27 research outputs found
Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members
Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic.
Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine.
Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis.
Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years
Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study
: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
Laparoscopic repair of Amyand's hernia complicated with acute appendicitis. Report of a case
The presence of vermiform appendix in an inguinal hernia sac is known as
Amyand's hernia. Amyand's hernia complicated with acute appendicitis is
an extremely rare entity with challenging diagnosis and large debate
about the optimal treatment option. We report a case of a 58-year-old
man presenting to the Emergency Department with an incarcerated right
inguinal hernia. At laparoscopy, an inflamed appendix was identified
within the inguinal canal, representing an indirect Amyand's hernia. A
laparoscopic appendicectomy was performed followed by a trans-abdominal
pre-peritoneal mesh repair of the aforementioned hernia. We report this
rare clinical entity raising physicians' awareness to include acute
appendicitis within an Amyand's hernia in the differential diagnosis of
incarcerated inguinal hernias, along with a successful minimally
invasive surgical approach
Irreversible electroporation in a case of pancreatic leiomyosarcoma: a novel weapon versus a rare malignancy?
Abstract Background Primary pancreatic leiomyosarcoma is an extremely rare entity that needs high clinical suspicion in order to diagnose it at an early stage. Clinical characteristics, diagnosis, and management still remain challenging and controversial, especially in advanced stages, when tumor invades adjacent vessels and organs or gives distant metastases. Case presentation Herein, we describe a case of a 57-year-old woman suffering from advanced pancreatic leiomyosarcoma with thrombosis of the superior mesenteric vein, as well as liver lesions which were suspicious for metastasis. Multidisciplinary team decided for upfront chemotherapy to assess tumor response. Follow-up imaging after the completion of chemotherapy led tumor board to decide for subsequent surgical exploration. The patient underwent exploratory laparotomy and irreversible electroporation ablation of the pancreatic tumor. Postoperative course was uneventful, and she was discharged 10 days later with a plan to receive adjuvant therapy. To the best of our knowledge, this is the first case of pancreatic leiomyosarcoma ever reported, treated with this novel technique of irreversible electroporation that could be an alternative and feasible way for the management of these rare malignancies. Conclusions In conclusion, primary pancreatic leiomyosarcoma is a rare and highly malignant tumor associated with poor prognosis. Nowadays, R0 surgical resection remains the cornerstone treatment, combined with adjuvant and/or neoadjuvant chemotherapy prior to resection. In the advanced setting, when major vessel invasion and distant metastases occur, chemotherapy along with irreversible electroporation ablation could be a helpful and possibly effective modality for the management of this highly aggressive tumor
Traumatic Closed Proximal Muscle Rupture of the Biceps Brachii in Military Paratrooper.
Traumatic closed proximal muscle rupture of the biceps brachii has been infrequently cited in the medical bibliography. Early reports of this injury derived from US military during parachute jumps, and it may compromise >4% of injuries at altitude. The mechanism is a direct blow to the upper extremity by static lines. We report a case of traumatic closed proximal rupture of the biceps brachii in a healthy 25 years of age military paratrooper. He was managed with primary surgical repair, and after three years of follow-up, the patient has excellent functional results
An extraordinary rare anastomotic band causing food bolus obstruction following uneventful minimally invasive esophagectomy: endoscopic treatment
The most common long-term complication post esophagectomy implicating
the esophagogastric anastomosis is stricture-induced stenosis leading to
late postoperative dysphagia. Herein, we present a case of a male
patient readmitted to our Upper Gastrointestinal Department due to a
food bolus obstruction through an anastomotic epithelial band arisen
from a prior esophagogastric anastomosis performed 5 months earlier. A
band transection in between two hemostatic clips placed on both sides of
the band, followed by a release and fragmentation of the foreign body
into several pieces led to its final transoral removal endoscopically.
The patient experienced a direct resolution of his dysphagia and
discharged on the same day. At 6 months follow-up, he remains
symptom-free. In conclusion, endoscopic state-of-the-art techniques when
combined with standard hemostatic surgical principles in a minimally
invasive manner are excellent tools for the management of
post-esophagectomy syndromes
Over-the-scope-clip treatment of gastrobronchial fistula following minimally invasive oesophagectomy: a novel approach
Gastrobronchial fistulae (GBF) following minimally invasive
oesophagectomy (MIO) is a rare entity, with an estimated incidence of
0.3-1.5% according to the published literature. It could present with
persistent cough (Ohno’s sign), chest pain, haemoptysis and recurrent
pneumonia. Barium swallow examination remains the most sensitive
investigation in 78% of the cases; the main stay of management is
surgical and in some cases endoscopic (stent insertion). We report a
rare case of a GBF 1 month after two-stage MIO for cancer of the
gastro-oesophageal junction, which was successfully treated for the
first time with an over-the-scope-clip
Cervical Twin Heterotopic Pregnancy: Overview of Ectopic Pregnancies and Scanning Detection Algorithm
Background: Ectopic pregnancy is the leading cause of gestation-related
deaths during the first trimester. Cervical twin heterotopic
pregnancies, when ectopic, constitute a small and rare part of
gynecological surgery. Case Presentation: A 30-year-old pregnant woman
(gravida 3, para 2) presented with mild pain in the lower abdomen and
traces of bleeding per vaginum for three days. Transvaginal
ultrasonography revealed a balloon-shaped cervical canal with a visible
gestational sac measuring 3.5 x 3.9 cm. A second gestational sac was
seen in the uterine cavity. The measurements of the gestational sacs
corresponded to 7 + 4 weeks' pregnancy. A decision for medical abortion
with mifepristone and misoprostol was made. However, due to an
incomplete abortion and continuous bleeding, a curettage was performed.
Conclusions: Spontaneous heterotopic pregnancy with the ectopic
pregnancy located in the cervix is an extremely rare clinical condition
requiring urgent treatment in order to reduce maternal mortality and
morbidity and preserve fertility