Initial treatment of traumatic pneumothorax with water seal leads to significantly shorter chest tube durations compared to suction, without increased complications. Median initial chest tube duration was 41 hours for water seal vs 51 hours for suction (p = 0.001). Total chest tube duration was also reduced, with water seal requiring 44 hours compared to […]
Category: Appendix, Gallbladder and Surgical Emergencies
Hybrid ATLS Courses Match Traditional Format in Quality
Hybrid Advanced Trauma Life Support (ATLS) courses provide equivalent educational effectiveness and learner satisfaction compared to traditional formats, potentially improving access to trauma training. Adjusted pass rates were 93.3% for hybrid and 92.9% for traditional courses, within the non-inferiority margin. Satisfaction rates were similar, 94.9% for hybrid versus 95.9% for traditional, again showing no significant […]
Timing of Appendectomy Impacts Outcomes in Perforated Appendicitis
In patients with perforated appendicitis, delaying appendectomy leads to significantly worse clinical outcomes compared to performing it at the time of admission. Elective interval appendectomy is associated with a nearly doubled risk of ileocecal resection compared to early appendectomy (adjusted OR 1.92). Both elective and failed interval appendectomies increase the risk of infectious complications (adjusted […]
Endoscopic Therapy for Cystic Duct Remnant Stones Shows High Success
ERCP is a highly effective and safe option for managing symptomatic cystic duct remnant stones in post-cholecystectomy patients, reducing the need for surgical excision. Technical success was achieved in 95% of cases (20/21), with clinical success at 91% (19/21). Balloon sweep alone cleared stones in 43% of patients, with cholangioscopy and electrohydraulic lithotripsy frequently required […]
Consensus Framework Improves Appendiceal Abscess Management
A new consensus from Italian experts offers a standardized, physiology-driven approach to managing appendiceal abscesses, aiming to reduce variability in surgical practice. Early appendectomy remains the go-to for grade 1 phlegmons and small abscesses, while a short conservative trial can be considered for stable, low-risk patients. For abscesses >3-4 cm, image-guided drainage is recommended as […]
Prophylactic Negative Pressure Therapy Cuts Infection Risk in Emergency Laparotomy
In patients undergoing emergency laparotomy, incisional negative pressure wound therapy (INPWT) significantly decreases the risk of surgical site infections (SSI) compared to standard dressings. INPWT is linked to lower odds of overall SSI (OR 0.36), superficial and deep infections, and seroma formation. Hospital length of stay was reduced by about 1.5 days with INPWT (MD […]
Trauma-team actions improve major trauma definition
A new definition of major trauma that combines injury severity with urgent trauma-team interventions identified more high-risk patients and deaths than injury scoring alone. In 2.68 million National Trauma Data Bank patients, 22.4% met the combined definition, versus 17.8% with Injury Severity Score above 15. The combined definition had the best discrimination for 24-hour mortality […]
IVC Filter Use Varies Widely in Trauma Care
In severely injured trauma patients, higher hospital use of inferior vena cava filters did not improve survival and was linked to more thromboembolic events. Among 2.28 million patients at 427 level I and II trauma centers, 0.81% received a filter. Use fell from 1.15% in 2017 to 0.59% in 2024, but rates ranged from 0% […]
Conversion drainage matches primary in acute cholecystitis
For high-risk patients with acute cholecystitis, conversion to endoscopic ultrasound-guided gallbladder drainage after percutaneous drainage achieved outcomes comparable to primary drainage. Multicenter study of 141 patients: technical success was 95.8% after conversion versus 98.3% with primary drainage. Results remained comparable after adjustment, despite more cancer and greater comorbidity in the conversion group. Clinical success, adverse […]
Robotic Cholecystectomy Reduces Bile Duct Injury Risks
Robot-assisted cholecystectomy shows lower bile duct injury rates compared to laparoscopic procedures in complex cases of acute cholecystitis. Bile duct injury rates: 0.65% for robotic vs. 1.02% for laparoscopic. Adjusted odds of bile duct injury were 71% lower for robotic cholecystectomy (AOR 0.29). This suggests that robotic-assisted approaches can enhance surgical safety and outcomes even […]