Erratum

Introduction: Free perforation of the stomach or the duodenum usually requires emergency surgery. In fact, perforation is associated with short-term mortality and morbidity in up to 30 and 50% of patients, respectively, due to secondary peritonitis and sepsis. We hypothesized that postoperative clinical outcomes with duodenal perforation (DP) are worse than those with stomach perforation (SP). This retrospective study aimed to compare the early postoperative clinical outcomes of patients with SP and DP, focusing on morbidity and mortality, to identify differences that could indicate potential changes in surgical management. Methods: A total of 110 patients underwent emergency surgery between 2012 and 2022 for free SP or DP. We compared the demographic, intra-, and postoperative data, including morbidity and mortality during primary hospitalization in the two groups of patients. One group consisted of patients with SP and the second group consisted of patients with DP. Results: The incidence of any postoperative complication, the rate of planned reoperation, median operation time, as well as the median hospital stay after surgery were significantly increased in patients with DP compared to those with SP. In addition, surgical and nonsurgical complications, as well as mortality were common in the total patient population, and higher in DP than in SP patients; however, these differences were not statistically significant. Conclusion: Common postoperative problems occurring after surgery for DP or SP are similar and often life-threatening in both situations. However, patients with DP experienced these problems significantly more often, indicating a more complex injury that required considerably more medical intervention and extended treatment.

The management of surgical patients during the coronavirus disease 2019 (COVID-19) pandemic

Background: Nontraumatic acute abdominal pain is a common presentation in emergency settings, often requiring surgical intervention. This study aimed to explore the clinical presentations, surgical management, and outcomes in patients with nontraumatic acute abdominal pain, providing insights for improving management strategies.Methods: This observational study was conducted at a tertiary care hospital in North India and included 433 patients who underwent elective and emergency abdominal surgeries from June 2021 to May 2023. Data were collected on patient demographics, comorbidities, duration of symptoms, initial presenting symptoms, and surgical procedures performed. Laboratory parameters were assessed preoperatively, and postoperative outcomes, including complications, recovery metrics, and length of hospital stay, were recorded. Statistical analyses, including logistic regression, were utilized to determine the adjusted odds ratios for significant predictors of complications.Results: A total of 433 patients were included in the analysis, with a mean age of 42.3 ± 12.1 years. The study revealed that 5.5% of patients experienced complications, with wound infections (3.0%) and intra-abdominal abscesses (0.9%) being the most common. Recovery metrics indicated that the mean time to resume oral intake was 2.5 ± 1.2 days, the time to first bowel movement was 3.0 ± 1.5 days, and the duration of the postoperative hospital stay averaged 5.0 ± 2.0 days. Logistic regression analysis identified significant predictors of complications, including diabetes mellitus (adjusted OR, 2.02; p < 0.001), hypertension (adjusted OR, 1.44; p = 0.025), and intraoperative findings such as appendiceal perforation (adjusted OR, 2.14; p < 0.001).Conclusion: The study underscores the critical role of timely diagnosis and appropriate surgical management in patients with nontraumatic acute abdominal pain. Recognizing high-risk factors, such as diabetes and elevated American Society of Anesthesiologists scores, can enhance surgical decision-making and improve patient outcomes. These findings advocate for refined management protocols and a multidisciplinary approach to optimize care for patients presenting with acute abdominal pain.

BackgroundSince the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers.MethodA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology.ResultsGiven the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts’ opinion.ConclusionsThe aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment.We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient.The management of COVID-19 surgical patients is multidisciplinary.If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.

Hypothesis: Even at the beginning of the new millennium, secondary peritonitis presents a common life-threatening condition associated with high mortality and morbidity. Objective: This article comments on epidemiology, diagnosis and general principles of surgical management in patients with secondary peritonitis. Methods and Results: The demographic data, clinical findings and surgical outcome of 204 patients who had a confirmed generalized secondary peritonitis were analyzed retrospectively. Our approach was laparotomy, surgical control of contamination, antibiotic therapy and modern intensive care support. Acid peptic disease was the most common cause of perforation peritonitis 60 (29,41%), following by the perforated appendicitis 45 ( 22,06%). The faecal peritonitis and colon perforation were found in 42 patients (20,59%). The morbidity rate was 50%; 41 (40,2%) patients had more than one complication. The morbidity rate was significantly the highest in patients with colon perforation (n=38, 90%) (Hi-square=40,1; p<0,001). The overall mortality rate in our study was 8,82%. The mortality rate was significantly the highest among the patients with mesenteric ischemia in 4 patients (66,67%), followed by colon perforation in 10 cases (23,81%), and 4(6,6%) deaths due to gastro-duodenal perforation (Hi-square=45,7; p<0,001). Discussion: This study has confirmed that the clinical presentation and outcome of the secondary peritonitis depend on duration of abdominal infection, the site of perforation and the general condition of the patient. Rapid surgical source control, modern intensive care and sepsis therapy may offer the chance of decreased morbidity and mortality of the intra-abdominal infections. Abbreviations Intensive Care Unit (ICU), Perforated Diverticular Disease (PDD), Inflammatory Bowel Disease (IBD), Multiple Organ Dysfunction Syndrome (MODS), Acute Respiratory Distress Syndrome (ARDS), Nonsteroidal Anti-inflammatory Drugs (NSAID), Peptic Ulcer Disease(PUD), Ultrasonography (US), Computer Tomography (CT), Colorectal Cancer (CRC), Postoperative Adhesive Disease (PAD), Acute Mesenteric Ischemia (AMI).

Assessment and treatment considerations for patients with colorectal liver metastases: AHPBA consensus guideline and update for surgeons.

Modern surgical medicine strives to manage trauma while improving outcomes using functional imaging. Identification of viable tissues is crucial for the surgical management of polytrauma and burn patients presenting with soft tissue and hollow viscus injuries. Bowel anastomosis after trauma-related resection is associated with a high rate of leakage. The ability of the surgeon's bare eye to determine bowel viability remains limited, and the need for a more standardized objective assessment has not yet been fulfilled. Hence, there is a need for more precise diagnostic tools to enhance surgical evaluation and visualization to aid early diagnosis and timely management to minimize trauma-associated complications. Indocyanine green (ICG) coupled with fluorescence angiography is a potential solution for this problem. ICG is a fluorescent dye that responds to near-infrared irradiation. We conducted a narrative review to address the utility of ICG in the surgical management of patients with trauma as well as elective surgery. ICG has many applications in different medical fields and has recently become an important clinical indicator for surgical guidance. However, there is a paucity of information regarding the use of this technology to treat traumas. Recently, angiography with ICG has been introduced in clinical practice to visualize and quantify organ perfusion under several conditions, leading to fewer cases of anastomotic insufficiency. This has great potential to bridge this gap and enhance the clinical outcomes of surgery and patient safety. However, there is no consensus on the ideal dose, time, and manner of administration nor the indications that ICG provides a genuine advantage through greater safety in trauma surgical settings. There is a scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy to facilitate intraoperative decisions and to limit the extent of surgical resection. This review will improve our understanding of the utility of intraoperative ICG fluorescence in guiding and assisting trauma surgeons to deal with the intraoperative challenges and thus improve the patients' operative care and safety in the field of trauma surgery.

Narrative Review. The spine remains the most common site for bony metastasis. It is estimated that up to 70% of cancer patients harbor secondary spinal disease. And up to 10% will develop a clinically significant lesion. The last two decades have seen a substantial leap forward in the advancements of the management of spinal metastases. What once was a death sentence is now a manageable, even potentially treatable condition. With marked advancements in the surgical treatment and post-operative radiotherapy, a standardized approach to stratify and manage these patients is both prudent and now feasible. This article looks to examine the best available evidence in the stratification and surgical management of patients with spinal metastases. So the aim of this review is to offer a standardized approach for surgical management and surgical planning of patients with spinal metastases.

Routine excision of posterior vaginal fornix is necessary in the surgical management of patients with deep infiltrating endometriotic nodules of more than 2 cm in size

When is intraoperative transesophageal echocardiography indicated?

Epidemics or outbreak is a sudden spread of the disease within a short time to a large number of people in a given population. The World Health Organization (WHO) named this pathogenic virus for 2019-nCoV. Surgical patients are particularly at risk of infection and negative outcome. To guarantee adequate care to these patients, while minimizing the risk for infection, the early postponing of elective surgery, the creation of COVID-free facilities and the identification of COVID- dedicated operating theaters and teams should be proposed. Meanwhile, because the operating room is a busy environment, it further increases the risk of nosocomial infections of the perioperative team. Ayurveda is an ancient system of medicine, clearly mentioned about such diseases causing epidemic under a broad term 'Janapadodhwamsa’. To assess the concepts of epidemiology in Ayurveda and to compare the same with recent COVID-19 pandemic. When COVID-19 pandemic compares with Janapadodhwamsa, it shows similarity in concepts like aetiology, modes of transmission, principles of prevention of outbreaks etc. Also, control measures of COVID-19 can be compared with Hetu-viparit and Vyadhi-viparitchikitsa. The concepts described in Ayurveda regarding Janapadodhwamsa are more or like the present modern concept of the pandemic/epidemic. The coronavirus disease 2019 (COVID-19) pandemic has raised several issues regarding the management of surgical patients. The aim of the current study was to clarify the management of surgical patients during the pandemic. Therefore, development of safe medical practices and infection prevention protocols for the perioperative management of patients with COVID-19 is important.

Craniovertebral junction (CVJ) is a complex anatomic region providing stability and mobility to the most important part of the craniospinal axis. The purpose of this study is to analyse clinical characteristics and outcome after surgical management of patients with CVJ anomalies presented to Neurosurgery department, Bir hospital Kathmandu Nepal. A retrospective analysis of 21 patients, managed surgically for craniovertebral instability between 2013 and 2017, was performed. Imaging studies were reviewed for bony and soft tissue details. Patients managed with posterior approach alone (either occipitocervical fusion or C1-2 fusion with or without bony decompression) were included in the study. Outcome was assessed by comparing pre and post operative Nurick grade. Most common causes of CVJ instability were non union of old odontoid fracture (38.1%)and OsOdontoidium (38.1%). 76.2% had intramedullary high signal intensities in T2 weighted MRI while 90% had cervicomedullary compression. Pre operatively, 52.38% had Nurick grading scale of 4 to 5 while 47.62%had 0-3 Nurick grade scale. Post operatively, 71.42% improved clinically, 23.80% remained unchanged while one patient deteriorated. Mean duration of follow up was 20.87 months (6-60 months). Pre operative Nurick grade was significantly associated with post operative outcome (p=0.042). Early surgical intervention is associated with better clinical outcome. Larger prospective study with clinical and radiological follow up is recommended.

IntroductionPeptic ulcer perforation is a life-threatening surgical emergency with significant morbidity and mortality, particularly in resource-limited settings. This study aimed to evaluate the surgical management and outcomes of patients with perforative peritonitis secondary to gastroduodenal perforation, analyzing demographic patterns, clinical presentations, surgical techniques, and postoperative outcomes.MethodsA prospective observational study was performed over 18 months at Mata Gujri Memorial Medical College and Lions Seva Kendra Hospital in Kishanganj, Bihar, India. The study enrolled thirty patients who exhibited clinical symptoms and radiological signs consistent with gastroduodenal perforation. Collected data included demographic information, clinical presentation, laboratory results, imaging studies, operative findings, surgical interventions utilized, and postoperative outcomes. The primary surgical methods for repair involved Graham's patch and the modified Graham's patch techniques.ResultsThe study population had a mean age of 50.23 ± 18.45 years with male predominance (21/30, 70%, M:F ratio 2.33:1). Duodenal perforations were more common (20/30, 66.67%) than gastric perforations (10/30, 33.33%). All patients presented with abdominal pain, while 15/30 (50%) had nausea or vomiting. Most perforations were small, less than 0.5 cm, observed in 20/30 (66.67%) cases. Graham’s omental patch technique was predominantly used, 16/30 (53.33%) for duodenal and 6/30 (20%) for gastric perforations. Gastric perforations showed higher complication rates, with 2/10 (20%) abscess formation and 1/10 (10%) mortality, compared to duodenal perforations, which had 3/20 (15%) abscess rate and 1/20 (5%) mortality.ConclusionPerforative peritonitis due to peptic ulcer disease remains a significant surgical emergency predominantly affecting middle-aged males. Graham's omental patch repair offers favorable outcomes in majority of cases. Gastric perforations demonstrate higher morbidity and mortality compared to duodenal perforations. Prompt diagnosis, timely surgical intervention, and efficient perioperative care are critical for improving clinical outcomes.

A team approach is required of the surgical management of the spinal cord-injured patient with a pressure ulcer, beginning preoperatively with patient selection and preparation, continuing through wound debridement and flap closure. and progressing to rehabilitation and patient education. Although possible surgical complication are numerous and the recurrence rate is relatively high. the surgical management of patients with pressure ulcers can be very rewarding. Goals for surgical closer of pressure ulcers include reduction of protein loss through the wound, reduction of rehabilitation costs, prevention of progressive osteomyelitis and improvement of patient hygiene. The ultimate reward is the restoration of patients to the rehabilitated sitting position so that they can enjoy productive and happy lives.

The utilization of left ventricular assist devices (LVADs) in end-stage heart failure has doubled in the past ten years and is bound to continue to increase. Since the first of these devices was approved in 1994, the technology has changed tremendously, and so has the medical and surgical management of these patients. In this review, we discuss the history of LVADs, evaluating survival and complications over time. We also aim to discuss practical aspects of the medical and surgical management of LVAD patients and future directions for outcome improvement in this population.