Emergency Surgery Cases Research Articles

Clinical Evaluation of Primary Suturing of Normal-Diameter Common Bile Ducts After Microincision of Cystic Duct Confluence for Stone Removal.

In patients with gallstones complicated by common bile duct (CBD) stones, both normal and dilated common bile ducts have been reported. The goal of this study was to investigate the efficacy and safety of primary suturing after microincision of the cystic duct confluence in treating these patients. Between July 2018 and December 2021, 104 patients were admitted to the Department of General Surgery at Guannan County People's Hospital with gallstone complications, and their records were reviewed retrospectively. The patients were divided into 2 groups: normal CBD group (n=70, CBD diameter: 6.0 to 8.0mm) and dilated CBD group (n=34, CBD diameter: >8.0mm). In these 104 patients, there were 75 cases of CBD stones with acute cholangitis, 12 cases of CBD stones without cholangitis, and 17 cases of mild biliary pancreatitis with CBD stones (including 2 cases of biliary pancreatitis with cholangitis). Among all patients, there were 37 cases with jaundice, 67 cases without jaundice, and 5 cases of emergency surgery. All patients underwent microincision of the cystic duct confluence followed by primary suturing. Both groups were compared on a variety of general and perioperative indicators. All patients underwent laparoscopy combined with choledochoscopy; there were no cases of biliary tract injury or conversion to laparotomy. There was no statistically significant difference in operation duration ( P =0.286), blood loss ( P =0.06), length of stay ( P =0.821), and time to drainage tube removal ( P =0.096) between the 2 groups. Microincision of the cystic duct confluence, followed by a primary suture, is a safe and effective treatment for CBD stones in patients with a normal CBD diameter, as determined by preoperative imaging.

Results of using thoraflextm hybrid prothesis for the treatment of complex aortic disease at Viet Duc University Hospital

Background: The aim of this study was to introduce and evaluate the early results after the frozen elephant trunk (FET) procedure with ThoraflexTM Hybrid prothesis for the treatment of complex aortic disease at Viet Duc University Hospital. Methods: This is a retrospective descriptive study of all acceptable patients after the frozen elephant trunk (FET) procedure with ThoraflexTM Hybrid prothesis at Viet Duc University Hospital from January 2021 to May 2023. Results: There were 21 patients with a male rate of 85.7% and an average age 58.2±10 years old (range 40–73). History of patients with hypertension: 19 (90.5%); post-dissection aortic aneurysm: 2 (9.5%) patients. By cause, the number of patients with thoracic aortic aneurysm was 03 (14.3%), acute aortic dissection type A was 16 (76.1%), and aortic dissection type B was 02 (9.5%). In which there were 16 cases of emergency surgery (76.1%). Replacement of the aortic arch was performed under moderate hypothermic (280 °C on average) circulatory arrest and bilateral selective antegrade cerebral perfusion with permanent monitoring of cerebral tissue oxygenation by the MASIMO machine. Average cardio-pulmonary bypass time, aortic cross clamp time, distal hypothermic circulatory arrest time, and operating time were 137,5±22,9 minutes; 86,3±17,6 minutes; 25,2±8,9 minutes; and 7,7±10,3 hours. The average ventilation time, length of intensive care unit stay, and hospital stay were 7,2±9,7 days, 18,8±20,7 days, and 19,9 ± 6,5 days. There was one patient with post-operative cerebrospinal fluid drainage. No patient had bleeding complications, recurrent nerve palsy, reoperation, or in-hospital mortality. Conclusion: The initial results after the frozen elephant trunk procedure with ThoraflexTM Hybrid prothesis for the treatment of complex aortic disease at Viet Duc University Hospital were safe, good, and feasible.

Safety and outcomes of surgical treatment of atrial fibrillation in emergency surgery cases.

Recent developments in surgical devices, including left atrial appendage closure, have enabled surgeons to perform aggressive operations for atrial fibrillation (AF). However, the outcomes of AF surgery in emergent cases have not been extensively studied. The present study aimed to investigate the effectiveness of AF surgery in emergency surgery cases associated with cardiovascular events. We enrolled 18 patients who underwent various types of AF surgery due to emergencies, including acute aortic dissection (n = 6), acute myocardial infarction (n = 5), bleeding due to perforation from radiofrequency catheter ablation (n = 4), acute mitral regurgitation (n = 2), and cardiac tumor (n = 1). Four and ten patients underwent the full maze procedure and pulmonary vein isolation, respectively. Ganglionated plexi ablation was also performed in three patients as part of a combined procedure. The left atrial appendage was solely closed in four patients. There was no surgical mortality or major adverse cardiac and cerebrovascular events in our patient series. The rates of freedom of recurrence of AF or atrial tachycardia at 1 and 3years were 92.9% and 82.5%, respectively. After a mean follow-up period of 46.7 ± 25.8months, no thromboembolism events were observed in the patients. Furthermore, no cardiovascular death was recorded. The surgical procedures for AF are safe and effective in cases requiring emergency surgery.

Evaluation of a scoring system to predict treatment success with single-dose methotrexate in ectopic pregnancy.

This study sought to assess the efficacy of a newly developed scoring system in predicting treatment outcomes for ectopic pregnancy among patients undergoing single-dose methotrexate therapy. The primary research question centered on the reliability and predictive accuracy of objective parameters in determining methotrexate therapy success. Conducted as a retrospective single-center cohort study, data from 172 ectopic pregnancy patients treated with methotrexate between January 2021 and January 2023 were analyzed. Parameters including adnexal mass size, peritoneal fluid presence, yolk sac identification, endometrial thickness, ectopic pregnancy location, and initial B-hCG levels were meticulously evaluated for their association with treatment outcomes. Following the exclusion of 21 emergency surgery cases, the final analysis comprised 151 patients. Notable associations were observed between specific parameters (fetal cardiac activity, adnexal mass size > 3.5cm, peritoneal fluid presence, yolk sac identification, endometrial thickness > 10mm, and initial B-hCG levels) and treatment outcomes (p < 0.001). Additionally, the novel scoring system demonstrated promising predictive performance. At a cutoff of 2.50, it achieved a sensitivity of 91.7% and a specificity of 59.7%. Increasing the cutoff to 3.50 resulted in a sensitivity of 94.0%, with a specificity of 46.3%. Objective parameters, particularly those integrated into the developed scoring system, exhibited substantial associations with methotrexate therapy outcomes in ectopic pregnancy. These findings underscore the potential of an objective scoring model to significantly influence clinical decision-making in therapy, offering avenues for enhanced prognostication and patient care in treatment outcomes.

Midterm results of infrarenal abdominal aneurysm treatment at Dong Nai General Hospital

Introduction: Abdominal aortic aneurysm is an increasingly common pathology, open surgery as well as intervention are effective methods of treatment, mortality in emergency treatment of ruptured aortic aneurysm. The abdomen is still high and is a challenge for vascular surgeons.[1]&#x0D; Objective: To evaluate the short-term and medium-term results of abdominal aortic aneurysm treatment including intervention and surgery at Dong Nai General Hospital.&#x0D; Subjects and methods: All patients treated for abdominal aortic aneurysm at Dong Nai General Hospital from January 2021 to December 2022. Descriptive study of a series of cases.&#x0D; Results: There were 22 cases of abdominal aortic aneurysm treatment, in which: 17 men (77.3%), mean age 68.8 ± 7.5 years. There were 19 cases of surgery, 3 cases of intervention, 6 cases of emergency surgery due to rupture of aneurysms. Postoperative results: 3 deaths, 1 case of acute limb embolism, 1 case of abdominal wound infection, 2 cases of postoperative acute kidney injury, average postoperative time: Surgery: 8 1 day, intervention: 6.3 days. Mean follow-up time: 10.6 months. 0 cases died during the follow-up period.&#x0D; Conclusion: The initial results of the treatment of abdominal aortic aneurysms at Dong Nai General Hospital showed positive results, however, the follow-up time and sample size were small.

It is time to revisit and re-evaluate Africa’s sub-par emergency surgical delivery

It is time to revisit and re-evaluate Africa’s sub-par emergency surgical delivery

Hemicorporectomy; Describing a Single-Stage Surgical Technique: A Case Report

Background: Hemicorporectomy is a life-saving operation to maintain the survival of patients with severe and irreversible pelvis and lower extremities injuries. In the typical procedure, removing lower extremities and pelvic viscera in the two stages might result in hemodynamic instability, intraoperative and postoperative morbidities, and more deficient patients' survival. In this study, we aim to describe our experience with a new technique for one-stage hemicorporectomy, which minimizes surgical time and intraoperative bleeding&#x0D; Case Report: A 77-year-old male patient with lower limb gangrene after previous vascular surgery for an abdominal aortic aneurysm in an unstable situation underwent hemicorporectomy in one step.&#x0D; Conclusion: We believe that achieving a one-step procedure, especially in non-malignant cases or in the absence of severe trauma lesions, may be a viable option in emergency surgery cases or hemodynamic instability. However, there is still a need to modify the single-stage surgical technique in later experiments.

Multicenter retrospective cohort Italian study on elective laparoscopic cholecystectomy performed by the surgical residents

This retrospective multicenter cohort study aimed to evaluate the clinical outcomes (mortality rate, operative time, complications) of elective laparoscopic cholecystectomy (LC) when performed by a surgical resident in comparison to experienced consultant in the backdrop of Italian academic centers. Retrospective review of all patients undergoing elective LC between January 2016 and January 2022 at six teaching hospitals across Italy was performed. Cases were identified using the Current Procedural Terminology (CPT) code 5123 (LC without cholangiogram). All cases of emergency surgery, ASA score > 3, or when cholecystectomy was performed with another surgical procedure, were excluded. All suitable cases were divided into 2 groups based on primary surgeon: consultant or senior resident. Main outcome was complication rates (intraoperative and peri/postoperative); secondary outcomes included operative time, the length of stay, and the rate of conversion to open. A total of 2331 cases (1425 females) were included, of which, consultants performed 1683 LCs (72%), while the residents performed 648 (28%) surgeries. The groups were statistically comparable regarding demographics, history of previous abdominal surgery, operative time, or intraoperative complications. The rate of conversion to open cholecystectomy was 1.42% for consultant and none for resident (p = 0.02). A statistically significant difference was observed between groups regarding the average length of stay (2.2 ± 3 vs 1.6 ± 1.3days p = 0.03). Similarly, postoperative complications (1.7% vs 0.5%) resulted in statistically significant (p = 0.02) favoring resident group. Our study demonstrates that in selected patients, senior residents can safely perform LC when supervised by senior staff surgeons.

Predictors of sedation period for critical illness patients focusing on early rehabilitation on the bed

There are various interventions of rehabilitation on the bed, but these are time-consuming and cannot be performed for all patients. The purpose of this study was to identify the patients who require early mobilization based on the level of sedation. We retrospectively evaluated the data of patients who underwent physical therapy, ICU admission of > 48 h, and were discharged alive. Sedation was defined as using sedative drugs and a Richmond Agitation–Sedation Scale score of < − 2. Multiple regression analysis was performed using sedation period as the objective variable, and receiver operating characteristic (ROC) curve and Spearman’s rank correlation coefficient were performed. Of 462 patients admitted to the ICU, the data of 138 patients were analyzed. The Sequential Organ Failure Assessment (SOFA) score and non-surgery and emergency surgery cases were extracted as significant factors. The ROC curve with a positive sedation period of more than 3 days revealed the SOFA cutoff score was 10. A significant positive correlation was found between sedation period and the initial day on early mobilization. High SOFA scores, non-surgery and emergency surgery cases may be indicators of early mobilization on the bed in the ICU.

Effects of the COVID-19 pandemic on the approach to emergency surgery: a comparative study

Background &amp; objective: Corona pandemic has had profound effects on the practice of healthcare delivery across the globe. The institutional practices and protocols had to be rewritten to cope up with the surge of corona patients and to save the staff and the non-corona patients. We evaluated the emergency surgery cases during the first wave of COVID-19 after the decision to stop elective surgeries, in regard to differences in terms of case distribution, patient profile, anesthesia methods used and the management, and compared with an equivalent period before the pandemic.&#x0D; Methodology: Patient files related to emergency surgery from October-November 2019 and April-May 2020, were retrospectively evaluated. Assessment parameters included age, gender, surgical discipline, ASA score, type of anesthesia, time to discharge, reoperation, laparoscopic or open surgery.&#x0D; Results: The most common surgical cases in both periods belonged to general surgery. While the number of patients in ASA-I decreased during the COVID period, those in ASA-II increased. We found that while general anesthesia was preferred in majority of the surgeries during the non-COVID period, spinal anesthesia gained popularity in the COVID period (p &lt; 0.05).&#x0D; Conclusion: The decrease in the number of patients with ASA-I indicates a change in the surgeons’ priorities in emergency surgery cases. Although there is a worldwide approach to the use of laparoscopic surgery, the use of open surgical techniques increased in our hospital.&#x0D; Key words: Covid-19; Pandemic, Emergency surgery&#x0D; Citation: Akcaalan Y, Erkilic E, Gulec H, Gumus T, Ozturk L, Kayan G, Kanbak O, Celik N. Effects of the COVID-19 pandemic on the approach to emergency surgery: a comparative study. Anaesth. pain intensive care 2022;26(3):469-473; DOI: 10.35975/apic.v26i4.1949&#x0D; Received: Sep 29, 2021; Reviewed: Jan 10, 2022; Accepted: Mar 26, 2022

Surgical strategies for intestinal Crohn's disease.

As a type of inflammatory bowel disease, Crohn's disease (CD) is characterized by jumping lesions and transmural inflammation. The treatment goal is to control the development of inflammation with drugs such as 5-Amino Salicylic Acid, azathioprine and hormones, but most patients still need surgical treatment eventually. The surgical treatment of CD requires exquisite surgical design and solid surgical procedures to minimize the progression of intestinal lesions and preserve the normal bowel segment as much as possible. This study aims to summarize and discuss the surgical treatments for intestinal CD, and to provide references for the surgical treatment of intestinal CD. Clinical data of 122 patients with CD were analyzed retrospectively. They all received surgical treatments in the Second Xiangya Hospital of Central South University between Jan. 1, 2015 and Jan. 1, 2021. The data included general information, clinical manifestations, preoperative examination, preoperative preparation, surgical methods, pathological examination, complications, and follow-up data. Except 1 case of emergency surgery, all the other patients met the surgical indications of intestinal CD after multi-disciplinary discussion (MDT) and they were transferred to surgery for elective surgery, and received high-quality intestinal preparation before surgery. Among them, 99 cases underwent one-stage abdominal operation and 23 cases underwent the second abdominal operation. All patients underwent successful surgery with good surgical results, with significantly alleviated clinical symptoms and the BMI significantly increased compared with those before surgery. There were 14 cases (11.5%) of postoperative complications. One case of delayed anastomotic fistula and one case of small intestinal cutaneous fistula which were successfully treated by conservative treatment, the other 12 cases were successfully treated by reoperation, and there were no complications with follow-up operation. The postoperative pathological diagnosis for all patients was clear. All patients received regular follow-up with 5-70 (median 36) months and no clinical recurrence was found. As the surgical treatment of intestinal CD, surgeons should strictly grasp the surgical indications based on the MDT. During the operation of small intestinal CD, it is advisable to preserve bowel segment as much as possible. For patients with short remaining normal bowel segment, the intestinal canal should be preserved as far as possible, even for the mildly diseased bowel, so as to avoid the occurrence of short bowel syndrome and leave room for possible reoperation. In the treatment of secondary duodenal CD, it is necessary to carefully identify the nature of the local lesions. Different surgical treatments should be performed according to whether there is an internal fistula and the size of this fistula. Meanwhile, duodenectomy or pancreaticoduodenectomy should be considered as the final surgical method in the treatment of primary duodenal CD.

Worse ECOG-PS Is Associated with Increased 30-Day Mortality among Adults Older than 90 Years Undergoing Non-Cardiac Surgery: A Single-Center Retrospective Study

A growing number of older patients are undergoing surgeries. However, reliable preoperative predictors of surgical mortality among older patients have not been identified. This study compared predictive factors for 30-day survival in patients older than 90 years after non-cardiac surgery.This retrospective study at Nippon Medical School Hospital investigated the records of patients aged >90 years who underwent non-cardiac surgeries between 2010 and 2020. The data collected included age, gender, American Society of Anesthesiologists physical status (ASA-PS), preoperative Charlson score, preoperative fall risk assessment, Eastern Cooperative Oncology Group performance status (ECOG-PS), modified 5-item frailty index (mFI-5), need for intraoperative transfusion, postoperative complications, and 30-day survival after surgery.A total of 327 cases of elective surgery and 149 cases of emergency surgery were examined. Nonsurvivors (n=20, 4.2%) had significantly worse preoperative ASA-PS (for emergency cases) (nonsurvivors vs. survivors, 2.8 [2-3] vs. 2.3 [1-4], p=0.045), ECOG-PS (3.0 [2-4] vs. 1.0 [0-4], p<0.001), and mFI-5 values (3.0 [1-4] vs. 1.0 [0-3], p<0.001), more emergency cases (75.0% vs. 36.2%, p=0.004), and a greater need for intraoperative transfusion (55.0% vs. 13.4%, p<0.001). Among frailty assessment methods, ECOG-PS was the most strongly associated with 30-day mortality (area under the curve, ECOG-PS: 0.98, p<0.001; mFI-5: 0.86, p<0.001; Charlson score: 0.53, p=0.71; fall risk assessment: 0.55, p=0.44). Kaplan-Maier curves and multivariate logistic regression analysis demonstrated that an ECOG-PS of >3 was significantly associated with 30-day mortality (ECOG-PS: Kaplan-Maier curve, p<0.001, Log-rank test; odds ratio 1.71, 95% confidence interval: 1.35-2.16, p<0.001).An ECOG-PS of >3 was significantly correlated with 30-day mortality after non-cardiac surgery in patients older than 90 years.

A Case of Emergency Surgery for Hemorrhagic Rupture of a Liver Cyst in a 91-Year-Old Woman

A Case of Emergency Surgery for Hemorrhagic Rupture of a Liver Cyst in a 91-Year-Old Woman

Endoscopic submucosal resection: a technique using novel devices for incision and resection of neoplastic lesions.

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are established techniques for treatment of superficial gastrointestinal neoplasia. Limitations of EMR are low en bloc resection rates for larger lesions, resulting in frequent recurrences. Major disadvantages of ESD are technical difficulty and long procedure times. We evaluated technical feasibility and safety of newly designed devices for en bloc resection of lesions measuring 20-40 mm in a technique called endoscopic submucosal resection (ESR). This case series included 93 lesions from different locations (11 stomach, 25 colon, 57 rectum) with a median size of 29 mm (range 10-70). ESR was performed using two novel instruments for circumferential mucosal incision and deep submucosal resection, respectively. Resection by ESR was feasible in all cases. En bloc and R0 rates were insufficient when ESR was attempted without prior circumferential mucosal incision, but were 70 % and 63 %, respectively, when mucosal incision was done before application of the submucosal resection device. We observed three complications (two delayed bleedings, one microperforation) but no cases of emergency surgery or 30-day mortality. Results demonstrated feasibility and excellent safety of ESR using two novel devices for en bloc resection of early gastrointestinal neoplasia. The technique offered relative technical ease and high efficacy.

The impact of the first wave of the COVID-19 pandemic on the exposure of general surgery trainees to operative procedures.

IntroductionDuring the COVID-19 pandemic, the redeployment of operating room (OR) staff resulted in a significant ramp-down of elective surgery. To mitigate the negative effects of the pandemic on surgical education, this study was planned to estimate the impact of the first wave of the pandemic on the participation of general surgery residency and fellowship trainees in operative procedures.MethodsThis study is a retrospective review of all adult general surgery procedures performed at 3 sites of an academic health care network. Cases performed during the first wave of the pandemic (March–June 2020) were compared to the same period of the previous year pre-pandemic (March–June 2019). Trainees were categorized as junior (Post-Graduate-Year [PGY] 1–2), senior (PGY3-5), or fellows (PGY6-7). Operating exposure was defined as (1) the total number of cases attended by at least one trainee and (2) total time spent in the OR by all trainees (hours). The impact of the pandemic was estimated as percentage of baseline (2019).ResultsDuring the first wave of the pandemic, a total of 914 cases were performed, compared to 1328 in the pre-pandemic period (69%). Junior trainees were more affected than senior trainees with reductions in both case volume (68% versus 78% of baseline attendance) and time (68% versus 77% of baseline operating time). Minimally invasive surgery fellows were most severely affected trainees and colorectal fellows were least affected (14% and 75% of baseline cases, respectively). Participation in emergency surgery cases and surgical oncology cases was relatively preserved (87% and 105% of baseline, respectively).ConclusionsThe first wave of the COVID-19 pandemic reduced operative exposure for general surgery trainees by approximately 30%. Procedure-specific patterns reflected institutional policies for prioritizing cancer operations and emergency surgeries. These findings may inform the design of remediation activities to mitigate the impact of the pandemic on surgical training.

Peripartum Hysterectomy: Is There Any Difference Between Emergency and Planned Surgeries?

To compare the outcomes of emergency and planned peripartum hysterectomies. The present retrospective cross-sectional study was conducted in two hospitals. Maternal and neonatal outcomes were compared according to emergency and planned peripartum hysterectomies. A total of 34,020 deliveries were evaluated retrospectively, and 66 cases of peripartum hysterectomy were analyzed. Of these, 31 were cases of planned surgery, and 35 were cases of emergency surgery. The patients who underwent planned peripartum hysterectomy had a lower rate of blood transfusion (83.9% versus 100%; p = 0.014), and higher postoperative hemoglobin levels (9.9 ± 1.3 versus 8.3 ± 1.3; p < 0.001) compared with the emergency hysterectomy group. The birth weight was lower, although the appearance, pulse, grimace, activity, and respiration (Apgar) scores were higher in the planned surgery group compared with the emergency cases. Planned peripartum hysterectomy with an experienced team results in less need for transfusion and improved neonatal outcomes compared with emergency peripartum hysterectomy.

Comparison of Skin Antisepsis between Povidone-Iodine and Olanexidine Gluconate in Hepato-Biliary-Pancreatic Surgery

Introduction: Surgical site infections (SSIs) are major postoperative complications following hepato-biliary-pancreatic surgery. Globally, to reduce SSIs, especially superficial SSIs (S-SSIs), 4-5% chlorhexidine gluconate (CHG) is used for preoperative skin antisepsis. However, in Japan, since only a CHG concentration of less than 1% is permitted, Povidone-iodine (PVI) is commonly used. Recently, Olanexidine Gluconate (OLG) was developed as an alternative for CHG. We compared the cost and efficacy of preoperative skin cleansing with OLG compared to PVI in preventing S-SSI. Methods: We investigated patients who underwent laparotomy for hepatectomy or pancreatectomy between January 2019 and July 2021 at the Department of Hepato-Biliary-Pancreatic Surgery, Ehime University, excluding emergency surgery cases. PVI was used in all cases from January 2019 to December 2020 (PVI-group), while OLG was used in all cases from January 2021. We surveyed the presence of S-SSI based on CDC guidelines. We also evaluated patient demographic data, anthropometric parameters and perioperative data. Result: The PVI and OLG groups included 144 and 35 patients, respectively. The incidence of S-SSI was 3.5% (5 patients) in the PVI group and 2.9% (1 patient) in the OLG group, indicating no statistically significant difference. Three patients in the PVI group had adverse events, with none in the OLG group. Further, the cost of PVI was significantly lower than that of OLG. Conclusion: OLG did not show significant reduction of S-SSIs, although our study is limited by the small sample size. Therefore, antisepsis with PVI is useful considering its current widespread use and medical costs in Japan.

Childhood Obesity and Its Relation To The Development of Acute Appendicitis

Acute appendicitis is caused by the inflammation of the appendix and is the disease associated with the largest number of cases of emergency surgery in pediatrics and involves 1% to 2% of children who consult the emergency service, on the other hand, the Obesity is a multicausal, chronic and systemic disease, not only present in countries with great economic development, but also involved in all ethnic groups, ages and social classes, for this reason, the relationship between these two pathologies should be better studied especially from the pediatric approach. In patients with childhood obesity, the diagnosis of appendicitis is usually difficult and challenging despite advances in imaging diagnosis and in the treatment of acute appendicitis. In this age group, misdiagnosis is common, which is associated with a high incidence of complications, increased morbidity and mortality and prolonged hospitalizations that allow the development of this disease.

The effect of Covid-19 on Emergency Surgical Cases. Data From a High-Volume City.

Objective COVID -19 placed a tremendous and unforeseen burden on the health system worldwide. In addition to the general surgery practice, the approach to emergency surgery cases, and patients’ admissions to the hospitals were also seriously affected by this unexpected consequence. Herein we aim to pay attention to the notable decrease in cases requiring urgent surgical intervention in our city and to try to explain this upshot. Methods In this multicenter retrospective study, emergency general surgical interventions performed in the 3rd and 2nd stage private and public hospitals, before the pandemic (January 2020- February 2020), and acute phase of the pandemic (Mid-March 2020 - Mid-May 2020) in Sakarya province were compared. Results The distribution of patients before pandemic by gender was 53.1% in male patients, 46.9% in female patients, while 61.6% in male, and 38.4% in female patients during the pandemic respectively. The mean age of patients was 54.72±3.65 before pandemic and 38.54±2.32 during the pandemic, and there was a statistically significant difference in terms of the age distribution of patients undergoing emergency surgery (p&amp;lt;0.05). During the two months before the pandemic, a total of 290 emergency surgeries were performed, while in the acute pandemic period, 164 emergency operations were performed in the same time interval. There was a statistically significant decrease in the number of patients undergoing emergency surgery during the pandemic period compared to non-pandemic (p= 0.012). Conclusion Although the causes for the decrease in cases requiring emergency surgery may be partially defined. However, the disease groups whose alteration reasons cannot be explained at the moment may need further detailed strategic preparation in order not to encounter undesired results in the future.

頸髄損傷に対して緊急手術を施行し再生医療のために転院した1例(A case of emergency surgery for cervical spinal cord injury and transferred for regenerative medicine)

要旨再生医療は，脊髄損傷の有望な治療法として浮上してきている。本邦では2019年2月に自己骨髄間葉系細胞投与に保険が適応された。今回，頸髄損傷の患者に対して早期の固定術と早期からのmechanical insufflation–exsufflation（MI–E）の使用と再生医療を実施した症例を経験したため報告する。14歳の女児。遊具からの転落により後頸部を強打して受傷30分後に来院した。精査の結果，麻痺を伴う第5，6頸椎脱臼骨折を認めたため，同日に非観血的整復術を施行したが困難であり観血的整復術を施行した。第3病日に抜管したが咳嗽力が低下していたため第4病日からMI–Eを用いてリハビリを開始した。その後，再生医療を受けるため第14病日に北海道へ転院した。入院期間中にはステロイドは一切使用しなかった。急性期頸髄損傷に対する治療方針は変わり大量ステロイドの有用性は乏しく，急性期手術と早期リハビリが合併症を減少させている。新たな治療として再生医療も行われている。救急医としてはこれらを認識して初期治療を行うことが重要である。