, Diego; Doria, Emanuele; Santarelli, Mauro; Luppi, Davide; Bonilauri, Stefano; Grossi, Ugo; Zanus, Giacomo; Sartori, Alberto; Piatto, Giacomo; De Luca, Maurizio; Vita, Domenico; Conti, Luigi; Capelli, Patrizio; Cattaneo, Gaetano M.; Marinis, Athanasios; Vederaki, Styliani-Aikaterini; Bayrak, Mehmet; Altıntas, Yasemin; Uzunoglu, Mustafa Y.; Demirbas, Iskender E.; Altinel, Yuksel; Meric, Serhat; Aktimur, Yunus E.; Uymaz, Derya S.; Omarov, Nail; Azamat, Ibrahim; Lostoridis, Eftychios; Nagorni, Eleni-Aikaterini; Pujante, Antonio; Anania, Gabriele; Bombardini, Cristina; Bagolini, Francesco; Gonullu, Emre; Mantoglu, Baris; Capoglu, Recayi; Cappato, Stefano; Muzio, Elena; Colak, Elif; Polat, Suleyman; Koylu, Zehra A.; Altintoprak, Fatih; Bayhan, Zülfü; Akin, Emrah; Andolfi, Enrico; Rezart, Sulce; Kim, Jae I.; Jung, Sung W.; Shin, Yong C.; Enciu, Octavian; Toma, Elena A.; Medas, Fabio; Canu, Gian L.; Cappellacci, Federico; D’Acapito, Fabrizio; Ercolani, Giorgio; Solaini, Leonardo; Roscio, Francesco; Clerici, Federico; Gelmini, Roberta; Serra, Francesco; Rossi, Elena G.; Fleres, Francesco; Clarizia, Guglielmo; Spolini, Alessandro; Ferrara, Francesco; Nita, Gabriela; Sarnari, Jlenia; Gachabayov, Mahir; Abdullaev, Abakar; Poillucci, Gaetano; Palini, Gian M.; Veneroni, Simone; Garulli, Gianluca; Piccoli, Micaela; Pattacini, Gianmaria C.; Pecchini, Francesca; Argenio, Giulio; Armellino, Mariano F.; Brisinda, Giuseppe; Tedesco, Silvia; Fransvea, Pietro; Ietto, Giuseppe; Franchi, Caterina; Carcano, Giulio; Martines, Gennaro; Trigiante, Giuseppe; Negro, Giulia; Vega, Gustavo M.; González, Agustín R.; Ojeda, Leonardo; Piccolo, Gaetano; Bondurri, Andrea; Maffioli, Anna; Guerci, Claudio; Sin, Boo H.; Zuhdi, Zamri; Azman, Azlanudin; Mousa, Hussam; al Bahri, Shadi; Augustin, Goran; Romic, Ivan; Moric, Trpimir; Nikolopoulos, Ioannis; Andreuccetti, Jacopo; Pignata, Giusto; D’Alessio, Rossella; Kenig, Jakub; Skorus, Urszula; Fraga, Gustavo P.; Hirano, Elcio S.; de Lima Bertuol, Jackson V.; Isik, Arda; Kurnaz, Eray; Asghar, Mohammad S.; Afzal, Ameer; Akbar, Ali; Nikolouzakis, Taxiarchis K.; Lasithiotakis, Konstantinos; Chrysos, Emmanuel; Das, Koray; Özer, Nazmi; Seker, Ahmet; Ibrahim, Mohamed; Hamid, Hytham K. S.; Babiker, Ahmed; Bouliaris, Konstantinos; Koukoulis, George; Kolla, Chrysoula-Christina; Lucchi, Andrea; Agostinelli, Laura; Taddei, Antonio; Fortuna, Laura; Agostini, Carlotta; Licari, Leo; Viola, Simona; Callari, Cosimo; Laface, Letizia; Abate, Emmanuele; Casati, Massimiliano; Anastasi, Alessandro; Canonico, Giuseppe; Gabellini, Linda; Tosi, Lorenzo; Guariniello, Anna; Zanzi, Federico; Bains, Lovenish; Sydorchuk, Larysa; Iftoda, Oksana; Sydorchuk, Andrii; Malerba, Michele; Costanzo, Federico; Galleano, Raffaele; Monteleone, Michela; Costanzi, Andrea; Riva, Carlo; Walędziak, Maciej; Kwiatkowski, Andrzej; Czyżykowski, Łukasz; Major, Piotr; Strzałka, Marcin; Matyja, Maciej; Natkaniec, Michal; Valenti, Maria R.; Di Vita, Maria D. P.; Sotiropoulou, Maria; Kapiris, Stylianos; Massalou, Damien; Veroux, Massimiliano; Volpicelli, Alessio; Gioco, Rossella; Uccelli, Matteo; Bonaldi, Marta; Olmi, Stefano; Nardi, Matteo; Livadoti, Giada; Mesina, Cristian; Dumitrescu, Theodor V.; Ciorbagiu, Mihai C.; Ammendola, Michele; Ammerata, Giorgio; Romano, Roberto; Slavchev, Mihail; Misiakos, Evangelos P.; Pikoulis, Emmanouil; Papaconstantinou, Dimitrios; Elbahnasawy, Mohamed; Abdel-elsalam, Sherief; Felsenreich, Daniel M.; Jedamzik, Julia; Michalopoulos, Nikolaos V.; Sidiropoulos, Theodoros A.; Papadoliopoulou, Maria; Cillara, Nicola; Deserra, Antonello; Cannavera, Alessandro; Negoi, Ionuţ; Schizas, Dimitrios; Syllaios, Athanasios; Vagios, Ilias; Gourgiotis, Stavros; Dai, Nick; Gurung, Rekha; Norrey, Marcus; Pesce, Antonio; Feo, Carlo V.; Fabbri, Nicolo’; Machairas, Nikolaos; Dorovinis, Panagiotis; Keramida, Myrto D.; Mulita, Francesk; Verras, Georgios I.; Vailas, Michail; Yalkin, Omer; Iflazoglu, Nidal; Yigit, Direnc; Baraket, Oussama; Ayed, Karim; Ghalloussi, Mohamed h.; Patias, Parmenion; Ntokos, Georgios; Rahim, Razrim; Bala, Miklosh; Kedar, Asaf; Sawyer, Robert G.; Trinh, Anna; Miller, Kelsey; Sydorchuk, Ruslan; Knut, Ruslan; Plehutsa, Oleksandr; Liman, Rumeysa K.; Ozkan, Zeynep; Kader, Saleh A.; Gupta, Sanjay; Gureh, Monika; Saeidi, Sara; Aliakbarian, Mohsen; Dalili, Amin; Shoko, Tomohisa; Kojima, Mitsuaki; Nakamoto, Raira; Atici, Semra D.; Tuncer, Gizem K.; Kaya, Tayfun; Delis, Spiros G.; Rossi, Stefano; Picardi, Biagio; del Monte, Simone R.; Triantafyllou, Tania; Theodorou, Dimitrios; Pintar, Tadeja; Salobir, Jure; Manatakis, Dimitrios K.; Tasis, Nikolaos; Acheimastos, Vasileios; Ioannidis, Orestis; Loutzidou, Lydia; Symeonidis, Savvas; de Sá, Tiago C.; Rocha, Mónica; Guagni, Tommaso; Pantalone, Desiré; Maltinti, Gherardo; Khokha, Vladimir; Abdel-elsalam, Wafaa; Ghoneim, Basma; López-Ruiz, José A.; Kara, Yasin; Zainudin, Syaza; Hayati, Firdaus; Azizan, Nornazirah; Khei, Victoria T. P.; Yi, Rebecca C. X.; Sellappan, Harivinthan; Demetrashvili, Zaza; Lekiashvili, Nika; Tvaladze, Ana; Froiio, Caterina; Bernardi, Daniele; Bonavina, Luigi; Gil-Olarte, Angeles; Grassia, Sebastiano; Romero-Vargas, Estela; Bianco, Francesco; Gumbs, Andrew A.; Dogjani, Agron; Agresta, Ferdinando; Litvin, Andrey; Balogh, Zsolt J.; Gendrikson, George; Martino, Costanza; Damaskos, Dimitrios; Pararas, Nikolaos; Kirkpatrick, Andrew; Kurtenkov, Mikhail; Gomes, Felipe C.; Pisanu, Adolfo; Nardello, Oreste; Gambarini, Fabrizio; Aref, Hager; Angelis, Nicola d.; Agnoletti, Vanni; Biondi, Antonio; Vacante, Marco; Griggio, Giulia; Tutino, Roberta; Massani, Marco; Bisetto, Giovanni; Occhionorelli, Savino; Andreotti, Dario; Lacavalla, Domenico; Biffl, Walter L.; Catena, FaustoAbstract Background The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands. Graphical abstractItem Open Access The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections(2017-07-10) Sartelli, Massimo; Chichom-Mefire, Alain; Labricciosa, Francesco M; Hardcastle, Timothy; Abu-Zidan, Fikri M; Adesunkanmi, Abdulrashid K; Ansaloni, Luca; Bala, Miklosh; Balogh, Zsolt J; Beltrán, Marcelo A; Ben-Ishay, Offir; Biffl, Walter L; Birindelli, Arianna; Cainzos, Miguel A; Catalini, Gianbattista; Ceresoli, Marco; Che Jusoh, Asri; Chiara, Osvaldo; Coccolini, Federico; Coimbra, Raul; Cortese, Francesco; Demetrashvili, Zaza; Di Saverio, Salomone; Diaz, Jose J; Egiev, Valery N; Ferrada, Paula; Fraga, Gustavo P; Ghnnam, Wagih M; Lee, Jae G; Gomes, Carlos A; Hecker, Andreas; Herzog, Torsten; Kim, Jae I; Inaba, Kenji; Isik, Arda; Karamarkovic, Aleksandar; Kashuk, Jeffry; Khokha, Vladimir; Kirkpatrick, Andrew W; Kluger, Yoram; Koike, Kaoru; Kong, Victor Y; Leppaniemi, Ari; Machain, Gustavo M; Maier, Ronald V; Marwah, Sanjay; McFarlane, Michael E; Montori, Giulia; Moore, Ernest E; Negoi, Ionut; Olaoye, Iyiade; Omari, Abdelkarim H; Ordonez, Carlos A; Pereira, Bruno M; Pereira Júnior, Gerson A; Pupelis, Guntars; Reis, Tarcisio; Sakakushev, Boris; Sato, Norio; Segovia Lohse, Helmut A; Shelat, Vishal G; Søreide, Kjetil; Uhl, Waldemar; Ulrych, Jan; Van Goor, Harry; Velmahos, George C; Yuan, Kuo-Ching; Wani, Imtiaz; Weber, Dieter G; Zachariah, Sanoop K; Catena, FaustoAbstract Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.