World Journal of Emergency Surgery最新文献

{"title":"Safety and efficacy of prophylactic onlay resorbable synthetic mesh with a comprehensive wound bundle at laparotomy closure in high-risk emergency abdominal surgery: an observational study","authors":"Emily Kelly, Angus Lloyd, Daniah Alsaadi, Ian Stephens, Michael Sugrue","doi":"10.1186/s13017-025-00579-6","DOIUrl":"https://doi.org/10.1186/s13017-025-00579-6","url":null,"abstract":"There has been a slow uptake of wound bundles and prophylactic mesh augmentation (PMA) strategies despite evidence supporting their role in reducing burst abdomens and incisional hernias (IH). This study evaluates outcomes of resorbable synthetic prophylactic mesh augmentation in reducing these rates and assesses the complication profile in emergency abdominal surgery. A retrospective ethically approved observational study of all patients who underwent emergency open abdominal surgery using supplemental prophylactic onlay TIGR® Mesh at Letterkenny University Hospital between September 2017 and April 2024 was undertaken to assess safety, complication profiles and outcomes. Comprehensive wound bundles and subcutaneous space closure were used. Of the 49 patients included, the mean age was 64 years (± 16.4, 31–86), 33/49 (67%) were female, and the mean body mass index (BMI) was 27 (± 7.4,17.3–45). 20% of patients had previous abdominal surgery. 19/49 (38%) patients experienced postoperative complications, of these 8 (42%) were Clavien-Dindo Grade I-II, and 11 (58%) were Grade III-IV. There were 7 in-hospital post-operative deaths (Grade V). 8 patients had open abdomens. Thirteen surgical site occurrences (SSO) were identified in 9 (18%) patients. There were no burst abdomens. Four of the superficial SSIs responded to antibiotics while one required opening and wound NPWT. Three patients (6%) developed an incisional hernia, which was detected at a mean follow-up of 353 days. A comprehensive, evidence-based wound bundle using onlay PMA with a synthetic resorbable mesh, achieves efficacious, safe abdominal wall closure in high-risk, emergency laparotomy patients, including those who require delayed abdominal wall closure.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"53 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning for the rElapse risk eValuation in acute biliary pancreatitis: The deep learning MINERVA study protocol","authors":"Mauro Podda, Adolfo Pisanu, Gianluca Pellino, Adriano De Simone, Lucio Selvaggi, Valentina Murzi, Eleonora Locci, Matteo Rottoli, Giacomo Calini, Stefano Cardelli, Fausto Catena, Carlo Vallicelli, Raffaele Bova, Gabriele Vigutto, Fabrizio D’Acapito, Giorgio Ercolani, Leonardo Solaini, Alan Biloslavo, Paola Germani, Camilla Colutta, Savino Occhionorelli, Domenico Lacavalla, Maria Grazia Sibilla, Stefano Olmi, Matteo Uccelli, Alberto Oldani, Alessio Giordano, Tommaso Guagni, Davina Perini, Francesco Pata, Bruno Nardo, Daniele Paglione, Giusi Franco, Matteo Donadon, Marcello Di Martino, Dario Bruzzese, Daniela Pacella","doi":"10.1186/s13017-025-00594-7","DOIUrl":"https://doi.org/10.1186/s13017-025-00594-7","url":null,"abstract":"Mild acute biliary pancreatitis (MABP) presents significant clinical and economic challenges due to its potential for relapse. Current guidelines advocate for early cholecystectomy (EC) during the same hospital admission to prevent recurrent acute pancreatitis (RAP). Despite these recommendations, implementation in clinical practice varies, highlighting the need for reliable and accessible predictive tools. The MINERVA study aims to develop and validate a machine learning (ML) model to predict the risk of RAP (at 30, 60, 90 days, and at 1-year) in MABP patients, enhancing decision-making processes. The MINERVA study will be conducted across multiple academic and community hospitals in Italy. Adult patients with a clinical diagnosis of MABP, in accordance with the revised Atlanta Criteria, who have not undergone EC during index admission will be included. Exclusion criteria encompass non-biliary aetiology, severe pancreatitis, and the inability to provide informed consent. The study involves both retrospective data from the MANCTRA-1 study and prospective data collection. Data will be captured using REDCap. The ML model will utilise convolutional neural networks (CNN) for feature extraction and risk prediction. The model includes the following steps: the spatial transformation of variables using kernel Principal Component Analysis (kPCA), the creation of 2D images from transformed data, the application of convolutional filters, max-pooling, flattening, and final risk prediction via a fully connected layer. Performance metrics such as accuracy, precision, recall, and area under the ROC curve (AUC) will be used to evaluate the model. The MINERVA study aims to address the specific gap in predicting RAP risk in MABP patients by leveraging advanced ML techniques. By incorporating a wide range of clinical and demographic variables, the MINERVA score aims to provide a reliable, cost-effective, and accessible tool for healthcare professionals. The project emphasises the practical application of AI in clinical settings, potentially reducing the incidence of RAP and associated healthcare costs. ClinicalTrials.gov ID: NCT06124989.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted puncture versus conservative treatment for severe brainstem hemorrhage: clinical outcomes comparison with experience of 138 cases in a single medical center","authors":"Xingwang Sun, Junhao Zhu, Miao Lu, Zhibin Zhang, Cuiling Li, Rucai Zhan","doi":"10.1186/s13017-025-00592-9","DOIUrl":"https://doi.org/10.1186/s13017-025-00592-9","url":null,"abstract":"The application of robot-assisted surgical technology in treating brainstem hemorrhage has garnered increasing attention. Treatments such as stereotactic hematoma aspiration and neuroendoscopic surgery are becoming more prevalent in China. The aim of this study is to provide a detailed comparative analysis of the clinical effects of robot-assisted puncture technology versus traditional conservative treatment, offering a scientific basis for optimizing treatment plans and improving patient outcomes. A retrospective observational study was conducted from January 2019 to December 2023 at a single neurosurgery center. A total of 138 patients with severe brainstem hemorrhage were included, with 103 in the conservative treatment group and 35 in the robot-assisted puncture group.ROSA robot-assisted brainstem hemorrhage drainage is a precise neurosurgical procedure involving pre-surgical evaluations and examinations, including cranial CT, to determine the hemorrhage’s location, extent, and severity. Baseline data was extracted from the hospital’s electronic medical record system, including demographics, medical history, and clinical characteristics. Statistical analysis was performed to compare outcomes between the two treatment groups. The baseline characteristics of the patients in both groups were similar, with no significant differences in age, gender, smoking history, alcohol consumption, or other relevant factors. The median stay time was longer in the robot-assisted group (21.0 days) compared to the conservative group (15.0 days), with a significant difference (p = 0.004). The median cost of hospitalization was also higher in the robot-assisted group (105231.0 yuan) compared to the conservative group (55221.5 yuan), with a significant difference (p < 0.001). The mortality rate of the robot assisted group was significantly lower than that of the conservative treatment group, and the difference was significant. Additionally, the robot-assisted group had a lower discharge hematoma volume and a trend towards better clinical outcomes, as measured by the Glasgow Coma Scale (GCS) and modified Rankin Scale (mRS) scores. The results suggest that robot-assisted puncture technology may offer improved clinical outcomes in patients with brainstem hemorrhage compared to traditional conservative treatment. The precision and accuracy of the ROSA robot may contribute to better hematoma drainage and reduced complications. While the cost of hospitalization was higher in the robot-assisted group, the potential for improved patient outcomes and reduced long-term healthcare costs should be considered when evaluating the cost-effectiveness of this treatment approach. Further research is needed to validate these findings in larger, multicenter studies and to explore the potential benefits of robot-assisted treatment in different subpopulations of patients with brainstem hemorrhage. This study provides preliminary evidence that robot-assisted puncture technology may offer","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"174 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 infection is a significant risk factor for death in patients presenting with acute cholecystitis: a secondary analysis of the ChoCO-W cohort study","authors":"Belinda De Simone, Fikri M. Abu-Zidan, Lucienne Kasongo, Ernest E. Moore, Mauro Podda, Massimo Sartelli, Arda Isik, Miklosh Bala, Raul Coimbra, Zsolt J. Balogh, Kemal Rasa, Francesco Marchegiani, Carlo Alberto Schena, Nicola DèAngelis, Marcello Di Martino, Luca Ansaloni, Federico Coccolini, Andrew A. Gumbs, Walter L. Biffl, Emmanouil Pikoulis, Nikolaos Pararas, Elie Chouillard, Fausto Catena","doi":"10.1186/s13017-025-00591-w","DOIUrl":"https://doi.org/10.1186/s13017-025-00591-w","url":null,"abstract":"During the coronavirus disease (COVID-19) pandemic, there has been a surge in cases of acute cholecystitis. The ChoCO-W global prospective study reported a higher incidence of gangrenous cholecystitis and adverse outcomes in COVID-19 patients. Through this secondary analysis of the ChoCO-W study data, we aim to identify significant risk factors for mortality in patients with acute cholecystitis during the COVID-19 pandemic, emphasizing the role of COVID-19 infection in patient outcomes and treatment efficacy.” The ChoCO-W global prospective study reported data from 2546 patients collected at 218 centers from 42 countries admitted with acute cholecystitis during the COVID-19 pandemic, from October 1, 2020, to October 31, 2021. Sixty-four of them died. Nonparametric statistical univariate analysis was performed to compare patients who died and patients who survived. Significant factors were then entered into a logistic regression model to define factors predicting mortality. The significant independent factors that predicted death in the logistic regression model with were COVID-19 infection (p < 0.001), postoperative complications (p < 0.001), and type (open/laparoscopic) of surgical intervention (p = 0.003). The odds of death increased 5 times with the COVID-19 infection, 6 times in the presence of complications, and it was reduced by 86% with adequate source control. Survivors predominantly underwent urgent laparoscopic cholecystectomy (52.3% vs. 23.4%). COVID-19 was an independent risk factor for death in patients with acute cholecystitis. Early laparoscopic cholecystectomy has emerged as the cornerstone of treatment for hemodynamically stable patients. ","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"39 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A risk prediction model for venous thromboembolism in hospitalized patients with thoracic trauma: a machine learning, national multicenter retrospective study","authors":"Kaibin Liu, Di Qian, Dongsheng Zhang, Zhichao Jin, Yi Yang, Yanfang Zhao","doi":"10.1186/s13017-025-00583-w","DOIUrl":"https://doi.org/10.1186/s13017-025-00583-w","url":null,"abstract":"Early treatment and prevention are the keys to reducing the mortality of VTE in patients with thoracic trauma. This study aimed to develop and validate an automatic prediction model based on machine learning for VTE risk screening in patients with thoracic trauma. In this national multicenter retrospective study, the clinical data of chest trauma patients hospitalized in 33 hospitals in China from October 2020 to September 2021 were collected for model training and testing. The data of patients with thoracic trauma at Shanghai Sixth People’s Hospital from October 2021 to September 2022 were included for further verification. The performance of the model was measured mainly by the area under the receiver operating characteristic curve (AUROC) and the mean accuracy (mAP), and the sensitivity, specificity, positive predictive value, and negative predictive value were also measured. A total of 3116 patients were included in the training and validation of the model. External validation was performed in 408 patients. The random forest (RF) model was selected as the final model, with an AUROC of 0·879 (95% CI 0·856–0·902) in the test dataset. In the external validation, the AUROC was 0.83 (95% CI 0.794–0.866), the specificity was 0.756 (95% CI 0.713–0.799), the sensitivity was 0.821 (95% CI 0.692–0.923), the negative predictive value was 0.976 (95% CI 0.958–0.993), and the positive likelihood ratio was 3.364. This model can be used to quickly screen for the risk of VTE in patients with thoracic trauma. More than 90% of unnecessary VTE tests can be avoided, which can help clinicians target interventions to high-risk groups and ensure resource optimization. Although further validation and improvement are needed, this study has considerable clinical value.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"8 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper","authors":"Belinda De Simone, Fikri M. Abu-Zidan, Luigi Boni, Ana Maria Gonzalez Castillo, Elisa Cassinotti, Francesco Corradi, Francesco Di Maggio, Hajra Ashraf, Gian Luca Baiocchi, Antonio Tarasconi, Martina Bonafede, Hung Truong, Nicola De’Angelis, Michele Diana, Raul Coimbra, Zsolt J. Balogh, Elie Chouillard, Federico Coccolini, Micheal Denis Kelly, Salomone Di Saverio, Giovanna Di Meo, Arda Isik, Ari Leppäniemi, Andrey Litvin, Ernest E. Moore, Alessandro Pasculli, Massimo Sartelli, Mauro Podda, Mario Testini, Imtiaz Wani, Boris Sakakushev, Vishal G. Shelat, Dieter Weber, Joseph M. Galante, Luca Ansaloni, Vanni Agnoletti, Jean-Marc Regimbeau, Gianluca Garulli, Andrew L. Kirkpatrick, Walter L. Biffl, Fausto Catena","doi":"10.1186/s13017-025-00575-w","DOIUrl":"https://doi.org/10.1186/s13017-025-00575-w","url":null,"abstract":"Decision-making in emergency settings is inherently complex, requiring surgeons to rapidly evaluate various clinical, diagnostic, and environmental factors. The primary objective is to assess a patient’s risk for adverse outcomes while balancing diagnoses, management strategies, and available resources. Recently, indocyanine green (ICG) fluorescence imaging has emerged as a valuable tool to enhance surgical vision, demonstrating proven benefits in elective surgeries. This consensus paper provides evidence-based and expert opinion-based recommendations for the standardized use of ICG fluorescence imaging in emergency settings. Using the PICO framework, the consensus coordinator identified key research areas, topics, and questions regarding the implementation of ICG fluorescence-guided surgery in emergencies. A systematic literature review was conducted, and evidence was evaluated using the GRADE criteria. A panel of expert surgeons reviewed and refined statements and recommendations through a Delphi consensus process, culminating in final approval. ICG fluorescence imaging, including angiography and cholangiography, improves intraoperative decision-making in emergency surgeries, potentially reducing procedure duration, complications, and hospital stays. Optimal use requires careful consideration of dosage and timing due to limited tissue penetration (5–10 mm) and variable performance in patients with significant inflammation, scarring, or obesity. ICG is contraindicated in patients with known allergies to iodine or iodine-based contrast agents. Successful implementation depends on appropriate training, availability of equipment, and careful patient selection. Advanced technologies and intraoperative navigation techniques, such as ICG fluorescence-guided surgery, should be prioritized in emergency surgery to improve outcomes. This technology exemplifies precision surgery by enhancing minimally invasive approaches and providing superior real-time evaluation of bowel viability and biliary structures—areas traditionally reliant on the surgeon’s visual assessment. Its adoption in emergency settings requires proper training, equipment availability, and standardized protocols. Further research is needed to evaluate cost-effectiveness and expand its applications in urgent surgical procedures. ","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"41 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of the appendicitis inflammatory response (AIR) score. A systematic review and meta-analysis","authors":"Roland E. Andersson, Joachim Stark","doi":"10.1186/s13017-025-00582-x","DOIUrl":"https://doi.org/10.1186/s13017-025-00582-x","url":null,"abstract":"Clinical scoring algorithms are cost efficient in patients with suspicion of acute appendicitis. This is a systematic review and meta-analysis of the diagnostic properties of the Appendicitis Inflammatory Response (AIR) score compared with the Alvarado score. The PubMed, EMBASE, Web of Science and Google Scholar databases were searched for reports on the diagnostic properties of the AIR score from 2008 to July 18, 2024. A meta-analysis of the receiver operating characteristic (ROC) area and the sensitivity and specificity for all and advanced appendicitis patients was performed. Advanced appendicitis was defined as perforated or gangrenous appendicitis or appendicitis abscess or phlegmon or if described as complicated appendicitis. The risk of bias was estimated via the QUADAS-2 tool. The ROC areas of the AIR score and the Alvarado score were compared. A total of 26 reports with a total of 15.699 patients were included. The area under the ROC curve for the AIR score was 0.86 (95% CI 0.83–0.88) for all patients with appendicitis and 0.93 (CI 0.91–0.96) for those with advanced appendicitis, which was greater than the corresponding areas for the Alvarado score (0.79, CI 0.76; 0.81) and 0.88, CI 0.82; 0.95), respectively. At > 4 points, the sensitivity was 0.91 (CI 0.88; 0.94) for all patients with appendicitis and 0.95 (CI 0.94; 0.97) for those with advanced appendicitis. At > 3 points, the sensitivity was 0.95 (0.90; 0.97) for all patients with appendicitis and 0.99 (0.97; 0.99) for those with advanced appendicitis. At > 8 points, the specificity was 0.98 (0.97; 0.99) for all patients with appendicitis and 0.99 (0.97; 0.99) for those with advanced appendicitis. The included studies had a low risk for bias and low heterogeneity. The AIR score has a better diagnostic capacity than the Alvarado score does. The AIR score is a safe and efficient basis for risk-stratified management of patients suspected of having appendicitis.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"11 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcome analysis for surgical fixation versus conservative treatment on rib fractures: a systematic evaluation and meta-analysis","authors":"Penglong Zhao, Qiyue Ge, Haotian Zheng, Jing Luo, Xiaobin Song, Liwen Hu","doi":"10.1186/s13017-025-00581-y","DOIUrl":"https://doi.org/10.1186/s13017-025-00581-y","url":null,"abstract":"The efficacy of surgical intervention for traumatic rib fractures in improving clinical outcomes remains a subject of considerable debate. Over the past decade, the adoption of surgical stabilization for rib fractures (SSRF) has increased substantially. This study presents a systematic review and meta-analysis of the literature published over the past 20 years, with the objective of comparing the clinical outcomes of adult patients with multiple traumatic rib fractures who underwent SSRF, relative to those treated conservatively. We searched six online databases (PubMed, Web of Science, Embase, Cochrane Library, and the Sino-American Clinical Trials Database) for literature published between June 2004 and June 2024. The Cochrane Collaboration Risk of Bias 2 (RoB 2) and the Newcastle–Ottawa Scale (NOS) tool were employed to assess methodological quality, and relative risks (RR) with 95% confidence intervals (CI) were calculated to evaluate the outcome measures. The primary outcome was all-cause mortality, while the secondary outcomes included hospital length of stay (HLOS), ICU length of stay (ILOS), duration of mechanical ventilation (DMV), and the incidence of pneumonia. Subgroup analyses were performed to assess the effects of fracture type, age, timing of surgical fixation, and study design on treatment outcomes. A total of 47 studies involving 1,078,795 patients were included, consisting of three randomized controlled trials and 44 case–control studies. The results demonstrated that patients who underwent SSRF experienced better outcomes than those receiving conservative treatment in terms of all-cause mortality. However, SSRF was not superior to conservative treatment regarding HLOS, ILOS, or health care costs. Subgroup analyses revealed that the SSRF group had a lower incidence of pneumonia and shorter DMV in patients with flail chest, and patients older than 60 years may also benefit from SSRF, Furthermore, those who underwent SSRF within 72 h had shorter HLOS and DMV compared to those treated conservatively. SSRF reduces mortality in patients with multiple rib fractures compared to conservative management, particularly in those with flail chest and in patients over 60 years of age. It also offers benefits in terms of pneumonia incidence and DMV for patients with flail chest. Early SSRF may significantly reduce HLOS and DMV. However, careful screening of appropriate candidates is crucial to maximize the benefits of SSRF.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"79 1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors of 180-day rebleeding after management of blunt splenic injury without surgery and embolization: a national database study","authors":"Chung-Yen Chen, Hung-Yu Lin, Pie-Wen Hsieh, Yi-Kai Huang, Po-Chin Yu, Jian-Han Chen","doi":"10.1186/s13017-025-00586-7","DOIUrl":"https://doi.org/10.1186/s13017-025-00586-7","url":null,"abstract":"This study aimed to identify risk factors for rebleeding within 180 days post-discharge in blunt splenic injury patients managed without splenectomy or embolization. A retrospective analysis was conducted using Taiwan’s National Health Insurance Research Database. Adult patients aged ≥ 18 years with blunt splenic injury (ICD-9-CM codes 865.01–865.09) from 2000 to 2012 were included. Patients who died, underwent splenectomy (ICD-9-OP codes 41.5, 41.42,41.43, and 41.95) or transcatheter arterial embolization (TAE) (ICD-9-OP codes 39.79 and 99.29) on the first admission were excluded. The primary endpoint was rebleeding, which was identified if patients underwent splenectomy or TAE at 180 days after discharge. Multivariate logistic regression was used to identify risk factors, which were validated in a separate cohort. Of 6,140 patients, 80 (1.302%) experienced rebleeding within 180 days. Five significant risk factors were identified: age < 54 years (aOR 3.129, p = 0.014), male sex (aOR 2.691, p = 0.010), non-traffic accident-induced injury (aOR 2.459, p = 0.006), ISS ≥ 16 (aOR 2.130, p = 0.021), and congestive heart failure (aOR 6.014, p = 0.006). We generate Delayed Splenic Bleeding System (DSBS). Patients with > 2 points had significantly higher rebleeding rates (risk-identifying cohort: 2.2% vs. 0.6%, OR 3.790, p < 0.001; validation cohort: 2.6% vs. 0.8%, OR 3.129, p = 0.022). Age < 54 years, male, non-traffic accident-induced injury, ISS ≥ 16, and congestive heart failure are risk factors of rebleeding within 180 days after discharge from treating blunt splenic injury without splenectomy or embolization. Despite limitations, this study underscores large-scale data’s role in identifying risks which can aid clinicians in prioritizing additional interventions during NOM.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"11 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute cholecystitis and subtotal cholecystectomy","authors":"Antonio Pesce, Rosario Lombardo, Antonio Di Cataldo, Gaetano La Greca","doi":"10.1186/s13017-024-00573-4","DOIUrl":"https://doi.org/10.1186/s13017-024-00573-4","url":null,"abstract":"&lt;p&gt;&lt;i&gt;Dear Editor&lt;/i&gt;,&lt;/p&gt;&lt;p&gt;We enjoyed reading the article by Toro A et al. [1], in which the authors reported a preliminary experience with a new technique to avoid subtotal cholecystectomy in acute cholecystitis. We would like to raise some interesting points and comments.&lt;/p&gt;&lt;p&gt;The authors reported that only three patients have undergone this technique in the last two years; this is a very small sample size for a trauma center service. Moreover, in the results section, the authors stated that “in the last 2 years from January 2019 to December 2021”, but this time interval spans three years, not two.&lt;/p&gt;&lt;p&gt;The original French technique is characterized by four-ports insertion. We would like to inquire why the authors used three ports in acute cholecystitis, where laparoscopic surgery is undoubtedly more challenging. However, it has been demonstrated that there isn’t any significant clinical benefit in using fewer than four-ports laparoscopic cholecystectomy compared to the standard four-ports approach during elective procedures. In emergency settings, the presence of dense fibrosis and inflammation of the hepatoduodenal ligament, as well as diffuse cholecysto-omental and cholecysto-duodeno-colic adhesions, may hinder proper exposure of the hepatocystic triangle when using only three ports. This increases the risk of iatrogenic biliary, vascular, and visceral injuries. In our opinion, under these specific conditions, the use of a fourth trocar is helpful to pull the gallbladder fundus upwards and facilitate wide exposure of the hepatocystic triangle, ensuring the safe dissection of Calot’s triangle [2]. Moreover, the three ports approach may lead to subsequent medico-legal litigations in case of biliary iatrogenic injuries. Neverthless, while a four-port approach may offer better exposure, particularly in this specific technique and generally in difficult cases, experienced surgeons may opt for a three-port approach if they are confident in their ability to handle challenging intraoperative situations. In such cases as patients with transhepatic percutaneous cholecystostomy, the three-port approach may be useful and sufficient without the need for a fourth trocar. Surgeons should feel empowered to adapt their approach based on intraoperative findings and should not hesitate to add an additional port at any time if they encounter difficulties during dissection.&lt;/p&gt;&lt;p&gt;Another technical comment is related to trocars’ size: the authors used two 5-mm operative trocars. Using a 5-mm clips applicator on an inflamed and edematous cystic duct in acute cholecystitis can indeed pose some challenges and risks, such as difficulties in performing a reconstituting subtotal cholecystectomy where the use of a linear endostapler might be necessary. There is also a risk that the clips may not securely close the cystic duct due to the tissue’s condition, potentially leading to postoperative cystic duct leakage. One important point to emphasize is that the endostap","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"44 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}