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

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.

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

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.

Enhanced perioperative care in emergency general surgery: the WSES position paper.

Enhanced perioperative care protocols become the standard of care in elective surgery with a significant improvement in patients' outcome. The key element of the enhanced perioperative care protocol is the multimodal and interdisciplinary approach targeted to the patient, focused on a holistic approach to reduce surgical stress and improve perioperative recovery. Enhanced perioperative care in emergency general surgery is still a debated topic with little evidence available. The present position paper illustrates the existing evidence about perioperative care in emergency surgery patients with a focus on each perioperative intervention in the preoperative, intraoperative and postoperative phase. For each item was proposed and approved a statement by the WSES collaborative group.

Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines.

Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.

It's time for a minimum synoptic operation template in patients undergoing laparoscopic cholecystectomy: a systematic review.

BACKGROUND: Despite the call to enhance accuracy and value of operation records few international recommended minimal standards for operative notes documentation have been described. This study undertook a systematic review of existing operative reporting systems for laparoscopic cholecystectomy (LC) to fashion a comprehensive, synoptic operative reporting template for the future. METHODS: A search for all relevant articles was conducted using PubMed version of Medline, Scopus and Web of Science databases in June 2021, for publications from January 1st 2011 to October 25th 2021, using the keywords: laparoscopic cholecystectomy AND operation notes OR operative notes OR proforma OR documentation OR report OR narrative OR audio-visual OR synoptic OR digital. Two reviewers (NOC, GMC) independently assessed each published study using a MINORS score of ≥ 16 for comparative and ≥ 10 for non-comparative for inclusion. This systematic review followed PRISMA guidelines and was registered with PROSPERO. Synoptic operative templates from published data were assimilated into one "ideal" laparoscopic operative report template following international input from the World Society of Emergency Surgery board. RESULTS: A total of 3567 articles were reviewed. Following MINORS grading 25 studies were selected spanning 14 countries and 4 continents. Twenty-two studies were prospective. A holistic overview of the operative procedure documentation was reported in 6/25 studies and a further 19 papers dealt with selective surgical aspects of LC. A unique synoptic LC operative reporting template was developed and translated into Chinese/Mandarin, French and Arabic. CONCLUSION: This systematic review identified a paucity of publications dealing with operative reporting of LC. The proposed new template may be integrated digitally with hospitals' medical systems and include additional narrative text and audio-visual data. The template may help define new OR (operating room) recording standards and impact on care for patients undergoing LC.

Propranolol in use for treatment of complex infant hemangiomas: literature review regarding current guidelines for preassessment and standards of care before initiation of therapy.

In 2008, the positive effects of propranolol on infantile hemangiomas (IH) have been discovered serendipitously by Léauté-Labrèze and her coworkers. Since then, propranolol has been in use in allday clinical practice worldwide for treatment of IH. It even caused some kind of paradigm shift in the overall management of these lesions, though propranolol is still not FDA approved, respectively, in "off-label" use for this indication in the majority of institutions. Thus, the aim of this communication is to evaluate the literature for current evidence regarding guidelines for preassessment and standards of care before initiation of therapy.

Case report: Dieterich's disease in a teenage boy.

Aseptic metacarpal head necrosis or 'Dieterich disease' is a rare condition, especially in children or adolescents, not routinely described in hand surgery literature reviews. This case report presents course and treatment of a teenage boy with the exceptional fifth ray involved.

A pediatric civil war burn victim: the patient's and caregivers' stress and coping.

A patient's and the caregivers' threats and reliefs during nursing of a pediatric civil war burn victim, treated through a charity grant in a Western hospital, are discussed and supported by a literature review.

New perspectives in pediatric trauma care.

An "American-style" pediatric trauma care symposia consisting of lectures, workshops, and skill stations was held at a pediatric trauma center to improve pre- and post-hospital care for children, facilitate communication, and to set up standards within the regional rescue chain.

Discussing the relationship between quality care and cost-effective care in Swiss pediatric wound care.

The growing individual and public demand for high-quality care within a context of restricted budgets dominates the political as well as medical agenda. This demand for "quality care" has developed an "industry" and lobby relating to auditing practice even in the small subpopulation of pediatric surgical patients. With children, complex and nonhealing wounds are quite rare, but there are pressures to provide modern and high-quality wound care even in Switzerland. Thus, in accordance with practice in neighboring countries, guidelines for wound care have been established in the Swiss healthcare sector. Their validity and reliability in the context of cost-effective versus quality care are critically discussed in this paper.

Influence of silicone on abnormal scarring.

The problem of scarring represents a large area of an unmet medical need, since people with abnormal skin scarring may face physical and psychological consequences that may be associated with substantial emotional and financial costs. To date, treatment options are to leave the scar alone or use invasive or noninvasive management. Silicone is the key in noninvasive management, with the following overall results reported: great improvement of the scar appearance, easy to apply, painless, and almost free of side effects. When analyzing all presented results in this research sample, it becomes obvious that they are mainly based on subjective, not well-defined scar assessment by the individual without comparison to controls or rating against validated scores and therefore lacking real scientific or evidence-based criteria.

Ultrasound detection of soft and bony tissues in congenital hand malformations. Examples taken in daily paediatric surgical clinics.

According to the everyday use of ultrasound in the whole field of paediatric surgery we would like to define its potential role in the assessment of congenital hand malformation (CHM). We therefore tested it for several diagnoses like digitus saltans, camptodactylism, triphalangeal thumb and syndrome-associated malformations in comparison as well as in addition to clinical and x-ray findings. All soft and bony tissue details could be displayed reasonable giving the paediatric surgeon additional information. Additional information that is available at the bedside, non-invasive, less costly and does not use ionising radiation.

Integra artificial skin in use for full-thickness burn surgery: benefits or harms on patient outcome.

Full thickness burns usually lead to a great loss of skin and physiological instability because human skin is not only the biggest organ of our body it is the most important protection barrier as well. As natural skin has only limited options to recover, there is a great need for the development of synthetic skin in order to save patients with these high total body surface area full-thickness burns. Many artificial skin substitutes have been developed for this purpose so far. The benefits and harms of one substitute--Integra artificial skin--are discussed in a critical literature review.

Treatment of pressure ulcers with topical negative pressure versus traditional wound management methods: a research sampler.

The treatment of pressure ulcers is still a matter of debate. The pros and cons of topical negative pressure versus traditional saline wet-to-moist dressings, platelet-derived growth factor, and surgical debridement are discussed in the literature review. This article examines literature that relates to the mechanism of action and efficacy of topical negative pressure.

Thoracoplasty for treatment of asphyxiating thoracic dysplasia in a newborn.

In our case report and literature review, we report about a female newborn with severe asphyxiating thoracic dysplasia of the spondylocostal dysostosis classification to whom an expandable thoracoplasty with metal implants offered survival and discharge at home from newborn to infancy.

A pediatric civil war burn victim: the patient's and caregivers' stress and coping.

A patient's and the caregivers' threats and reliefs during nursing of a pediatric civil war burn victim, treated through a charity grant in a Western hospital, are discussed and supported by a literature review.