Massimo Sartelli | University of Macerata (original) (raw)

Papers by Massimo Sartelli

Research paper thumbnail of Laparoscopic Transgastric versus Endoscopic Drainage of a Large Pancreatic Pseudocyst. A Case Report

Journal of gastrointestinal and liver diseases : JGLD, 2016

Pancreatic pseudocysts are the most common complication of acute and chronic pancreatitis. They a... more Pancreatic pseudocysts are the most common complication of acute and chronic pancreatitis. They account for 75% of the cystic lesions of the pancreas. A 37 year-old woman was admitted three months after an episode of severe acute pancreatitis with a large tumor mass located in her left abdomen, abdominal tenderness and asthenia. Abdominal Computed Tomography (CT) revealed a giant pancreatic pseudocyst of 23/15/12 centimeters. We performed an anterior laparoscopic transgastric cystogastrostomy. The postoperative clinical course was uneventful, and she was discharged nine days later. After another month she was re-admitted for general malaise and fever. We performed endoscopic evaluation of the cystogastrostomy patency followed by lavage of the pseudocyst cavity. After five days of broad spectrum antibiotic therapy the clinical course started to improve and the patient was discharged after another eight days. One- and two-year follow-ups revealed no remnant cavity. Laparoscopic transg...

Research paper thumbnail of Abdominal emergency surgery in patients over 90 years old: is it worthwhile? An Italian multicenter retrospective study

Journal of Peritoneum (and other serosal surfaces), 2016

Research paper thumbnail of Sepsis is a dynamic syndrome

Journal of Peritoneum (and other serosal surfaces), 2016

Research paper thumbnail of WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

World journal of emergency surgery : WJES, 2016

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA i... more Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified a...

Research paper thumbnail of Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

World journal of emergency surgery : WJES, 2016

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associate... more Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming i...

Research paper thumbnail of Laparoscopic source control for large pelvic abscess after perforated appendicitis, not amenable to percutanous drainage: Video Vignette

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 18, 2016

A 16-year-old male was operated for peritonitis from perforated appendicitis with the finding of ... more A 16-year-old male was operated for peritonitis from perforated appendicitis with the finding of a large abscess in the pelvic and right iliac fossa (RIF). He returned 12 days after discharge, complaining of fever and diffuse abdominal pain. An urgent abdominal ultrasound examination showed a large deep pelvic collection covered by the bladder and small bowel loops, with a further collection in the RIF. The white cell count (WCC) was 25,980 mm(-3) and the C-reactive protein (CRP) 23.70 mg/dL. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Laparoscopic Approach has Benefits in Gynecological Emergencies - Even for Massive Hemoperitoneum

Chirurgia (Bucharest, Romania : 1990)

The purpose of this study is to compare the laparoscopic with the open approach in hemoperitoneum... more The purpose of this study is to compare the laparoscopic with the open approach in hemoperitoneum of gynecological origin. Retrospective study of patients admitted to a tertiary emergency hospital between January 2013 - January 2015. There were 56 patients, 27 in the laparoscopic group (LG) and 28 in the open group (OG). The gynecological emergency was a ruptured ovarian cyst in 20 (74%) versus 17 (59%) cases, and an ectopic pregnancy with tubal rupture in 7 (26%) versus 12 (41%) patients in both the laparoscopic and open approaches, respectively. The main outcome - mean intraoperative hemoglobin decrease - was 1.5 +- 1.2 g/dl in the laparoscopic and 1.9 ‚+-1.4 in the open approach (p=0.344). There were no differences regarding red blood transfusion rate, needs for analgesics, postoperative complications and inhospital stay. The laparoscopic approach in acute abdomen of gynecologic origin is non-inferior to open surgery.

Research paper thumbnail of Adhesive small bowel adhesions obstruction: Evolutions in diagnosis, management and prevention

World journal of gastrointestinal surgery, Jan 27, 2016

Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They ar... more Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast follow-through and computed tomography scan. For patients presenting no signs of strangulation, peritonitis or severe intestinal impairment there is good evidence to support non-operative management. Open surgery is the preferred method for the surgical treatment of adhesive small bowel obstruction, in case of suspected strangulation or after failed conservative management, but laparoscopy is gaining widespread acceptance especially in selected group of patients. "Good" surgical technique and anti-adhesive barriers are the main current concepts of adhesion prevention. We discuss current knowledge in modern diagnosis and evolving strategies for management and prevention that are leading to stratified care for patients.

Research paper thumbnail of Renewed Interest in Acute Appendicitis: Are Antibiotics Non-Inferior to Surgery or Possibly Clinically Superior? What Is Long-Term Follow-Up and Natural Evolution of Appendicitis Treated Conservatively with "Antibiotics First"?

Surgical infections, Jan 26, 2016

Research paper thumbnail of Mass casualty incidents - time to engage

World Journal of Emergency Surgery, 2016

Mass casualty incident continues to overwhelm medical systems worldwide. Preparedness for an MCI ... more Mass casualty incident continues to overwhelm medical systems worldwide. Preparedness for an MCI is a crucial requisite for the injured better outcome. The World Society of Emergency Surgery initiated a survey in regard to its senior member's personal and institutional preparedness for MCI. The results here in presented indicate that WSES should engage in a formatted and structured preparedness course for medical institutions and individuals."By all appearances it seems to be just another normal Saturday morning in the emergency department (ED). Patients occupy thirty out of the sixty beds; some awaits discharge, some awaits admission to the hospital. All of a sudden the squeaky voice of the red phone is tearing the air, the hard metal voice on the line is reporting of an explosion in the nearby train station, estimated number of casualties is 80. You ask for their estimated time of arrival, when you hear the first sirens of ambulances parking out of the ED; no answer was needed.

Research paper thumbnail of Antibiotic resistance evaluation and clinical analysis of acute appendicitis; report of 1431 consecutive worldwide patients: A cohort study

International Journal of Surgery, 2016

Acute appendicitis (AA) is one of the most common diseases affecting especially young but also ol... more Acute appendicitis (AA) is one of the most common diseases affecting especially young but also older people. A systematic evaluation of bacteriology of AA has been frequently conducted in children but is not well known and discussed in adult population. The study has been obtained from two multicenter prospective observational studies (CIAO and CIAOW studies). The aim of the study is to analyze the intra-abdominal bacteriology in AA and its relation with clinical outcomes. Patients included were 1431, 806 male (56.3%). The mean/median age was 38.9 (SD ± 18.4) and 35 (range 18-94). Clinical condition at the admission was sepsis in 623 patients (43.5%), severe sepsis and septic shock in 29 (2%) and 10 (0.7%). Peritonitis was localized in 1107 patients (77.4%) and generalized in 324 (22.6%). Adequate source-control and empirical antimicrobial therapy were reported in 95.2% and 88.7% of the patients. 47 isolated bacteria (6.8%) were resistant. Two (4.2%) were health-care-associated infections and 45 (95.7%) were community-acquired infections. Univariate analysis showed factor associated to resistant bacteria was the inadequacy of the empiric antimicrobial therapy (p = 0.013); at multivariated analysis factors associated with mortality were age>70 years (p = 0.003) and severe sepsis at the admission (p = 0.02); factors associated to ICU admission were: severe sepsis (p < 0.0001), generalized peritonitis (p < 0.0001), malignancy (p < 0.0001) and cardiovascular disease (p < 0.0001). The evolution of antimicrobial resistance, in common community-acquired infections, combined with lack of new antibiotics development are strictly linked to clinical outcomes. Adequate empirical antimicrobial therapy is fundamental to counteract bacterial resistance.

Research paper thumbnail of Advances in laparoscopy for acute care surgery and trauma

World journal of gastroenterology, Jan 14, 2016

The greatest advantages of laparoscopy when compared to open surgery include the faster recovery ... more The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technic...

Research paper thumbnail of Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings

World journal of emergency surgery : WJES, 2015

Advances in the technology and improved access to imaging modalities such as Computed Tomography ... more Advances in the technology and improved access to imaging modalities such as Computed Tomography and laparoscopy have changed the contemporary diagnostic and management of acute appendicitis. Complicated appendicitis (phlegmon, abscess and/ or diffuse peritonitis), is now reliably distinguished from uncomplicated cases. Therefore, a new comprehensive grading system for acute appendicitis is necessary. The goal is review and update the laparoscopic grading system of acute appendicitis and to provide a new standardized classification system to allow more uniform patient stratification. During the last World Society of Emergency Surgery Congress in Israel (July, 2015), a panel involving Acute Appendicitis Experts and the author's discussed many current aspects about the acute appendicitis between then, it will be submitted a new comprehensive disease grading system. It was idealized based on three aspect of the disease (clinical and imaging presentation and laparoscopic findings). ...

Research paper thumbnail of Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study)

World journal of emergency surgery : WJES, 2015

To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal i... more To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p < 0.0001). The multivariate logistic regression model was highly significant (p < 0.0001, R2 = 0.54) and showed that all these factors were indepe...

Research paper thumbnail of Erratum to: caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion

World Journal of Emergency Surgery, 2015

[This corrects the article DOI: 10.1186/s13017-015-0043-4.].

Research paper thumbnail of WSES position paper on vascular emergency surgery

World Journal of Emergency Surgery, 2015

Trauma, both blunt and penetrating, is extremely common worldwide, as trauma to major vessels. Th... more Trauma, both blunt and penetrating, is extremely common worldwide, as trauma to major vessels. The management of these patients requires specialized surgical skills and techniques of the trauma surgeon. Furthermore few other surgical emergencies require immediate diagnosis and treatment like a ruptured abdominal aortic aneurysm (rAAA). Mortality of patients with a rAAA reaches 85 %, with more than half dying before reaching the hospital. These are acute events demanding immediate intervention to save life and limb and precluding any attempt at transfer or referral. It is the purpose of this position paper to discuss neck, chest, extremities and abdominal trauma, bringing to light recent evidence based data as well as expert opinions; besides, in this paper we present a review of the recent literature on rAAA and we discuss the rationale for transfer to referral center, the role of preoperative imaging and the pros and cons of Endoluminal repair of rAAA (REVAR) versus Open Repair (OR).

Research paper thumbnail of Duration of Antimicrobial Therapy in Treating Complicated Intra-Abdominal Infections: A Comprehensive Review

Surgical infections, Jan 15, 2015

Surgeons managing intra-abdominal infections should always respect the basic principles of antibi... more Surgeons managing intra-abdominal infections should always respect the basic principles of antibiotic treatment. An adequate duration of antimicrobial therapy is important to optimize empiric therapy and minimize selective pressures favoring antimicrobial resistance. The optimal duration of antibiotic therapy for intra-abdominal infections (IAIs) has been debated in the last years. A literature research, based on PubMed database and limited to English language publications, was performed without restriction of time or type of manuscript. In stable patients a short course of antimicrobial therapy (3-5 d) after adequate source control, depending on fever and leukocytosis, may be a reasonable option. In critically ill patients with severe sepsis and septic shock, an individualized approach is always mandatory and patient's inflammatory response should be monitored regularly. Procalcitonin may be helpful for guiding antibiotic treatment in critically ill surgical patients and in pre...

Research paper thumbnail of Non-Restrictive Antimicrobial Stewardship Program in a General and Emergency Surgery Unit

Surgical Infections, 2016

The goal of an antimicrobial stewardship program (ASP) is to prevent the emergence of antimicrobi... more The goal of an antimicrobial stewardship program (ASP) is to prevent the emergence of antimicrobial drug resistance and reduce adverse drug events, optimizing the selection, dosing, and duration of therapy in individual patients. This retrospective study evaluated changes in antimicrobial agent use associated with implementation of an ASP in a general and emergency unit. The pre-intervention and post-intervention periods were defined as July 1, 2013, to December 31, 2013 (pre-intervention) and January 1, 2014, to June 30, 2014 (post-intervention). The mean total monthly antimicrobial use decreased by 18.8%, from 1,074.9 defined daily doses (DDD) per 1,000 patient-days to 873.0 DDD per 1,000 patient-days after the intervention. There was a significant reduction in the use of piperacillin-tazobactam, by 33.7% (p &amp;amp;amp;amp;amp;amp;lt; 0.05), in imipenem/cilastatin, by 63.9% (p &amp;amp;amp;amp;amp;amp;lt; 0.05), in meropenem by 68.0% (p &amp;amp;amp;amp;amp;amp;lt; 0.05), and in levofloxacin by 45.0% (p &amp;amp;amp;amp;amp;amp;lt; 0.05) without any negative effect on patient susceptibility to infections. Indeed, patient outcomes, including deaths, length of stay in the hospital, and re-admission within 30 days were not affected. The implementation of an education-based ASP achieved a significant improvement in all antimicrobial agent prescriptions in the surgical unit and a reduction in antimicrobial drug consumption, even when no restrictive measures were implemented.

Research paper thumbnail of Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion

World journal of emergency surgery : WJES, 2015

Caustic material ingestion injuries (CMI) are uncommon. Only 5,000 cases are reported in the Unit... more Caustic material ingestion injuries (CMI) are uncommon. Only 5,000 cases are reported in the United States each year and most acute care healthcare facilities admit only a few cases annually. Accordingly, no single institution can claim extensive experience, and management protocols are most probably based on either expert opinion or literature reports. In this study, we will attempt to review opinions and practices of representatives of the board members of the World Society of Emergency Surgery and compare them to the current literature.

Research paper thumbnail of The challenge of post-operative peritonitis after gastrointestinal surgery

Updates in Surgery, 2015

Post-operative peritonitis (PP) is a life-threatening hospital-acquired intra-abdominal infection... more Post-operative peritonitis (PP) is a life-threatening hospital-acquired intra-abdominal infection with high rates of mortality. Diffuse PP remains a challenge for surgeons. Prognosis and outcome of patients are directly related to early diagnosis and prompt intervention. The diagnosis of PP may be difficult because there are no specific clinical signs and laboratory tests to reject or confirm the diagnosis. Atypical clinical features may be responsible for a delay in reoperation. An early diagnosis and prompt treatment is crucial to prevent the development of organ failure and improve the outcome of the patients with PP. The cornerstones in the management of patients with PP are early hemodynamic support, prompt source control and adequate antimicrobial therapy.

Research paper thumbnail of Laparoscopic Transgastric versus Endoscopic Drainage of a Large Pancreatic Pseudocyst. A Case Report

Journal of gastrointestinal and liver diseases : JGLD, 2016

Pancreatic pseudocysts are the most common complication of acute and chronic pancreatitis. They a... more Pancreatic pseudocysts are the most common complication of acute and chronic pancreatitis. They account for 75% of the cystic lesions of the pancreas. A 37 year-old woman was admitted three months after an episode of severe acute pancreatitis with a large tumor mass located in her left abdomen, abdominal tenderness and asthenia. Abdominal Computed Tomography (CT) revealed a giant pancreatic pseudocyst of 23/15/12 centimeters. We performed an anterior laparoscopic transgastric cystogastrostomy. The postoperative clinical course was uneventful, and she was discharged nine days later. After another month she was re-admitted for general malaise and fever. We performed endoscopic evaluation of the cystogastrostomy patency followed by lavage of the pseudocyst cavity. After five days of broad spectrum antibiotic therapy the clinical course started to improve and the patient was discharged after another eight days. One- and two-year follow-ups revealed no remnant cavity. Laparoscopic transg...

Research paper thumbnail of Abdominal emergency surgery in patients over 90 years old: is it worthwhile? An Italian multicenter retrospective study

Journal of Peritoneum (and other serosal surfaces), 2016

Research paper thumbnail of Sepsis is a dynamic syndrome

Journal of Peritoneum (and other serosal surfaces), 2016

Research paper thumbnail of WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

World journal of emergency surgery : WJES, 2016

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA i... more Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified a...

Research paper thumbnail of Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

World journal of emergency surgery : WJES, 2016

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associate... more Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming i...

Research paper thumbnail of Laparoscopic source control for large pelvic abscess after perforated appendicitis, not amenable to percutanous drainage: Video Vignette

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 18, 2016

A 16-year-old male was operated for peritonitis from perforated appendicitis with the finding of ... more A 16-year-old male was operated for peritonitis from perforated appendicitis with the finding of a large abscess in the pelvic and right iliac fossa (RIF). He returned 12 days after discharge, complaining of fever and diffuse abdominal pain. An urgent abdominal ultrasound examination showed a large deep pelvic collection covered by the bladder and small bowel loops, with a further collection in the RIF. The white cell count (WCC) was 25,980 mm(-3) and the C-reactive protein (CRP) 23.70 mg/dL. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Laparoscopic Approach has Benefits in Gynecological Emergencies - Even for Massive Hemoperitoneum

Chirurgia (Bucharest, Romania : 1990)

The purpose of this study is to compare the laparoscopic with the open approach in hemoperitoneum... more The purpose of this study is to compare the laparoscopic with the open approach in hemoperitoneum of gynecological origin. Retrospective study of patients admitted to a tertiary emergency hospital between January 2013 - January 2015. There were 56 patients, 27 in the laparoscopic group (LG) and 28 in the open group (OG). The gynecological emergency was a ruptured ovarian cyst in 20 (74%) versus 17 (59%) cases, and an ectopic pregnancy with tubal rupture in 7 (26%) versus 12 (41%) patients in both the laparoscopic and open approaches, respectively. The main outcome - mean intraoperative hemoglobin decrease - was 1.5 +- 1.2 g/dl in the laparoscopic and 1.9 ‚+-1.4 in the open approach (p=0.344). There were no differences regarding red blood transfusion rate, needs for analgesics, postoperative complications and inhospital stay. The laparoscopic approach in acute abdomen of gynecologic origin is non-inferior to open surgery.

Research paper thumbnail of Adhesive small bowel adhesions obstruction: Evolutions in diagnosis, management and prevention

World journal of gastrointestinal surgery, Jan 27, 2016

Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They ar... more Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast follow-through and computed tomography scan. For patients presenting no signs of strangulation, peritonitis or severe intestinal impairment there is good evidence to support non-operative management. Open surgery is the preferred method for the surgical treatment of adhesive small bowel obstruction, in case of suspected strangulation or after failed conservative management, but laparoscopy is gaining widespread acceptance especially in selected group of patients. "Good" surgical technique and anti-adhesive barriers are the main current concepts of adhesion prevention. We discuss current knowledge in modern diagnosis and evolving strategies for management and prevention that are leading to stratified care for patients.

Research paper thumbnail of Renewed Interest in Acute Appendicitis: Are Antibiotics Non-Inferior to Surgery or Possibly Clinically Superior? What Is Long-Term Follow-Up and Natural Evolution of Appendicitis Treated Conservatively with "Antibiotics First"?

Surgical infections, Jan 26, 2016

Research paper thumbnail of Mass casualty incidents - time to engage

World Journal of Emergency Surgery, 2016

Mass casualty incident continues to overwhelm medical systems worldwide. Preparedness for an MCI ... more Mass casualty incident continues to overwhelm medical systems worldwide. Preparedness for an MCI is a crucial requisite for the injured better outcome. The World Society of Emergency Surgery initiated a survey in regard to its senior member&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s personal and institutional preparedness for MCI. The results here in presented indicate that WSES should engage in a formatted and structured preparedness course for medical institutions and individuals.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;By all appearances it seems to be just another normal Saturday morning in the emergency department (ED). Patients occupy thirty out of the sixty beds; some awaits discharge, some awaits admission to the hospital. All of a sudden the squeaky voice of the red phone is tearing the air, the hard metal voice on the line is reporting of an explosion in the nearby train station, estimated number of casualties is 80. You ask for their estimated time of arrival, when you hear the first sirens of ambulances parking out of the ED; no answer was needed.

Research paper thumbnail of Antibiotic resistance evaluation and clinical analysis of acute appendicitis; report of 1431 consecutive worldwide patients: A cohort study

International Journal of Surgery, 2016

Acute appendicitis (AA) is one of the most common diseases affecting especially young but also ol... more Acute appendicitis (AA) is one of the most common diseases affecting especially young but also older people. A systematic evaluation of bacteriology of AA has been frequently conducted in children but is not well known and discussed in adult population. The study has been obtained from two multicenter prospective observational studies (CIAO and CIAOW studies). The aim of the study is to analyze the intra-abdominal bacteriology in AA and its relation with clinical outcomes. Patients included were 1431, 806 male (56.3%). The mean/median age was 38.9 (SD ± 18.4) and 35 (range 18-94). Clinical condition at the admission was sepsis in 623 patients (43.5%), severe sepsis and septic shock in 29 (2%) and 10 (0.7%). Peritonitis was localized in 1107 patients (77.4%) and generalized in 324 (22.6%). Adequate source-control and empirical antimicrobial therapy were reported in 95.2% and 88.7% of the patients. 47 isolated bacteria (6.8%) were resistant. Two (4.2%) were health-care-associated infections and 45 (95.7%) were community-acquired infections. Univariate analysis showed factor associated to resistant bacteria was the inadequacy of the empiric antimicrobial therapy (p = 0.013); at multivariated analysis factors associated with mortality were age&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;70 years (p = 0.003) and severe sepsis at the admission (p = 0.02); factors associated to ICU admission were: severe sepsis (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), generalized peritonitis (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), malignancy (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) and cardiovascular disease (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). The evolution of antimicrobial resistance, in common community-acquired infections, combined with lack of new antibiotics development are strictly linked to clinical outcomes. Adequate empirical antimicrobial therapy is fundamental to counteract bacterial resistance.

Research paper thumbnail of Advances in laparoscopy for acute care surgery and trauma

World journal of gastroenterology, Jan 14, 2016

The greatest advantages of laparoscopy when compared to open surgery include the faster recovery ... more The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technic...

Research paper thumbnail of Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings

World journal of emergency surgery : WJES, 2015

Advances in the technology and improved access to imaging modalities such as Computed Tomography ... more Advances in the technology and improved access to imaging modalities such as Computed Tomography and laparoscopy have changed the contemporary diagnostic and management of acute appendicitis. Complicated appendicitis (phlegmon, abscess and/ or diffuse peritonitis), is now reliably distinguished from uncomplicated cases. Therefore, a new comprehensive grading system for acute appendicitis is necessary. The goal is review and update the laparoscopic grading system of acute appendicitis and to provide a new standardized classification system to allow more uniform patient stratification. During the last World Society of Emergency Surgery Congress in Israel (July, 2015), a panel involving Acute Appendicitis Experts and the author's discussed many current aspects about the acute appendicitis between then, it will be submitted a new comprehensive disease grading system. It was idealized based on three aspect of the disease (clinical and imaging presentation and laparoscopic findings). ...

Research paper thumbnail of Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study)

World journal of emergency surgery : WJES, 2015

To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal i... more To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p < 0.0001). The multivariate logistic regression model was highly significant (p < 0.0001, R2 = 0.54) and showed that all these factors were indepe...

Research paper thumbnail of Erratum to: caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion

World Journal of Emergency Surgery, 2015

[This corrects the article DOI: 10.1186/s13017-015-0043-4.].

Research paper thumbnail of WSES position paper on vascular emergency surgery

World Journal of Emergency Surgery, 2015

Trauma, both blunt and penetrating, is extremely common worldwide, as trauma to major vessels. Th... more Trauma, both blunt and penetrating, is extremely common worldwide, as trauma to major vessels. The management of these patients requires specialized surgical skills and techniques of the trauma surgeon. Furthermore few other surgical emergencies require immediate diagnosis and treatment like a ruptured abdominal aortic aneurysm (rAAA). Mortality of patients with a rAAA reaches 85 %, with more than half dying before reaching the hospital. These are acute events demanding immediate intervention to save life and limb and precluding any attempt at transfer or referral. It is the purpose of this position paper to discuss neck, chest, extremities and abdominal trauma, bringing to light recent evidence based data as well as expert opinions; besides, in this paper we present a review of the recent literature on rAAA and we discuss the rationale for transfer to referral center, the role of preoperative imaging and the pros and cons of Endoluminal repair of rAAA (REVAR) versus Open Repair (OR).

Research paper thumbnail of Duration of Antimicrobial Therapy in Treating Complicated Intra-Abdominal Infections: A Comprehensive Review

Surgical infections, Jan 15, 2015

Surgeons managing intra-abdominal infections should always respect the basic principles of antibi... more Surgeons managing intra-abdominal infections should always respect the basic principles of antibiotic treatment. An adequate duration of antimicrobial therapy is important to optimize empiric therapy and minimize selective pressures favoring antimicrobial resistance. The optimal duration of antibiotic therapy for intra-abdominal infections (IAIs) has been debated in the last years. A literature research, based on PubMed database and limited to English language publications, was performed without restriction of time or type of manuscript. In stable patients a short course of antimicrobial therapy (3-5 d) after adequate source control, depending on fever and leukocytosis, may be a reasonable option. In critically ill patients with severe sepsis and septic shock, an individualized approach is always mandatory and patient's inflammatory response should be monitored regularly. Procalcitonin may be helpful for guiding antibiotic treatment in critically ill surgical patients and in pre...

Research paper thumbnail of Non-Restrictive Antimicrobial Stewardship Program in a General and Emergency Surgery Unit

Surgical Infections, 2016

The goal of an antimicrobial stewardship program (ASP) is to prevent the emergence of antimicrobi... more The goal of an antimicrobial stewardship program (ASP) is to prevent the emergence of antimicrobial drug resistance and reduce adverse drug events, optimizing the selection, dosing, and duration of therapy in individual patients. This retrospective study evaluated changes in antimicrobial agent use associated with implementation of an ASP in a general and emergency unit. The pre-intervention and post-intervention periods were defined as July 1, 2013, to December 31, 2013 (pre-intervention) and January 1, 2014, to June 30, 2014 (post-intervention). The mean total monthly antimicrobial use decreased by 18.8%, from 1,074.9 defined daily doses (DDD) per 1,000 patient-days to 873.0 DDD per 1,000 patient-days after the intervention. There was a significant reduction in the use of piperacillin-tazobactam, by 33.7% (p &amp;amp;amp;amp;amp;amp;lt; 0.05), in imipenem/cilastatin, by 63.9% (p &amp;amp;amp;amp;amp;amp;lt; 0.05), in meropenem by 68.0% (p &amp;amp;amp;amp;amp;amp;lt; 0.05), and in levofloxacin by 45.0% (p &amp;amp;amp;amp;amp;amp;lt; 0.05) without any negative effect on patient susceptibility to infections. Indeed, patient outcomes, including deaths, length of stay in the hospital, and re-admission within 30 days were not affected. The implementation of an education-based ASP achieved a significant improvement in all antimicrobial agent prescriptions in the surgical unit and a reduction in antimicrobial drug consumption, even when no restrictive measures were implemented.

Research paper thumbnail of Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion

World journal of emergency surgery : WJES, 2015

Caustic material ingestion injuries (CMI) are uncommon. Only 5,000 cases are reported in the Unit... more Caustic material ingestion injuries (CMI) are uncommon. Only 5,000 cases are reported in the United States each year and most acute care healthcare facilities admit only a few cases annually. Accordingly, no single institution can claim extensive experience, and management protocols are most probably based on either expert opinion or literature reports. In this study, we will attempt to review opinions and practices of representatives of the board members of the World Society of Emergency Surgery and compare them to the current literature.

Research paper thumbnail of The challenge of post-operative peritonitis after gastrointestinal surgery

Updates in Surgery, 2015

Post-operative peritonitis (PP) is a life-threatening hospital-acquired intra-abdominal infection... more Post-operative peritonitis (PP) is a life-threatening hospital-acquired intra-abdominal infection with high rates of mortality. Diffuse PP remains a challenge for surgeons. Prognosis and outcome of patients are directly related to early diagnosis and prompt intervention. The diagnosis of PP may be difficult because there are no specific clinical signs and laboratory tests to reject or confirm the diagnosis. Atypical clinical features may be responsible for a delay in reoperation. An early diagnosis and prompt treatment is crucial to prevent the development of organ failure and improve the outcome of the patients with PP. The cornerstones in the management of patients with PP are early hemodynamic support, prompt source control and adequate antimicrobial therapy.