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Background and Aims: Patients undergoing surgery are prone to infections, either at the site of surgery (superficial or organ-space) or at remote sites (e.g. pneumonia or urinary tract). Surgical site infections are associated with substantial morbidity and mortality, increased length of hospital stay and represent a huge burden to the health economy across all healthcare systems. Here we discuss recent advances and challenges in the field of surgical site infections.Material and Methods: Review of pertinent English language literature.Results: Numerous guidelines and recommendations have been published in order to prevent surgical site infections. Compliance with these evidence-based guidelines vary and has not resulted in any major decrease in the surgical site infection rate. To date, most efforts to reduce surgical site infection have focused on the role of the surgeon, but a more comprehensive approach is necessary.Conclusion: Surgical site infections need to be addressed in a structured way, including checklists, audits, monitoring, and measurements. All stakeholders, including the medical profession, the society, and the patient, need to work together to reduce surgical site infections. Most surgical site infections are preventable—and we need a paradigm shift to tackle the problem.

Background and Aims: Routine drainage after pancreatoduodenectomy is a controversial issue. In this article, we present and discuss the current evidence on abdominal drains in pancreatic surgery.Material and Methods: Review of the pertinent English-language literature.Results: There is a growing body of evidence showing a lack of benefit of prophylactic drainage after pancreatoduodenectomy. Randomized trials have reported similar outcomes with or without routine drains. If drains were used, early removal was found to be superior to late removal in patients with a low risk of postoperative pancreatic fistula. Consequently, criteria for early drain removal have been developed based on the measurement of drain amylase levels. On the contrary, there exists a subgroup of patients where drains may have a role. In patients with high risk of pancreatic fistula formation, such as those having a soft pancreatic texture, small pancreatic duct and high body mass index, the placement of drains may give sentinel information about future clinical deterioration. The drain may thus help reduce failure-to-rescue rates.Conclusion: Despite much research, there are many unanswered questions regarding drains in pancreatic surgery. It is evident that routine drainage should be abandoned for a more selective strategy. Furthermore, what is needed is a postoperative warning score that early on can identify patients at risk of a pancreatic fistula, without the routine placement of drains.

Background: Temporal patterns of trauma deaths may indicate potential for prevention or systems improvement, but have been poorly investigated in the Scandinavian trauma population. This study examines patterns in trauma deaths to the occurrence in hour and time of the day, day and time in the week, and month and season.Materials and Methods: Investigation of the temporal patterns of death in 260 fatalities undergoing autopsy. Time of death were explored according to time of the day (hour; day/night), time of the week (day of week; weekday/weekend) and time of the year (month; season) and analyzed for difference in gender, age, injury type and severity, and mechanisms of injury and death.Results: A total of 260 trauma deaths were included, of which 125 (48%) died in hospital and 194 (75%) were male. No particular peak-hour of the day when deaths occurred was found. One-third of deaths occurred during weekends. For inhospital deaths during weekends, significantly more patients had respiratory distress (RR > 20 or < 16 in 72.5% for weekends and 47.0% for weekdays; p = 0.008) and hypotension (SBP < 90mmHg in 61% vs 40%; p = 0.048) during weekends. Deaths occurred with some monthly variance demonstrated with two monthly peaks in February/March and July/August, respectively. Overall, no statistically different seasonal differences in the occurrence of traumatic deaths, nor any differences in cause of death, type or severity of injury, nor in physiological parameters was found. However, a higher number of inhospital deaths presented with reduced consciousness level (GCS < 8) and severe head injuries (AIS-head ≥ 4) during spring and summer (P = 0.045, chi-square for trend) compared to winter and fall.Conclusions: Trauma deaths in a Scandinavian population did not demonstrate statistically significant differences in overall circadian, weekly or seasonal patterns of trauma death occurrence. However, the impact of fatal head injuries during spring and summer warrants further investigation.

Emergency department thoracotomy (EDT) may serve as a life-saving tool when performed for the right indications, in selected patients, and in the hands of a trained surgeon. Critically injured patients ‘in extremis‘ arrive at an increasing rate in the trauma bay, as an effect of improved pre-hospital trauma systems and rapid transport. Any patient in near, or full cardiovascular shock prompts the trauma surgeon to rapidly perform a thoracotomy. The EDT procedure is managed best by surgeons familiar with, and experienced in, penetrating cardiothoracic injuries. However, the geographical differences in trauma epidemiology lends no, or only scarce, experience with this procedure in most European trauma centres. Consequently, mandatory training is imperative for success. The rationale for performing an EDT is to: (I) resuscitate the agonal patient with penetratingcardiothoracic injuries; (II) release cardiac tamponade by evacuation of pericardial blood; (III) immediately control hemorrhage and repair cardiac or pulmonary injury; (IV)perform open cardiac massage; and (V) place a thoracic aortic cross-clamp to redistributethe remaining blood volume, and perfuse the carotids and coronary arteries. The prevalencerates of blood-borne viruses reported in critically injured patients in the USA (10–20%) exceed the prevalence in the Nordic countries (HIV prevalence <1% in general population). However, risk is not negligible and mandated universal precautions are needed. the literature is rich in series describing the use of EDT, however, the best evidence is derived from a few prospective trials. EDT saves about one in every five patients with isolated penetrating cardiac injury, while >98% die after blunt injury. Based on an updated review of the current available literature, this paper presents the current evidence regarding the rationale, risk, and outcomes for employing EDT in the field of trauma surgery.

The understanding of peptic ulcer disease (PUD) etiology, and improvements in treatment during the last two decades, has dramatically decreased the once so frequently performed procedures for PUD and its complications. Benign gastric outlet obstruction may, however, still require operative intervention when non-operative treatment fails. Today, surgeons in training, and even practicing surgeons, may have limited operative experience with procedures required to alleviate an obstructed pylorus. Our aim of this paper is to review the techniques (the Heineke-Mikulicz and Finney pyloroplasties, and modifications) and indications for pyloroplasty in the modern surgical era.