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1. Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper.

Author

Sermonesi, Giacomo, Bertelli, Riccardo, Pieracci, Fredric, Balogh, Zsolt, Coimbra, Raul, Galante, Joseph, Hecker, Andreas, Weber, Dieter, Bauman, Zachary, Kartiko, Susan, Patel, Bhavik, Whitbeck, SarahAnn, White, Thomas, Harrell, Kevin, Perrina, Daniele, Rampini, Alessia, Tian, Brian, Amico, Francesco, Beka, Solomon, Bonavina, Luigi, Ceresoli, Marco, Cobianchi, Lorenzo, Coccolini, Federico, Cui, Yunfeng, Dal Mas, Francesca, De Simone, Belinda, Di Carlo, Isidoro, Di Saverio, Salomone, Dogjani, Agron, Fette, Andreas, Fraga, Gustavo, Gomes, Carlos, Khan, Jim, Kirkpatrick, Andrew, Kruger, Vitor, Leppäniemi, Ari, Litvin, Andrey, Mingoli, Andrea, Navarro, David, Passera, Eliseo, Pisano, Michele, Podda, Mauro, Russo, Emanuele, Sakakushev, Boris, Santonastaso, Domenico, Sartelli, Massimo, Shelat, Vishal, Tan, Edward, Wani, Imtiaz, Abu-Zidan, Fikri, Biffl, Walter, Civil, Ian, Latifi, Rifat, Marzi, Ingo, Picetti, Edoardo, Pikoulis, Manos, Agnoletti, Vanni, Bravi, Francesca, Vallicelli, Carlo, Ansaloni, Luca, Moore, Ernest, and Catena, Fausto

Subjects
Consensus, Flail chest, Guidelines, Minimally invasive plating osteosynthesis (MIPO), Multiple rib fractures, Operative reduction and internal fixation (ORIF), Rib fixation, Rib fractures, Surgical stabilization of rib fractures (SSRF), Thoracic/chest trauma injury, Video-assisted thoracoscopy surgery (VATS), Rib Fractures, Humans, Fracture Fixation
Abstract

BACKGROUND: Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF. METHODS: This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements. RESULTS: A total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection. CONCLUSION: This consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research.

Published
2024

2. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma.

Author

Sermonesi, Giacomo, Tian, Brian, Vallicelli, Carlo, Abu-Zidan, Fikri, Damaskos, Dimitris, Kelly, Michael, Leppäniemi, Ari, Galante, Joseph, Tan, Edward, Kirkpatrick, Andrew, Khokha, Vladimir, Romeo, Oreste, Chirica, Mircea, Pikoulis, Manos, Litvin, Andrey, Shelat, Vishal, Sakakushev, Boris, Wani, Imtiaz, Sall, Ibrahima, Fugazzola, Paola, Cicuttin, Enrico, Toro, Adriana, Amico, Francesco, Mas, Francesca, De Simone, Belinda, Sugrue, Michael, Bonavina, Luigi, Campanelli, Giampiero, Carcoforo, Paolo, Cobianchi, Lorenzo, Coccolini, Federico, Chiarugi, Massimo, Di Carlo, Isidoro, Di Saverio, Salomone, Podda, Mauro, Pisano, Michele, Sartelli, Massimo, Testini, Mario, Fette, Andreas, Rizoli, Sandro, Picetti, Edoardo, Weber, Dieter, Latifi, Rifat, Kluger, Yoram, Balogh, Zsolt, Biffl, Walter, Jeekel, Hans, Civil, Ian, Hecker, Andreas, Ansaloni, Luca, Bravi, Francesca, Agnoletti, Vanni, Beka, Solomon, Moore, Ernest, and Catena, Fausto

Subjects
Acute appendicitis, Acute care surgery, Acute cholecystitis, Acute diverticulitis, Acute pancreatitis, Acute peritonitis, Adhesive small bowel obstruction, Colo–rectal emergencies, Emergency general surgery, Guidelines, Incarcerated/complicated ventral/inguinal hernia, Laparoscopic approach, Laparoscopy, Mesenteric ischemia, Minimally invasive surgery/approach, Penetrating/blunt abdominal trauma, Perforated peptic ulcer, Recommendations, Trauma surgery hemodynamic stability, Humans, Emergencies, Retrospective Studies, Laparoscopy, Abdomen, Abdominal Injuries, Randomized Controlled Trials as Topic
Abstract

BACKGROUND: Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS: This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS: A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS: The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.

Published
2023

4. Strategies to prevent blood loss and reduce transfusion in emergency general surgery, WSES-AAST consensus paper

Author

Coccolini, Federico, Shander, Aryeh, Ceresoli, Marco, Moore, Ernest, Tian, Brian, Parini, Dario, Sartelli, Massimo, Sakakushev, Boris, Doklestich, Krstina, Abu-Zidan, Fikri, Horer, Tal, Shelat, Vishal, Hardcastle, Timothy, Bignami, Elena, Kirkpatrick, Andrew, Weber, Dieter, Kryvoruchko, Igor, Leppaniemi, Ari, Tan, Edward, Kessel, Boris, Isik, Arda, Cremonini, Camilla, Forfori, Francesco, Ghiadoni, Lorenzo, Chiarugi, Massimo, Ball, Chad, Ottolino, Pablo, Hecker, Andreas, Mariani, Diego, Melai, Ettore, Malbrain, Manu, Agostini, Vanessa, Podda, Mauro, Picetti, Edoardo, Kluger, Yoram, Rizoli, Sandro, Litvin, Andrey, Maier, Ron, Beka, Solomon Gurmu, De Simone, Belinda, Bala, Miklosh, Perez, Aleix Martinez, Ordonez, Carlos, Bodnaruk, Zenon, Cui, Yunfeng, Calatayud, Augusto Perez, de Angelis, Nicola, Amico, Francesco, Pikoulis, Emmanouil, Damaskos, Dimitris, Coimbra, Raul, Chirica, Mircea, Biffl, Walter L., and Catena, Fausto

Published
2024
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5. Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Author

Perrone, Gennaro, Giuffrida, Mario, Abu-Zidan, Fikri, Kruger, Vitor F., Livrini, Marco, Petracca, Gabriele Luciano, Rossi, Giorgio, Tarasconi, Antonio, Tian, Brian W. C. A., Bonati, Elena, Mentz, Ricardo, Mazzini, Federico N., Campana, Juan P., Gasser, Elisabeth, Kafka-Ritsch, Reinhold, Felsenreich, Daniel M., Dawoud, Christopher, Riss, Stefan, Gomes, Carlos Augusto, Gomes, Felipe Couto, Gonzaga, Ricardo Alessandro Teixeira, Canton, Cassio Alfred Brattig, Pereira, Bruno Monteiro, Fraga, Gustavo P., Zem, Leticia Gonçalves, Cordeiro-Fonseca, Vinicius, de Mesquita Tauil, Renato, Atanasov, Boyko, Belev, Nikolay, Kovachev, Nikola, Meléndez, L. Juan José, Dimova, Ana, Dimov, Stefan, Zelić, Zdravko, Augustin, Goran, Bogdanić, Branko, Morić, Trpimir, Chouillard, Elie, Bajul, Melinda, De Simone, Belinda, Panis, Yves, Esposito, Francesco, Notarnicola, Margherita, Lauka, Lelde, Fabbri, Anna, Hentati, Hassen, Fnaiech, Iskander, Aurélien, Venara, Bougard, Marie, Roulet, Maxime, Demetrashvili, Zaza, Pipia, Irakli, Merabishvili, Giorgi, Bouliaris, Konstantinos, Koukoulis, Georgios, Doudakmanis, Christos, Xenaki, Sofia, Chrysos, Emmanuel, Kokkinakis, Stamatios, Vassiliu, Panteleimon, Michalopoulos, Nikolaos, Margaris, Ioannis, Kechagias, Aristotelis, Avgerinos, Konstantinos, Katunin, Jevgeni, Lostoridis, Eftychios, Nagorni, Eleni-Aikaterini, Pujante, Antonio, Mulita, Francesk, Maroulis, Ioannis, Vailas, Michail, Marinis, Athanasios, Siannis, Ioannis, Bourbouteli, Eirini, Manatakis, Dimitrios K., Tasis, Nikolaos, Acheimastos, Vasileios, Maria, Sotiropoulou, Stylianos, Kapiris, Kuzeridis, Harilaos, Korkolis, Dimitrios, Fradelos, Evangelos, Kavalieratos, George, Petropoulou, Thalia, Polydorou, Andreas, Papacostantinou, Ioannis, Triantafyllou, Tania, Kimpizi, Despina, Theodorou, Dimitrios, Toutouzas, Konstantinos, Chamzin, Alexandros, Frountzas, Maximos, Schizas, Dimitrios, Karavokyros, Ioannis, Syllaios, Athanasios, Charalabopoulos, Alexandros, Boura, Maria, Baili, Efstratia, Ioannidis, Orestis, Loutzidou, Lydia, Anestiadou, Elissavet, Tsouknidas, Ioannis, Petrakis, Georgios, Polenta, Eleni, Bains, Lovenish, Gupta, Rahul, Singh, Sudhir K., Khanduri, Archana, Bala, Miklosh, Kedar, Asaf, Pisano, Marcello, Podda, Mauro, Pisanu, Adolfo, Martines, Gennaro, Trigiante, Giuseppe, Lantone, Giuliano, Agrusa, Antonino, Di Buono, Giuseppe, Buscemi, Salvatore, Veroux, Massimiliano, Gioco, Rossella, Veroux, Gastone, Oragano, Luigi, Zonta, Sandro, Lovisetto, Federico, Feo, Carlo V., Pesce, Antonio, Fabbri, Nicolò, Lantone, Giulio, Marino, Fabio, Perrone, Fabrizio, Vincenti, Leonardo, Papagni, Vincenzo, Picciariello, Arcangelo, Rossi, Stefano, Picardi, Biagio, Del Monte, Simone Rossi, Visconti, Diego, Osella, Giulia, Petruzzelli, Luca, Pignata, Giusto, Andreuccetti, Jacopo, D’Alessio, Rossella, Buonfantino, Massimo, Guaitoli, Eleonora, Spinelli, Stefano, Sampietro, Gianluca Matteo, Corbellini, Carlo, Lorusso, Leonardo, Frontali, Alice, Pezzoli, Isabella, Bonomi, Alessandro, Chierici, Andrea, Cotsoglou, Christian, Manca, Giuseppe, Delvecchio, Antonella, Musa, Nicola, Casati, Massimiliano, Letizia, Laface, Abate, Emmanuele, Ercolani, Giorgio, D’Acapito, Fabrizio, Solaini, Leonardo, Guercioni, Gianluca, Cicconi, Simone, Sasia, Diego, Borghi, Felice, Giraudo, Giorgio, Sena, Giuseppe, Castaldo, Pasquale, Cardamone, Eugenia, Portale, Giuseppe, Zuin, Matteo, Spolverato, Ylenia, Esposito, Marialusia, Isernia, Roberta Maria, Di Salvo, Maria, Manunza, Romina, Esposito, Giuseppe, Agus, Marcello, Asti, Emanuele Luigi Giuseppe, Bernardi, Daniele Tiziano, Tonucci, Tommaso Panici, Luppi, Davide, Casadei, Massimiliano, Bonilauri, Stefano, Pezzolla, Angela, Panebianco, Annunziata, Laforgia, Rita, De Luca, Maurizio, Zese, Monica, Parini, Dario, Jovine, Elio, De Sario, Giuseppina, Lombardi, Raffaele, Aprea, Giovanni, Palomba, Giuseppe, Capuano, Marianna, Argenio, Giulio, Orio, Gianluca, Armellino, Mariano Fortunato, Troian, Marina, Guerra, Martina, Nagliati, Carlo, Biloslavo, Alan, Germani, Paola, Aizza, Giada, Monsellato, Igor, Chahrour, Ali Chaouki, Anania, Gabriele, Bombardini, Cristina, Bagolini, Francesco, Sganga, Gabriele, Fransvea, Pietro, Bianchi, Valentina, Boati, Paolo, Ferrara, Francesco, Palmieri, Francesco, Cianci, Pasquale, Gattulli, Domenico, Restini, Enrico, Cillara, Nicola, Cannavera, Alessandro, Nita, Gabriela Elisa, Sarnari, Jlenia, Roscio, Francesco, Clerici, Federico, Scandroglio, Ildo, Berti, Stefano, Cadeo, Alessandro, Filippelli, Alice, Conti, Luigi, Grassi, Carmine, Cattaneo, Gaetano Maria, Pighin, Marina, Papis, Davide, Gambino, Giovanni, Bertino, Vanessa, Schifano, Domenico, Prando, Daniela, Fogato, Luisella, Cavallo, Fabio, Ansaloni, Luca, Picheo, Roberto, Pontarolo, Nicholas, Depalma, Norma, Spampinato, Marcello, D’Ugo, Stefano, Lepre, Luca, Capponi, Michela Giulii, Campa, Rossella Domenica, Sarro, Giuliano, Dinuzzi, Vincenza Paola, Olmi, Stefano, Uccelli, Matteo, Ferrari, Davide, Inama, Marco, Moretto, Gianluigi, Fontana, Michele, Favi, Francesco, Picariello, Erika, Rampini, Alessia, Barberis, Andrea, Azzinnaro, Antonio, Oliva, Alba, Totaro, Luigi, Benzoni, Ilaria, Ranieri, Valerio, Capolupo, Gabriella Teresa, Carannante, Filippo, Caricato, Marco, Ronconi, Maurizio, Casiraghi, Silvia, Casole, Giovanni, Pantalone, Desire, Alemanno, Giovanni, Scheiterle, Maximilian, Ceresoli, Marco, Cereda, Marco, Fumagalli, Chiara, Zanzi, Federico, Bolzon, Stefano, Guerra, Enrico, Lecchi, Francesca, Cellerino, Paola, Ardito, Antonella, Scaramuzzo, Rosa, Balla, Andrea, Lepiane, Pasquale, Tartaglia, Nicola, Ambrosi, Antonio, Pavone, Giovanna, Palini, Gian Marco, Veneroni, Simone, Garulli, Gianluca, Ricci, Claudio, Torre, Beatrice, Russo, Iris Shari, Rottoli, Matteo, Tanzanu, Marta, Belvedere, Angela, Milone, Marco, Manigrasso, Michele, De Palma, Giovanni Domenico, Piccoli, Micaela, Pattacini, Gianmaria Casoni, Magnone, Stefano, Bertoli, Paolo, Pisano, Michele, Massucco, Paolo, Palisi, Marco, Luzzi, Andrea-Pierre, Fleres, Francesco, Clarizia, Guglielmo, Spolini, Alessandro, Kobe, Yoshiro, Toma, Takayuki, Shimamura, Fumihiko, Parker, Robert, Ranketi, Sinkeet, Mitei, Mercy, Svagzdys, Saulius, Pauzas, Henrikas, Zilinskas, Justas, Poskus, Tomas, Kryzauskas, Marius, Jakubauskas, Matas, Zakaria, Andee Dzulkarnaen, Zakaria, Zaidi, Wong, Michael Pak-Kai, Jusoh, Asri Che, Zakaria, Muhammad Nazreen, Cruz, Daniel Rios, Elizalde, Aurea Barbara Rodriguez, Reynaud, Alejandro Bañon, Hernandez, Edgard Efren Lozada, Monroy, Jose maria Victor Palomo, Hinojosa-Ugarte, Diego, Quiodettis, Martha, Du Bois, María Esther, Latorraca, José, Major, Piotr, Pędziwiatr, Michał, Pisarska-Adamczyk, Magdalena, Walędziak, Maciej, Kwiatkowski, Andrzej, Czyżykowski, Łukasz, da Costa, Silvia Dantas, Pereira, Bela, Ferreira, Ana Rita Oliveira, Almeida, Filipe, Rocha, Ricardo, Carneiro, Carla, Perez, Diego Pita, Carvas, João, Rocha, Catarina, Ferreira, Cátia, Marques, Rita, Fernandes, Urânia, Leao, Pedro, Goulart, André, Pereira, Rita Gonçalves, Patrocínio, Sara Daniela Direito, de Mendonça, Nuno Gonçalo Gonçalves, Manso, Maria Isabel Cerqueira, Morais, Henrique Manuel Cardoso, Cardoso, Paulo Sebastião, Calu, Valentin, Miron, Adrian, Toma, Elena Adelina, Gachabayov, Mahir, Abdullaev, Abakar, Litvin, Andrey, Nechay, Taras, Tyagunov, Alexander, Yuldashev, Anvar, Bradley, Alison, Wilson, Michael, Panyko, Arpád, Látečková, Zuzana, Lacko, Vladimír, Lesko, Dusan, Soltes, Marek, Radonak, Jozef, Turrado-Rodriguez, Victor, Termes-Serra, Roser, Morales-Sevillano, Xavier, Lapolla, Pierfrancesco, Mingoli, Andrea, Brachini, Gioia, Degiuli, Maurizio, Sofia, Silvia, Reddavid, Rossella, de Manzoni Garberini, Andrea, Buffone, Angelica, del Pozo, Eduardo Perea, Aparicio-Sánchez, Daniel, Dos Barbeito, Sandra, Estaire-Gómez, Mercedes, Vitón-Herrero, Rebeca, de los Ángeles Gil Olarte-Marquez, Mª, Gil-Martínez, José, Alconchel, Felipe, Nicolás-López, Tatiana, Rahy-Martin, Aida Cristina, Pelloni, María, Bañolas-Suarez, Raquel, Mendoza-Moreno, Fernando, Nisa, Francisca García-Moreno, Díez-Alonso, Manuel, Rodas, María Elisa Valle, Agundez, María Carmona, Andrés, María Inmaculada Pérez, Moreira, Claudia Cristina Lopes, Perez, Aintzane Lizarazu, Ponce, Iñigo Augusto, González-Castillo, Ana María, Membrilla-Fernández, Estela, Salvans, Silvia, Serradilla-Martín, Mario, Pardo, Pablo Sancho, Rivera-Alonso, Daniel, Dziakova, Jana, Huguet, Jose Mugüerza, Valle, Naila Pagès, Ruiz, Enrique Colás, Valcárcel, Cristina Rey, Moreno, Cristina Ruiz, Salazar, Yeniffer Tatiana Moreno, García, Juan Jesús Rubio, Micó, Silvia Sevila, López, Joaquín Ruiz, Farré, Silvia Pérez, Gomez, Maite Santamaria, Petit, Nuria Mestres, Titos-García, Alberto, Aranda-Narváez, Jose Manuel, Romacho-López, Laura, Sánchez-Guillén, Luis, Aranaz-Ostariz, Veronica, Bosch-Ramírez, Marina, Martínez-Pérez, Aleix, Martínez-López, Elías, Sebastián-Tomás, Juan Carlos, Jimenez-Riera, Granada, Jimenez-Vega, Javier, Cuellar, Jose Aurelio Navas, Campos-Serra, Andrea, Muñoz-Campaña, Anna, Gràcia-Roman, Raquel, Alegre, Javier Martínez, Pinto, Francisca Lima, O’Sullivan, Sara Nuñez, Antona, Francisco Blanco, Jiménez, Beatriz Muñoz, López-Sánchez, Jaime, Carmona, Zahira Gómez, Fernández, Rocio Torres, Sierra, Isabel Blesa, de León, Laura Román García, Moreno, Verónica Polaino, Iglesias, Eva, Cumplido, Paola Lora, Bravo, Altea Arango, Simó, Ignacio Rey, Domínguez, Carlota López, Caamaño, Aloia Guerreiro, Lozano, Rafael Calleja, Martínez, Manuel Durán, Torres, Álvaro Naranjo, de Quiros, Javier Tomas Morales Bernaldo, Pellino, Gianluca, Cloquell, Miriam Moratal, Moller, Elsa García, Jalal-Eldin, Sami, Abdoun, Ahmed K., Hamid, Hytham K. S., Lohsiriwat, Varut, Mongkhonsupphawan, Aitsariya, Baraket, Oussama, Ayed, Karim, Abbassi, Imed, Ali, Ali Ben, Ammar, Houssem, Kchaou, Ali, Tlili, Ahmed, Zribi, Imen, Colak, Elif, Polat, Suleyman, Koylu, Zehra Alan, Guner, Ali, Usta, Mehmet Arif, Reis, Murat Emre, Mantoglu, Baris, Gonullu, Emre, Akin, Emrah, Altintoprak, Fatih, Bayhan, Zulfu, Firat, Necattin, Isik, Arda, Memis, Ufuk, Bayrak, Mehmet, Altıntaş, Yasemin, Kara, Yasin, Bozkurt, Mehmet Abdussamet, Kocataş, Ali, Das, Koray, Seker, Ahmet, Ozer, Nazmi, Atici, Semra Demirli, Tuncer, Korhan, Kaya, Tayfun, Ozkan, Zeynep, Ilhan, Onur, Agackiran, Ibrahim, Uzunoglu, Mustafa Yener, Demirbas, Eren, Altinel, Yuksel, Meric, Serhat, Hacım, Nadir Adnan, Uymaz, Derya Salim, Omarov, Nail, Balık, Emre, Tebala, Giovanni D., Khalil, Hany, Rana, Mridul, Khan, Mansoor, Florence, Charlotte, Swaminathan, Christie, Leo, Cosimo Alex, Liasis, Lampros, Watfah, Josef, Trostchansky, Ivan, Delgado, Edward, Pontillo, Marcelo, Latifi, Rifat, Coimbra, Raul, Edwards, Sara, Lopez, Ana, Velmahos, George, Dorken, Ander, Gebran, Anthony, Palmer, Amanda, Oury, Jeffrey, Bardes, James M., Seng, Sirivan Suon, Coffua, Lauren S., Ratnasekera, Asanthi, Egodage, Tanya, Echeverria-Rosario, Karla, Armento, Isabella, Napolitano, Lena M., Sangji, Naveen F., Hemmila, Mark, Quick, Jacob A., Austin, Tyler R., Hyman, Theodore S., Curtiss, William, McClure, Amanda, Cairl, Nicholas, Biffl, Walter L., Truong, Hung P., Schaffer, Kathryn, Reames, Summer, Banchini, Filippo, Capelli, Patrizio, Coccolini, Federico, Sartelli, Massimo, Bravi, Francesca, Vallicelli, Carlo, Agnoletti, Vanni, Baiocchi, Gian Luca, and Catena, Fausto

Published
2024
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6. Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper.

Author

Giuffrida, Mario, Perrone, Gennaro, Abu-Zidan, Fikri, Agnoletti, Vanni, Ansaloni, Luca, Baiocchi, Gian, Bendinelli, Cino, Biffl, Walter, Bonavina, Luigi, Bravi, Francesca, Carcoforo, Paolo, Ceresoli, Marco, Chichom-Mefire, Alain, Coccolini, Federico, Coimbra, Raul, deAngelis, Nicola, de Moya, Marc, De Simone, Belinda, Di Saverio, Salomone, Fraga, Gustavo, Ivatury, Rao, Kashuk, Jeffry, Kelly, Michael, Kirkpatrick, Andrew, Kluger, Yoram, Koike, Kaoru, Leppaniemi, Ari, Maier, Ronald, Moore, Ernest, Peitzmann, Andrew, Sakakushev, Boris, Sartelli, Massimo, Sugrue, Michael, Tian, Brian, Broek, Richard, Vallicelli, Carlo, Wani, Imtaz, Weber, Dieter, Docimo, Giovanni, Catena, Fausto, and Galante, Joseph

Subjects
Congenital, Diaphragm hernia, Emergency surgery, Guidelines, Rupture, Trauma, Humans, Diaphragm, Hernias, Diaphragmatic, Congenital, Tomography, X-Ray Computed, Thorax, Hernia, Hiatal, Thoracic Injuries
Abstract

BACKGROUND: Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. METHODS: A bibliographic search using major databases was performed using the terms emergency surgery diaphragmatic hernia, traumatic diaphragmatic rupture and congenital diaphragmatic hernia. GRADE methodology was used to evaluate the evidence and give recommendations. RESULTS: CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients. CONCLUSIONS: Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.

Published
2023

7. Assessing and managing frailty in emergency laparotomy: a WSES position paper.

Author

Tian, Brian, Stahel, Philip, Picetti, Edoardo, Campanelli, Giampiero, Di Saverio, Salomone, Moore, Ernest, Bensard, Denis, Sakakushev, Boris, Galante, Joseph, Fraga, Gustavo, Koike, Kaoru, Di Carlo, Isidoro, Tebala, Giovanni, Leppaniemi, Ari, Tan, Edward, Damaskos, Dimitris, DeAngelis, Nicola, Hecker, Andreas, Pisano, Michele, Maier, Ron, De Simone, Belinda, Amico, Francesco, Ceresoli, Marco, Pikoulis, Manos, Weber, Dieter, Biffl, Walt, Beka, Solomon, Abu-Zidan, Fikri, Valentino, Massimo, Coccolini, Federico, Kluger, Yoram, Sartelli, Massimo, Agnoletti, Vanni, Chirica, Mircea, Bravi, Francesca, Sall, Ibrahima, and Catena, Fausto

Subjects
Elderly, Emergency surgery, Frail, Frailty, Laparotomy, Humans, Aged, Aged, 80 and over, Frailty, Laparotomy, Frail Elderly, Consensus, Comorbidity
Abstract

Many countries are facing an aging population. As people live longer, surgeons face the prospect of operating on increasingly older patients. Traditional teaching is that with older age, these patients face an increased risk of mortality and morbidity, even to a level deemed too prohibitive for surgery. However, this is not always true. An active 90-year-old patient can be much fitter than an overweight, sedentary 65-year-old patient with comorbidities. Recent literature shows that frailty-an age-related cumulative decline in multiple physiological systems, is therefore a better predictor of mortality and morbidity than chronological age alone. Despite recognition of frailty as an important tool in identifying vulnerable surgical patients, many surgeons still shun objective tools. The aim of this position paper was to perform a review of the existing literature and to provide recommendations on emergency laparotomy and in frail patients. This position paper was reviewed by an international expert panel composed of 37 experts who were asked to critically revise the manuscript and position statements. The position paper was conducted according to the WSES methodology. We shall present the derived statements upon which a consensus was reached, specifying the quality of the supporting evidence and suggesting future research directions.

Published
2023

9. WSES consensus guidelines on sigmoid volvulus management.

Author

Tian, Brian, Vigutto, Gabriele, Tan, Edward, van Goor, Harry, Bendinelli, Cino, Abu-Zidan, Fikri, Ivatury, Rao, Sakakushev, Boris, Di Carlo, Isidoro, Sganga, Gabriele, Maier, Ronald, Coimbra, Raul, Leppäniemi, Ari, Litvin, Andrey, Damaskos, Dimitrios, Broek, Richard, Biffl, Walter, Di Saverio, Salomone, De Simone, Belinda, Ceresoli, Marco, Picetti, Edoardo, Tebala, Giovanni, Beka, Solomon, Bonavina, Luigi, Cui, Yunfeng, Khan, Jim, Cicuttin, Enrico, Amico, Francesco, Kenji, Inaba, Hecker, Andreas, Ansaloni, Luca, Sartelli, Massimo, Moore, Ernest, Kluger, Yoram, Testini, Mario, Weber, Dieter, Agnoletti, Vanni, Angelis, Nicola, Coccolini, Federico, Sall, Ibrahima, Catena, Fausto, and Galante, Joseph

Subjects
Humans, Aged, Intestinal Volvulus, Decompression, Surgical, Lumbar Vertebrae, Colonic Diseases
Abstract

Sigmoid volvulus is a common surgical emergency, especially in elderly patients. Patients can present with a wide range of clinical states: from asymptomatic, to frank peritonitis secondary to colonic perforation. These patients generally need urgent treatment, be it endoscopic decompression of the colon or an upfront colectomy. The World Society of Emergency Surgery united a worldwide group of international experts to review the current evidence and propose a consensus guidelines on the management of sigmoid volvulus.

Published
2023

16. Cesena guidelines:WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma

Author

Sermonesi, Giacomo, Tian, Brian W.C.A., Vallicelli, Carlo, Abu‑Zidan, Fikri M., Damaskos, Dimitris, Kelly, Michael Denis, Leppäniemi, Ari, Galante, Joseph M., Tan, Edward, Kirkpatrick, Andrew W., Khokha, Vladimir, Romeo, Oreste Marco, Chirica, Mircea, Pikoulis, Manos, Litvin, Andrey, Shelat, Vishal Girishchandra, Sakakushev, Boris, Wani, Imtiaz, Sall, Ibrahima, Fugazzola, Paola, Cicuttin, Enrico, Toro, Adriana, Amico, Francesco, Mas, Francesca Dal, De Simone, Belinda, Sugrue, Michael, Bonavina, Luigi, Campanelli, Giampiero, Carcoforo, Paolo, Cobianchi, Lorenzo, Coccolini, Federico, Chiarugi, Massimo, Di Carlo, Isidoro, Di Saverio, Salomone, Podda, Mauro, Pisano, Michele, Sartelli, Massimo, Testini, Mario, Fette, Andreas, Rizoli, Sandro, Picetti, Edoardo, Weber, Dieter, Latifi, Rifat, Kluger, Yoram, Balogh, Zsolt Janos, Biffl, Walter, Jeekel, Hans, Civil, Ian, Hecker, Andreas, Ansaloni, Luca, Bravi, Francesca, Agnoletti, Vanni, Beka, Solomon Gurmu, Moore, Ernest Eugene, Catena, Fausto, Sermonesi, Giacomo, Tian, Brian W.C.A., Vallicelli, Carlo, Abu‑Zidan, Fikri M., Damaskos, Dimitris, Kelly, Michael Denis, Leppäniemi, Ari, Galante, Joseph M., Tan, Edward, Kirkpatrick, Andrew W., Khokha, Vladimir, Romeo, Oreste Marco, Chirica, Mircea, Pikoulis, Manos, Litvin, Andrey, Shelat, Vishal Girishchandra, Sakakushev, Boris, Wani, Imtiaz, Sall, Ibrahima, Fugazzola, Paola, Cicuttin, Enrico, Toro, Adriana, Amico, Francesco, Mas, Francesca Dal, De Simone, Belinda, Sugrue, Michael, Bonavina, Luigi, Campanelli, Giampiero, Carcoforo, Paolo, Cobianchi, Lorenzo, Coccolini, Federico, Chiarugi, Massimo, Di Carlo, Isidoro, Di Saverio, Salomone, Podda, Mauro, Pisano, Michele, Sartelli, Massimo, Testini, Mario, Fette, Andreas, Rizoli, Sandro, Picetti, Edoardo, Weber, Dieter, Latifi, Rifat, Kluger, Yoram, Balogh, Zsolt Janos, Biffl, Walter, Jeekel, Hans, Civil, Ian, Hecker, Andreas, Ansaloni, Luca, Bravi, Francesca, Agnoletti, Vanni, Beka, Solomon Gurmu, Moore, Ernest Eugene, and Catena, Fausto

Abstract

Background: Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma.Methods: This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. Results: A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic

Published
2023

19. Treatment of Freckles Using a Fractional Nonablative 2940nm Erb:YAG Laser in a Series of Asian Patients

Author

Tian, Brian

Subjects
Brief Report
Abstract

OBJECTIVE: The purpose of this study was to demonstrate a novel, effective, and safe way to utilize the Erb:YAG laser to clear freckles in Type III/IV Asian skin. DESIGN: This was a prospective study. SETTING: The setting was a Singapore-based clinic. PARTICIPANTS: Participants included five women, aged 25 to 38 years, three with Skin Type III and two with Skin Type IV. All of them had freckles. MEASUREMENTS: Photographs were taken pretreatment and one month after laser treatment. Three independent physicians evaluated the photographs using a grading system. Patients were followed clinically for a total of six months post-laser treatment to monitor for post-inflammatory hyperpigmentation and recurrence. RESULTS: At one month post-laser treatment, all five patients were evaluated. The three independent physicians agreed that all five patients had greater than 90-percent clearance of their freckles. During the subsequent follow-up visits (up to 6 months post-laser treatment), no post-inflammatory hyperpigmentation, hypopigmentation, or recurrence was seen. CONCLUSION: The Erb:Yag laser might be considered an effective and safe treatment for freckles in Asian patients.

Published
2017

20. The Asian Problem of Frequent Laser Toning for Melasma

Author

Tian, Brian

Subjects
Brief Report
Abstract

In recent years, laser toning or laser facial to treat melasma has become increasingly popular in Asia. It is common to see patients undergoing lasers three times a week, or even daily. This is part of a growing trend and is sometimes recommended in the user manuals from laser manufacturers. In our study, we report on 23 Chinese patients who had lasers performed three times a week for two consecutive months, followed by rest. All 23 of them developed bilateral confetti-like hypopigmentation at the end of two months. During the four-month follow-up and rest, 10 patients were lost to follow-up. Of the remaining 13 patients, none of them had repigmentation. We conclude that frequent laser facials or laser toning at regular intervals may result in undesirable outcomes and thus should not be performed in regular intervals.

Published
2017

28. Clinical update on acute cholecystitis and biliary pancreatitis: between certainties and grey areas.

Author

Fugazzola P, Podda M, Tian BW, Cobianchi L, Ansaloni L, and Catena F

Abstract

Acute calculous cholecystitis (ACC) and acute biliary pancreatitis (ABP) are significant complications of gallstone disease. This review aims to provide a comprehensive analysis of current management practices for ACC and ABP. The Tokyo Guidelines (TG) and World Society of Emergency Surgery (WSES) guidelines recommend early laparoscopic cholecystectomy (ELC) as the treatment of choice for ACC. High-risk patients may benefit from alternative treatments like biliary drainage, with emerging techniques such as endoscopic drainage showing promise. ABP requires prompt diagnosis and intervention. The Revised Atlanta Classification (RAC) criteria are used for diagnosis, with endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy as primary treatments. Minimally invasive approaches are preferred for managing complications like infected pancreatic necrosis, with the endoscopic step-up method showing superior outcomes. The management of ACC and ABP continues to evolve. Future research is needed to refine guidelines further and address existing controversies, ultimately improving patient outcomes in these acute biliary conditions., Competing Interests: Paola Fugazzola, Mauro Podda, Brian Wca Tian, Lorenzo Cobianchi, Luca Ansaloni and Fausto Catena declare that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Published
2024
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29. Treatment of Freckles Using a Fractional Nonablative 2940nm Erb:YAG Laser in a Series of Asian Patients.

Author

Tian B

Abstract

OBJECTIVE: The purpose of this study was to demonstrate a novel, effective, and safe way to utilize the Erb:YAG laser to clear freckles in Type III/IV Asian skin. DESIGN: This was a prospective study. SETTING: The setting was a Singapore-based clinic. PARTICIPANTS: Participants included five women, aged 25 to 38 years, three with Skin Type III and two with Skin Type IV. All of them had freckles. MEASUREMENTS: Photographs were taken pretreatment and one month after laser treatment. Three independent physicians evaluated the photographs using a grading system. Patients were followed clinically for a total of six months post-laser treatment to monitor for post-inflammatory hyperpigmentation and recurrence. RESULTS: At one month post-laser treatment, all five patients were evaluated. The three independent physicians agreed that all five patients had greater than 90-percent clearance of their freckles. During the subsequent follow-up visits (up to 6 months post-laser treatment), no post-inflammatory hyperpigmentation, hypopigmentation, or recurrence was seen. CONCLUSION: The Erb:Yag laser might be considered an effective and safe treatment for freckles in Asian patients., Competing Interests: FUNDING:No funding was provided for this article. DISCLOSURES:The author has no conflicts of interest relevant to the contents of this article.

Published
2017

30. The Asian Problem of Frequent Laser Toning for Melasma.

Author

Tian B

Abstract

In recent years, laser toning or laser facial to treat melasma has become increasingly popular in Asia. It is common to see patients undergoing lasers three times a week, or even daily. This is part of a growing trend and is sometimes recommended in the user manuals from laser manufacturers. In our study, we report on 23 Chinese patients who had lasers performed three times a week for two consecutive months, followed by rest. All 23 of them developed bilateral confetti-like hypopigmentation at the end of two months. During the four-month follow-up and rest, 10 patients were lost to follow-up. Of the remaining 13 patients, none of them had repigmentation. We conclude that frequent laser facials or laser toning at regular intervals may result in undesirable outcomes and thus should not be performed in regular intervals., Competing Interests: FUNDING:No funding was provided for this study. DISCLOSURES:The author has no conflicts of interest relevant to the content of this article.

Published
2017

31. Novel Low Fluence Combination Laser Treatment of Solar Lentigines in Type III Asian Skin.

Author

Tian BW

Abstract

Objective: To demonstrate a novel low fluence combination laser technique [Erbium-doped yttrium aluminum garnet (Erb:YAG) and neodymium-doped yttrium aluminum garnet (Nd:YAG)] to effectively treat solar lentigines in type III Asian skin in a single session., Design: A prospective study., Setting: A Singapore-based clinic., Participants: Five patients (all females) were enrolled into the study. The ages ranged 35-60 years; all patients had Fitzpatrick skin type III., Measurements: Photographs were taken at baseline and at 1-month follow-up. These were reviewed by two independent physicians who were blinded to the study. Changes in pigment severity were assessed by a 5-point scale (1: Aggravation of pigment, 2: No change, 3: 25-50% improvement, 4: 51-75% improvement, and 5: 76-100% improvement)., Results: All patients received a single treatment session. At 1-month follow-up, a reduction in pigment was observed in all patients. Both physicians' reports were independently agreeable. All patients scored 5, having >90% improvement in pigment severity. No hypopigmentation, postinflammatory hyperpigmentation (PIH), or recurrence was seen., Conclusion: Low fluence combination laser is effective and safe for clearance of solar lentigines in type III Asian skin.

Published
2015
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32. Novel treatment of Hori's nevus: A combination of fractional nonablative 2,940-nm Er:YAG and low-fluence 1,064-nm Q-switched Nd:YAG laser.

Author

Tian BW

Abstract

Objective: To demonstrate a combination laser therapy to treat Hori's nevus., Design: A prospective study., Setting: A Singapore-based clinic., Participants: Five female patients, aged 30-46 years, with bilateral malar Hori's nevus., Measurements: Photographs were taken before treatment and 1 month after laser treatment was completed. These were graded by three independent physicians. The patients were also asked to grade their treatment response subjectively. They were followed up for a total of 3 months after laser treatment to monitor recurrence., Materials and Methods: The fractional nonablative 2,940-nm Er:YAG laser with a fluence of 0.7 J/cm(2), spot size 12 mm, and frequency 15 Hz was used to perform a full-face single-pass treatment. Subsequently, a second pass and third pass over Hori's nevi were done bilaterally till the clinical endpoint of skin whitening. The 1,064-nm Q-switched (QS) Nd:YAG at a fluence of 2.0 J/cm(2), frequency 2 Hz, and 4-mm spot size was used to deliver multiple passes over Hori's nevus till erythema with mild petechiae appeared. We repeated the treatment once a week for 3 more consecutive weeks., Results: All five patients had above 80% improvement in their pigmentation and two (skin type III) achieved complete 100% clearance. Based on the patients' subjective assessments, all five of them expressed satisfaction and felt that their pigmentation had improved. There were no complications noted., Conclusion: The fractional nonablative 2940 nm Er:YAG laser and Q-switched 1064nm laser Nd:YAG combination is an effective and safe treatment for Hori's nevus.

Published
2015
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