The Operative management in Bariatric Acute abdomen (OBA) Survey: long-term complications of bariatric surgery and the emergency surgeon\u27s point of view.

Background: The number of bariatric procedures is increasing worldwide. No consensus or guidelines about the emergency management of long-term complications following bariatric surgery are currently available. The aim of this study is to investigate by a web survey how an emergency surgeon approaches this unique group of patients in an emergency medical scenario and to report their personal experience. Method: An international web survey was sent to 197 emergency surgeons with the aim to collect data about emergency surgeons\u27 experience in the management of patients admitted in the emergency department for acute abdominal pain after bariatric surgery. The survey was conceived as a questionnaire composed by 26 (multiple choice and open) questions and approved by a steering committee. Results: One hundred seventeen international emergency surgeons decided to join the project and answered to the web survey with a response rate of 59.39%. Conclusions: The aim of this WSES web survey was to highlight the current management of patients previously submitted to bariatric surgical procedures by ES.Emergency surgeons must be mindful of postoperative bariatric surgery complications. CT scan with oral intestinal opacification may be useful in making a diagnosis if carefully interpreted by the radiologist and the surgeon.In case of inconclusive clinical and radiological findings, when symptoms fail to improve, surgical exploration for bariatric patients presenting acute abdominal pain, by laparoscopy if expertise is available, is mandatory in the first 12-24 h, to have good outcomes and decrease morbidity rate

2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery

Bladder injury; Urinary injury management; Urinary injury preventionLesió de la bufeta; Maneig de lesions urinàries; Prevenció de lesions urinàriesLesión de la vejiga; Manejo de lesiones urinarias; Prevención de lesiones urinariasIatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs

The Acute Abdomen Decision Making course for the initial management of non traumatic acute abdomen: A proposition of the World Society of Emergency Surgeons

The Acute Abdomen Decision Making course® (AADM®) was developed by the World Society of Emergency Surgeons (WSES) members with the purpose to teach a systematic and concise method for approaching acute abdomen patient. It was first introduced in 2016. The course explains step by step the clinical reasoning to follow for immediate managing of the acute abdomen in emergency department with a safe and reliable method. We developed this original decision making model AADM following the Advanced Trauma Life Support (ATLS) philosophy in evaluating non-traumatic abdominal pain patient. The A-B-C-D-E-F management of non-traumatic acute abdominal pain is conceived by WSES to make easy and systematic the evaluation of patients in Emergency Department. AADM course teaches how to assess an acute abdomen patient’s diagnosis and determine the therapeutic approach to reduce unnecessary exams and hospitalizations

The Operative management in Bariatric Acute abdomen (OBA) Survey: long-term complications of bariatric surgery and the emergency surgeon's point of view

Background: The number of bariatric procedures is increasing worldwide. No consensus or guidelines about theemergency management of long-term complications following bariatric surgery are currently available. The aim ofthis study is to investigate by a web survey how an emergency surgeon approaches this unique group of patientsin an emergency medical scenario and to report their personal experience. Method: An international web survey was sent to 197 emergency surgeons with the aim to collect data aboutemergency surgeons\u2019experience in the management of patients admitted in the emergency department for acuteabdominal pain after bariatric surgery. The survey was conceived as a questionnaire composed by 26 (multiplechoice and open) questions and approved by a steering committee. Results: One hundred seventeen international emergency surgeons decided to join the project and answered tothe web survey with a response rate of 59.39%. Conclusions: The aim of this WSES web survey was to highlight the current management of patients previouslysubmitted to bariatric surgical procedures by ES.Emergency surgeons must be mindful of postoperative bariatric surgery complications. CT scan with oral intestinalopacification may be useful in making a diagnosis if carefully interpreted by the radiologist and the surgeon.In case of inconclusive clinical and radiological findings, when symptoms fail to improve, surgical exploration forbariatric patients presenting acute abdominal pain, by laparoscopy if expertise is available, is mandatory in the first12\u201324 h, to have good outcomes and decrease morbidity rate

Emergency general surgeons: the special forces of general surgery (the “navy seals paradigm”)

Abstract: Emergency surgeons have a crucial role in bridging the gap of skills resulting from the well-known general surgery fragmentation. The multi-specialist general surgery approach is still necessary to define proper diagnosis and therapy priorities in an emergency. Governments have to find effective organizational solutions to maintain emergency general surgery standards of care and to improve them further

Deregulation of apoptosis-related genes is associated with PRV1 overexpression and JAK2 V617F allele burden in Essential Thrombocythemia and Myelofibrosis

<p>Abstract</p> <p>Background</p> <p>Essential Thrombocythemia (ET) and Primary Myelofibrosis (PMF) are Chronic Myeloproliferative Neoplasms (MPN) characterized by clonal myeloproliferation/myeloaccumulation without cell maturation impairment. The JAK2 V617F mutation and <it>PRV1 </it>gene overexpression may contribute to MPN physiopathology. We hypothesized that deregulation of the apoptotic machinery may also play a role in the pathogenesis of ET and PMF. In this study we evaluated the apoptosis-related gene and protein expression of BCL2 family members in bone marrow CD34⁺hematopoietic stem cells (HSC) and peripheral blood leukocytes from ET and PMF patients. We also tested whether the gene expression results were correlated with JAK2 V617F allele burden percentage, <it>PRV1 </it>overexpression, and clinical and laboratory parameters.</p> <p>Results</p> <p>By real time PCR assay, we observed that <it>A1, MCL1, BIK and BID</it>, as well as <it>A1, BCLW </it>and <it>BAK </it>gene expression were increased in ET and PMF CD34⁺cells respectively, while pro-apoptotic <it>BAX </it>and anti-apoptotic <it>BCL2 </it>mRNA levels were found to be lower in ET and PMF CD34⁺cells respectively, in relation to controls. In patients' leukocytes, we detected an upregulation of anti-apoptotic genes <it>A1, BCL2, BCL-X_L</it>and <it>BCLW</it>. In contrast, pro-apoptotic <it>BID </it>and <it>BIM_EL</it>expression were downregulated in ET leukocytes. Increased BCL-X_Lprotein expression in PMF leukocytes and decreased BID protein expression in ET leukocytes were observed by Western Blot. In ET leukocytes, we found a correlation between JAK2 V617F allele burden and <it>BAX, BIK and BAD </it>gene expression and between <it>A1, BAX </it>and <it>BIK </it>and <it>PRV1 </it>gene expression. A negative correlation between <it>PRV1 </it>gene expression and platelet count was observed, as well as a positive correlation between <it>PRV1 </it>gene expression and splenomegaly.</p> <p>Conclusions</p> <p>Our results suggest the participation of intrinsic apoptosis pathway in the MPN physiopathology. In addition, <it>PRV1 </it>and JAK2 V617F allele burden were linked to deregulation of the apoptotic machinery.</p

The Congress Impact Factor: A proposal from board members of the World Society of Emergency Surgeons.it (WSES) and Academy of Emergency Medicine and Care (AcEMC) [version 2; referees: 2 approved]

Many scientific congresses and conferences are held every year around the world. The aim of the World Society of Emergency Surgeons.it (WSES) and Academy of Emergency Medicine and Care (AcEMC) was to develop a simple mathematical parameter as an indicator of academic quality and scientific validity of a congress. In this opinion article, a new metric, the Congress Impact Factor (IFc), is proposed taking into consideration the widely used Impact Factor as an indicator of journals’ prestige and using H-index analysis. The IFc is derived from the mathematical ratio between the mean H-index of invited lecturers normalized for lecture topic and number of lectures in the conference. In case of multiple sessions, the mean of all IFc is calculated along with its standard deviation.  We conclude that the IFc can be a useful measure for evaluating and comparing congress prestige, and may also represent a potentially useful parameter for improving academic curriculum and helping participants to choose the more prestigious meetings for their education

coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis): The MANCTRA-1 international audit

Background/objectives: Reports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines. Methods: All consecutive patients admitted to any of the 150 participating general surgery (GS), hepatopancreatobiliary surgery (HPB), internal medicine (IM) and gastroenterology (GA) departments with a diagnosis of biliary acute pancreatitis between 01/01/2019 and 31/12/2020 were included in the study. Categorical data were reported as percentages representing the proportion of all study patients or different and well-defined cohorts for each variable. Continuous data were expressed as mean and standard deviation. Differences between the compliance obtained in the four different subgroups were compared using the Mann-Whitney U, Student's t, ANOVA or Kruskal-Wallis tests for continuous data, and the Chi-square test or the Fisher's exact test for categorical data. Results: Complete data were available for 5275 patients. The most commonly discordant gaps between daily clinical practice and recommendations included the optimal timing for the index CT scan (6.1%, χ2 6.71, P&nbsp;=&nbsp;0.081), use of prophylactic antibiotics (44.2%, χ2 221.05, P&nbsp;&lt;&nbsp;0.00001), early enteral feeding (33.2%, χ2 11.51, P&nbsp;=&nbsp;0.009), and the implementation of early cholecystectomy strategies (29%, χ2 354.64, P&nbsp;&lt;&nbsp;0.00001), with wide variability based on the admitting speciality. Conclusions: The results of this study showed an overall poor compliance with evidence-based guidelines in the management of ABP, with wide variability based on the admitting speciality. Study protocol registered in ClinicalTrials.Gov (ID Number NCT04747990)