Pub Date : 2025-03-03DOI: 10.1186/s13017-025-00594-7
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
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.
{"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}
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
{"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}
Pub Date : 2025-02-25DOI: 10.1186/s13017-025-00591-w
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
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.
{"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}
Pub Date : 2025-02-13DOI: 10.1186/s13017-025-00583-w
Kaibin Liu, Di Qian, Dongsheng Zhang, Zhichao Jin, Yi Yang, Yanfang Zhao
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.
早期治疗和预防是降低胸外伤后静脉血栓栓塞死亡率的关键。本研究旨在开发并验证一种基于机器学习的VTE风险自动预测模型，用于胸部创伤患者的VTE风险筛查。在这项全国性多中心回顾性研究中，收集了2020年10月至2021年9月在中国33家医院住院的胸外伤患者的临床资料，进行模型训练和检验。纳入上海市第六人民医院2021年10月至2022年9月收治的胸外伤患者数据进行进一步验证。主要通过受试者工作特征曲线下面积（AUROC）和平均准确度（mAP）来衡量模型的性能，同时衡量模型的敏感性、特异性、阳性预测值和阴性预测值。共纳入3116例患者进行模型的训练和验证。在408例患者中进行了外部验证。随机森林（random forest， RF）模型作为最终模型，测试数据集的AUROC为0.879 （95% CI为0.856 - 0.902）。外部验证的AUROC为0.83 (95% CI 0.794-0.866)，特异性为0.756 (95% CI 0.713-0.799)，敏感性为0.821 (95% CI 0.692-0.923)，阴性预测值为0.976 (95% CI 0.958-0.993)，阳性似然比为3.364。该模型可用于快速筛选胸外伤患者静脉血栓栓塞的风险。可以避免90%以上不必要的静脉血栓栓塞检查，这可以帮助临床医生针对高危人群进行干预，并确保资源优化。虽然需要进一步的验证和改进，但本研究具有相当的临床价值。
{"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}
Pub Date : 2025-02-13DOI: 10.1186/s13017-025-00575-w
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
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.
{"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}
Pub Date : 2025-02-08DOI: 10.1186/s13017-025-00582-x
Roland E. Andersson, Joachim Stark
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.
{"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}
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.
外伤性肋骨骨折的手术干预在改善临床结果方面的有效性仍然是一个相当有争议的话题。在过去的十年中，采用手术稳定治疗肋骨骨折（SSRF）已经大大增加。本研究对过去20年发表的文献进行了系统回顾和荟萃分析，目的是比较多发外伤性肋骨骨折成人患者接受SSRF治疗与保守治疗的临床结果。我们检索了6个在线数据库（PubMed、Web of Science、Embase、Cochrane Library和中美临床试验数据库），检索了2004年6月至2024年6月间发表的文献。采用Cochrane Collaboration Risk of Bias 2 （RoB 2）和Newcastle-Ottawa Scale （NOS）工具评估方法学质量，计算具有95%置信区间（CI）的相对风险（RR）来评估结果测量。主要结局为全因死亡率，次要结局包括住院时间（HLOS）、ICU住院时间（ILOS）、机械通气时间（DMV）和肺炎发生率。进行亚组分析以评估骨折类型、年龄、手术固定时间和研究设计对治疗结果的影响。共纳入47项研究，涉及1,078,795例患者，包括3项随机对照试验和44项病例对照研究。结果表明，在全因死亡率方面，接受SSRF治疗的患者比接受保守治疗的患者有更好的结果。然而，在HLOS、ILOS或医疗费用方面，SSRF并不优于保守治疗。亚组分析显示，SSRF组连枷胸患者的肺炎发生率较低，DMV较短，年龄大于60岁的患者也可能受益于SSRF。此外，与保守治疗的患者相比，在72小时内接受SSRF治疗的患者HLOS和DMV较短。与保守治疗相比，SSRF降低了多发肋骨骨折患者的死亡率，尤其是连枷胸患者和60岁以上患者。它还为连枷胸患者提供肺炎发病率和DMV方面的益处。早期SSRF可显著降低HLOS和DMV。然而，仔细筛选合适的候选人对于最大化SSRF的益处至关重要。
{"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}
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.
本研究旨在确定未经脾切除术或栓塞治疗的钝性脾损伤患者出院后180天内再出血的危险因素。本研究采用台湾全民健保研究资料库进行回顾性分析。纳入2000 - 2012年年龄≥18岁的成人钝性脾损伤患者（ICD-9-CM代码865.01-865.09）。排除首次入院时死亡、行脾切除术（ICD-9-OP代码41.5、41.42、41.43和41.95）或经导管动脉栓塞（ICD-9-OP代码39.79和99.29）的患者。主要终点是再出血，如果患者在出院后180天接受脾切除术或TAE，则确定再出血。多变量逻辑回归用于确定危险因素，并在单独的队列中进行验证。在6140例患者中，80例（1.302%）在180天内再次出血。确定了5个显著的危险因素：2岁时再出血率显著升高(风险识别队列：2.2% vs. 0.6%, OR 3.790, p < 0.001；验证队列：2.6% vs. 0.8%, OR 3.129, p = 0.022)。年龄< 54岁，男性，非交通事故性损伤，ISS≥16，充血性心力衰竭是钝性脾损伤未经脾切除术或栓塞治疗出院后180天内再出血的危险因素。尽管存在局限性，但该研究强调了大规模数据在识别风险方面的作用，这可以帮助临床医生在NOM期间优先考虑额外的干预措施。
{"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}
Pub Date : 2025-02-01DOI: 10.1186/s13017-024-00573-4
Antonio Pesce, Rosario Lombardo, Antonio Di Cataldo, Gaetano La Greca
<p><i>Dear Editor</i>,</p><p>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.</p><p>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.</p><p>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.</p><p>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
尊敬的编辑：我们很高兴阅读Toro A等人的文章，在这篇文章中，作者报告了一种新技术的初步经验，以避免急性胆囊炎的胆囊次全切除术。我们想提出一些有趣的观点和意见。作者报告说，在过去两年中，只有三名患者接受了这种技术；这对创伤中心来说是一个很小的样本。此外，在结果部分，作者表示“从2019年1月到2021年12月的过去两年”，但这个时间间隔是三年，而不是两年。最初的法国技术的特点是四端口插入。我们想知道为什么作者在急性胆囊炎中使用三个端口，腹腔镜手术无疑更具挑战性。然而，已经证明，在选择性手术中，与标准四孔入路相比，使用少于四孔的腹腔镜胆囊切除术没有任何显著的临床益处。在紧急情况下，肝十二指肠韧带存在致密纤维化和炎症，以及弥漫性胆囊-网膜粘连和胆囊-十二指肠-结肠粘连，当仅使用三个端口时，可能会妨碍正确暴露肝囊三角。这增加了医源性胆道、血管和内脏损伤的风险。我们认为，在这些特殊情况下，使用第四套管针有助于将胆囊底向上拉，方便肝囊三角的广泛暴露，确保Calot三角[2]的安全剥离。此外，在胆道医源性损伤的情况下，三口入路可能导致随后的医学法律诉讼。然而，虽然四孔入路可以提供更好的暴露，特别是在这种特殊的技术中，通常在困难的情况下，经验丰富的外科医生可能会选择三孔入路，如果他们对自己处理术中困难情况的能力有信心。在经肝经皮胆囊造瘘患者中，三孔入路可能是有用且足够的，不需要第四个套管针。外科医生应该感到有权根据术中发现调整入路，如果在解剖过程中遇到困难，应毫不犹豫地随时增加额外的端口。另一个技术评论与套管针的尺寸有关：作者使用了两个5毫米的手术套管针。在急性胆囊炎中，在发炎和水肿的胆囊管上使用5mm夹子确实会带来一些挑战和风险，例如在进行重建胆囊次全切除术时，可能需要使用线性内吻合器。由于组织状况，夹子可能无法安全地关闭囊管，这也有可能导致术后囊管泄漏。需要强调的一点是，内吻合器在某些危急情况下是一种有用的工具，但只有在正确识别解剖结构后才应考虑和使用，以尽量减少医源性胆道和血管损伤的风险。急性胆囊炎的胆囊炎症通常会影响胆囊壁的所有层，因此我们不理解在这种技术中将外层与内层分离的基本原理。然而，在坏疽性胆囊炎中，炎症可扩展到胆囊管-胆囊管交界处，使胆囊管闭合变得困难，并造成胆道泄漏的高风险。此外，我们认为Toro A等人所描述的内粘膜-肌肉层与外浆膜层的完全分离仅具有理论基础。它不可行，也不实用，而且与已经描述的其他技术选择（包括世界各地外科医生在严重急性胆囊炎[3]病例中常用的抢救性胆囊次全切除术）相比更为复杂。我们认为，在考虑其广泛采用之前，需要通过更大规模的研究进一步验证该技术。另一个问题是关于Toro A和同事的建议，即使用单极钩横向切割整个胆囊壁。这是一个众所周知的事实，也是熟练外科医生的共同经验，单极能量的弥漫性热效应导致所有组织凝固和收缩，不可避免地导致被作者描述为“外部浆膜和内部肌肉层”的层融合。因此，建议使用冷剪刀切割胆囊壁，对不同层进行锋利的横切，希望能够按照建议识别和分离它们。我们认为，文章中描述的技术在使用单极钩时存在胆囊漏斗穿孔的高风险，特别是在胆囊壁坏死的区域。 在厚壁胆囊粘附于十二指肠或胆总管外侧的情况下，浆膜下剥离可能是一种更好的挽救策略。然而，应使用“鸭嘴”钳进行钝性剥离，以清除漏斗囊蒂周围的脂肪和纤维组织，或使用具有水剥离效果的冲洗和吸引。我们也不理解从“胆囊内壁”内部识别胆囊管的意义，因为我们不知道胆囊内壁和外壁的区别。我们只熟悉胆囊的前壁或后壁，最多也就是胆壁的内层和外层。我们强调这些看似“不寻常”或闻所未闻的定义，如“胆囊内壁”和“前血管”，因为它们可能不幸导致对胆囊解剖的混淆，特别是对年轻的外科医生和住院医生。在解剖学和超声检查中，胆囊壁由两层组成：内部低回声层（肌层）和外部高回声层（浆膜层）。因此，“内胆壁”一词可能具有误导性。此外，术语“前血管”也令人困惑。它指的是什么？有时，囊性动脉可能有一个前浅支，它可以不同程度地靠近囊管，和一个后深支，通常平行于胆囊床。在Pesce A et al.[5]的文章中，对囊性动脉最常见的解剖变异进行了清晰的描述，如单囊性动脉起源于右肝动脉，存在两条动脉分支（浅分支和深分支），单短囊性动脉起源于caterpillar右肝动脉，单长囊性动脉不是来自右肝动脉穿过肝总管前，双囊性动脉/副囊性动脉，囊性动脉在马斯卡尼淋巴结的前部比后部多见，胆囊床后外侧缘有一条恒定的血管，囊性动脉来自胃十二指肠动脉，经过卡洛三角外。因此，我们认为，在急性胆囊炎腹腔镜胆囊切除术中，正确而深入的血管解剖学知识是必不可少的。这项技术的确切适应症尚不清楚；根据东京指南，三名接受治疗的患者表现为II级中度急性胆囊炎。在Toro A等人的手稿图2中，清晰地描述了一例坏疽性急性胆囊炎。此外，囊管看起来很容易辨认，似乎可以安全地切开。此外，这种技术并不新颖；它类似于炎性厚壁胆囊的浆膜下夹层，并伴有胆囊底部周围的夹层。在2020年，Nassar AH等人已经提出并分析了可能的抢救策略，因为解剖学或病理学上的困难，实现安全的批判性观点具有挑战性。讨论部分描述和提出的四种次全腹腔镜胆囊切除术，正是Strasberg S等人在2016年描述的“开窗”和“重构”两种技术，其变体与剩余胆囊附着在肝脏上的数量有关。另一个评论是由于没有提及ICG（吲哚菁绿）实时成像，以更好地了解肝外胆道系统的术中解剖，并确保夹层安全远离mcelmoyle危险区域[7]的关键结构。当处理困难的急性胆囊炎时，特别是在有严重炎症、纤维化或解剖扭曲的情况下，进行胆囊次全切除术可能是全胆囊切除术更安全的选择。虽然这种方法可以防止危险的并发症，如胆道损伤，但它可能导致胆道瘘或残余结石的存在。在这种情况下，患者可能需要内窥镜治疗、再次手术和长期住院，这可能导致医疗法律问题。虽然可以减少胆囊次全切除术的数量，但很少转为开放手术。然而，决定必须仔细权衡，并根据个别患者的情况和术中发现量身定制的方法。在本研究中没有生成或分析数据集。Toro A, Rapisarda M, Maugeri D, Terrasi A, Gallo L, Ansaloni L, Catena F, Di Carlo I.急性胆囊炎：如何避免胆囊次全切除术的初步结果。中华外科杂志，2014;19(1):6。https://doi.org/10.1186/s13017-024-00534-x.Article PubMed PubMed Central谷歌学者Gurusamy KS， Vaughan J, Rossi M, Davidson BR。腹腔镜胆囊切除术中少于4个孔与4个孔比较。Cochrane Database system Rev. 2014年2月20日；2014(2):CD007109。https://doi。 org/10.1002/14651858.CD007109。[2] di Cataldo A, Perrotti S, Latino R, La Greca G.为什么胆囊次全切除术比过去更频繁？中国生物医学工程学报；2009;31(4):674 - 674。https://doi.org/10.1097/XC
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Pub Date : 2025-01-29DOI: 10.1186/s13017-024-00568-1
Giacomo Sermonesi, Riccardo Bertelli, Fredric M. Pieracci, Zsolt J. Balogh, Raul Coimbra, Joseph M. Galante, Andreas Hecker, Dieter Weber, Zachary M. Bauman, Susan Kartiko, Bhavik Patel, SarahAnn S. Whitbeck, Thomas W. White, Kevin N. Harrell, Daniele Perrina, Alessia Rampini, Brian Tian, Francesco Amico, Solomon G. Beka, Luigi Bonavina, Marco Ceresoli, Lorenzo Cobianchi, Federico Coccolini, Yunfeng Cui, Francesca Dal Mas, Belinda De Simone, Isidoro Di Carlo, Salomone Di Saverio, Agron Dogjani, Andreas Fette, Gustavo P. Fraga, Carlos Augusto Gomes, Jim S. Khan, Andrew W. Kirkpatrick, Vitor F. Kruger, Ari Leppäniemi, Andrey Litvin, Andrea Mingoli, David Costa Navarro, Eliseo Passera, Michele Pisano, Mauro Podda, Emanuele Russo, Boris Sakakushev, Domenico Santonastaso, Massimo Sartelli, Vishal G. Shelat, Edward Tan, Imtiaz Wani, Fikri M. Abu-Zidan, Walter L. Biffl, Ian Civil, Rifat Latifi, Ingo Marzi, Edoardo Picetti, Manos Pikoulis, Vanni Agnoletti, Francesca Bravi, Carlo Vall..
<p><b>Correction to: World Journal of Emergency Surgery (2024) 19:33</b></p><p><b>https://doi.org/10.1186/s13017-024-00559-2</b>.</p><p>The original publication of this article [1] contained an incorrect affiliation for author Imtiaz Wani. The incorrect and correct information is listed in this correction article; the original article has been updated.</p><p>Incorrect</p><p>Imtiaz Wani</p><p>43. Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India</p><p>Correct</p><p>Imtiaz Wani</p><p>43. Government Gousia Hospital, Srinagar, India</p><ol data-track-component="outbound reference" data-track-context="references section"><li data-counter="1."><p>Sermonesi G, Bertelli R, Pieracci FM. et al. Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper. World J Emerg Surg. 2024;19(33). https://doi.org/10.1186/s13017-024-00559-2.</p></li></ol><p>Download references<svg aria-hidden="true" focusable="false" height="16" role="img" width="16"><use xlink:href="#icon-eds-i-download-medium" xmlns:xlink="http://www.w3.org/1999/xlink"></use></svg></p><h3>Authors and Affiliations</h3><ol><li><p>Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy</p><p>Giacomo Sermonesi, Riccardo Bertelli, Daniele Perrina, Alessia Rampini, Emanuele Russo, Domenico Santonastaso, Vanni Agnoletti, Carlo Vallicelli & Fausto Catena</p></li><li><p>Department of Surgery, University of Colorado School of Medicine, Denver, CO, USA</p><p>Fredric M. Pieracci & Ernest E. Moore</p></li><li><p>Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia</p><p>Zsolt J. Balogh</p></li><li><p>Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA</p><p>Raul Coimbra</p></li><li><p>Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA</p><p>Joseph M. Galante</p></li><li><p>Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany</p><p>Andreas Hecker</p></li><li><p>Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia</p><p>Dieter Weber</p></li><li><p>Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA</p><p>Zachary M. Bauman</p></li><li><p>Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA</p><p>Susan Kartiko</p></li><li><p>Division of Trauma, Gold Coast University Hospital, Southport, QLD, Australia</p><p>Bhavik Patel</p></li><li><p>Chest Wall Injury Society, Salt Lake City, UT, USA</p><p>SarahAnn S. Whitbeck</p></li><li><p>Intermountain Medical Center, Salt Lake City, UT, USA</p><p>Thomas W. White</p></li><li><p>Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA</p><p>Kevin N. Ha
Correction to：World Journal of Emergency Surgery (2024) 19:33https://doi.org/10.1186/s13017-024-00559-2.The 本文[1]最初发表时，作者Imtiaz Wani的单位有误。本更正文章列出了错误和正确的信息；原文已更新。IncorrectImtiaz Wani43.印度斯利那加，Sheri-Kashmir 医学院外科系CorrectImtiaz Wani43.Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper.2024; 19(33). https://doi.org/10.1186/s13017-024-00559-2.下载参考文献作者和工作单位意大利切塞纳 Maurizio Bufalini 医院普通和急诊外科、麻醉和重症监护室贾科莫-塞莫内西、里卡多-贝尔泰利、达尼埃莱-佩里纳、阿莱西亚-兰皮尼、埃马纽埃尔-鲁索、多梅尼科-桑托纳斯塔索、万尼-阿格诺莱蒂、卡罗-瓦利切利& 福斯托-卡泰纳美国科罗拉多大学医学院外科系美国科罗拉多州丹佛市弗雷德里克-M.Pieracci & Ernest E. Moore澳大利亚新南威尔士州纽卡斯尔市约翰-亨特医院和纽卡斯尔大学创伤学系Zsolt J. Balogh美国加利福尼亚州莫雷诺谷河滨大学卫生系统医疗中心比较效果和临床结果研究中心Aaul Coimbra美国加利福尼亚州萨克拉门托市加利福尼亚大学戴维斯分校外科创伤和急症护理外科Joseph M. Galante美国加利福尼亚州萨克拉门托市加利福尼亚大学戴维斯分校外科创伤和急症护理外科急诊医学系M.Galante德国吉森大学医院普外科和胸外科急诊医学部Andreas Hecker澳大利亚珀斯皇家医院创伤外科Dieter Weber美国内布拉斯加州奥马哈市内布拉斯加大学医学中心外科Zachary M. Bauman美国内布拉斯加州奥马哈市内布拉斯加大学医学中心外科Department of Surgery.BaumanDepartment of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USASusan KartikoDivision of Trauma, Gold Coast University Hospital, Southport, QLD, AustraliaBhavik PatelChest Wall Injury Society, Salt Lake City, UT, USASarahAnn S．WhitbeckIntermountain Medical Center, Salt Lake City, UT, USAThomas W. WhiteDepartment of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USAKevin N. HarrellDepartment of General Surgery, Singapore General Hospital, Singapore, SingaporeBrian TianDiscipline of Surgery, School of Medicine and Public Health, Newcastle, NSW, AustraliaFrancesco AmicoEthiopian Air Force Hospital, Bishoftu, Oromia, EthiopiaSolomon G. BekaDepartment of Surgery, Singapore General Hospital, Singapore.贝卡意大利米兰米兰大学 IRCCS Policlinico San Donato 外科学系路易吉-博纳维纳意大利蒙扎米兰比可卡大学医学和外科学系普通外科和急诊外科马可-切雷索利意大利帕维亚帕维亚大学 Fondazione IRCCS Policlinico San Matteo 外科学系洛伦佐-科比安奇&；Luca AnsaloniCollegium Medicum, University of Social Sciences, Lodz, PolandLorenzo Cobianchi &；Francesca Dal Mas意大利比萨，比萨大学医院普通、急诊和创伤外科Federico Coccolini天津医科大学南开临床医学院天津南开医院外科，天津、意大利里米尼 Infermi 医院微创急诊和普通外科 Belinda De Simone 外科科学和先进技术系、意大利卡塔尼亚卡塔尼亚大学 Cannizzaro 医院普外科Isidoro Di Carlo 意大利马尔凯大区圣贝内德托德尔特龙托医院普外科Salomone Di Saverio 地拉那医科大学普外科阿尔巴尼亚地拉那Agron DogjaniPediatric Surgery，Children's Care Center，SRH Klinikum Suhl，Suhl，Thueringen，GermanyAndreas FetteDivision of Trauma Surgery，School of Medical Sciences，University of Campinas，Campinas，BrazilGustavo P．Fraga & Vitor F. KrugerFaculdade de Medicina, SUPREMA, Hospital Universitario Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, BrazilCarlos Augusto GomesDepartment of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UKJim S. KhanDepartments of Surgery and Countermanship, Portsmouth, UKJim S. KrugerFaculdade de Medicina, SUPREMA.KirkpatrickAbdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, FinlandAri LeppäniemiDepartment of Surgical Diseases No.
{"title":"Correction: Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper","authors":"Giacomo Sermonesi, Riccardo Bertelli, Fredric M. Pieracci, Zsolt J. Balogh, Raul Coimbra, Joseph M. Galante, Andreas Hecker, Dieter Weber, Zachary M. Bauman, Susan Kartiko, Bhavik Patel, SarahAnn S. Whitbeck, Thomas W. White, Kevin N. Harrell, Daniele Perrina, Alessia Rampini, Brian Tian, Francesco Amico, Solomon G. Beka, Luigi Bonavina, Marco Ceresoli, Lorenzo Cobianchi, Federico Coccolini, Yunfeng Cui, Francesca Dal Mas, Belinda De Simone, Isidoro Di Carlo, Salomone Di Saverio, Agron Dogjani, Andreas Fette, Gustavo P. Fraga, Carlos Augusto Gomes, Jim S. Khan, Andrew W. Kirkpatrick, Vitor F. Kruger, Ari Leppäniemi, Andrey Litvin, Andrea Mingoli, David Costa Navarro, Eliseo Passera, Michele Pisano, Mauro Podda, Emanuele Russo, Boris Sakakushev, Domenico Santonastaso, Massimo Sartelli, Vishal G. Shelat, Edward Tan, Imtiaz Wani, Fikri M. Abu-Zidan, Walter L. Biffl, Ian Civil, Rifat Latifi, Ingo Marzi, Edoardo Picetti, Manos Pikoulis, Vanni Agnoletti, Francesca Bravi, Carlo Vall..","doi":"10.1186/s13017-024-00568-1","DOIUrl":"https://doi.org/10.1186/s13017-024-00568-1","url":null,"abstract":"<p><b>Correction to: World Journal of Emergency Surgery (2024) 19:33</b></p><p><b>https://doi.org/10.1186/s13017-024-00559-2</b>.</p><p>The original publication of this article [1] contained an incorrect affiliation for author Imtiaz Wani. The incorrect and correct information is listed in this correction article; the original article has been updated.</p><p>Incorrect</p><p>Imtiaz Wani</p><p>43. Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India</p><p>Correct</p><p>Imtiaz Wani</p><p>43. Government Gousia Hospital, Srinagar, India</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Sermonesi G, Bertelli R, Pieracci FM. et al. Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper. World J Emerg Surg. 2024;19(33). https://doi.org/10.1186/s13017-024-00559-2.</p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><h3>Authors and Affiliations</h3><ol><li><p>Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy</p><p>Giacomo Sermonesi, Riccardo Bertelli, Daniele Perrina, Alessia Rampini, Emanuele Russo, Domenico Santonastaso, Vanni Agnoletti, Carlo Vallicelli & Fausto Catena</p></li><li><p>Department of Surgery, University of Colorado School of Medicine, Denver, CO, USA</p><p>Fredric M. Pieracci & Ernest E. Moore</p></li><li><p>Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia</p><p>Zsolt J. Balogh</p></li><li><p>Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA</p><p>Raul Coimbra</p></li><li><p>Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA</p><p>Joseph M. Galante</p></li><li><p>Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany</p><p>Andreas Hecker</p></li><li><p>Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia</p><p>Dieter Weber</p></li><li><p>Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA</p><p>Zachary M. Bauman</p></li><li><p>Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA</p><p>Susan Kartiko</p></li><li><p>Division of Trauma, Gold Coast University Hospital, Southport, QLD, Australia</p><p>Bhavik Patel</p></li><li><p>Chest Wall Injury Society, Salt Lake City, UT, USA</p><p>SarahAnn S. Whitbeck</p></li><li><p>Intermountain Medical Center, Salt Lake City, UT, USA</p><p>Thomas W. White</p></li><li><p>Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA</p><p>Kevin N. Ha","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"24 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054997","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}
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