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Don’t forget emergency surgery! Lessons to learn from elective indocyanine green-guided gastrointestinal interventions

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World Journal of Gastrointestinal surgery 2024年第2期16卷 270-275页

作者： Davina Perini Jacopo Martellucci Department of emergency Emergency and Minimally Invasive Surgery UnitCareggi University HospitalFirenze 50041Italy

Fluorescence-based imaging has found application in several fields of elective surgery,but there is still a lack of evidence in the literature about its use in the emergency setting.Clinical trials have consistently shown that indocyanine green(ICG)-guided surgery can dramatically reduce the risk of postoperative complic-ations,length of in-hospital stay and total healthcare costs in the elective setting.It is well-known that emergency surgery has a higher complication rate than its elective counterpart,therefore an impelling need for research studies to explore,validate and develop this issue has been highlighted.The present editorial aims to provide a critical overview of currently available applications and pitfalls of ICG fluorescence in abdominal emergencies.Furthermore,we evidenced how the experience of ICG-fluorescence in elective surgery might be of great help in implementing its use in acute situations.In the first paragraph we analyzed the tips and tricks of ICG-guided cancer surgery that might be exploited in acute cases.We then deepened the two most described topics in ICG-guided emergency surgery:Acute cholecystitis and intestinal ischemia,focusing on both the advantages and limitations of green-fluorescence application in these two fields.In emergency situations,ICG fluorescence demonstrates a promising role in preventing undue intestinal resections or their entity,facilitating the detection of intestinal ischemic zones,identifying biliary tree anatomy,reducing post-operative complications,and mitigating high mortality rates.The need to improve its application still exists,therefore we strongly believe that the elective and routinary use of the dye is the best way to acquire the necessary skills for emer-gency procedures.

关键词： Indocyanine green Fluorescence Navigation surgery Angiography emergency surgery Decision-making

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Correlation of serum albumin level on postoperative day 2 with hospital length of stay in patients undergoing emergency surgery for perforated peptic ulcer

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World Journal of Gastrointestinal surgery 2023年第7期15卷 1434-1441页

作者： Dan Xie Ping-Lan Lu Wen Xu Jing-Ya You Xiao-Gang Bi Ying Xian Department of General Intensive Care Unit Lingnan HospitalThe Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510530Guangdong ProvinceChina Department of Surgical Intensive Care Unit The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510000Guangdong ProvinceChina

BACKGROUND Perforated peptic ulcer(PPU)is a common emergency surgical condition and a significant cause of morbidity and mortality worldwide.While advances in surgical techniques have improved outcomes for patients with PPU,many factors still affect postoperative hospital stay and overall prognosis.One potential factor is the serum albumin(SA)level,a widely utilized marker of nutritional status that has been associated with length of stay and complications in various surgical procedures.AIM To clarify the correlation of SA level on postoperative day 2 with hospital length of stay(HLOS)in patients undergoing emergency surgery for perforated peptic ulcer(PPU).METHODS We retrospectively collected and analyzed clinical baseline data,including blood routine and SA levels,of patients who underwent emergency PPU surgery and postoperative treatment at the Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University between December 2012 and September 2021.Patients were grouped according to HLOS with 7 d as the cut-off value,and relevant indicators were analyzed using SPSS 26.0.RESULTS Of the 37 patients undergoing emergency surgery for PPU referred to our department,33 had gastric and 4 had duodenal ulcer perforation.The median HLOS was 10 d.There were 8 patients in the≤7-d group(median HLOS:7 d)and 29 patients in the>7-d group(median HLOS:10 d).The≤7-d group had markedly higher SA on postoperative day 2 than the>7-d group(37.7 g/L vs 32.6g/L;P7 d(Odds ratio=0.629,P=0.015).The cut-off of SA on postoperative day 2 was 30.6g/L,with an area under the curve of 0.86 and a negative predictive value of 100%for the prediction of HLOS≤7 d.CONCLUSION The SA level on postoperative day 2 was associated with the HLOS in patients undergoing emergency surgery for PPU.The pre-and post-operative albumin levels should be monitored,and infusion of human SA should be considered in a timely manner.

关键词： Perforated peptic ulcer emergency surgery Serum albumin Hospital length of stay

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emergency robotic colorectal surgery during the COVID-19 pandemic: A retrospective case series study

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Laparoscopic, Endoscopic and Robotic surgery 2022年第2期5卷 57-60页

作者： Vicky Maertens Samuel Stefan Emma Rawlinson Chris Ball Paul Gibbs Stuart Mercer Jim S.Khan Department of Colorectal surgery Queen Alexandra HospitalPortsmouth Hospitals UniversityNHS TrustUK Department of General and Abdominal surgery AZ Sint Lucas GhentBelgium Radiology Department Queen Alexandra HospitalPortsmouth Hospitals UniversityNHS TrustUK Care Group Director of surgery Queen Alexandra HospitalPortsmouth Hospitals UniversityNHS TrustUK Department of Upper GI surgery Queen Alexandra HospitalPortsmouth Hospitals UniversityNHS TrustUK Faculty of Sciences School of Health Sciences&Social WorkUniversity of PortsmouthUK

Objective: While interest in elective robotic surgery is growing, use in emergency setting remainslimited due to challenges posed by sicker patients, advanced pathology and logistical issues. During theCOVID-19 pandemic, robotic surgery could provide the benefit of having the surgeon away from thebedside and reducing the number of directly exposed medical staff. The objective of this study was toreport patient outcomes and initial learning experience of emergency robotic colorectal surgery duringthe COVID-19 pandemic.Methods: A case series study was conducted, including patients undergoing emergency robotic colorectalsurgery between February 2020 and February 2021 at Queen Alexandra Hospital in Portsmouth, UK.Patient data were collected from an ethics approved prospective database. Patient demographics,operative time, conversions and postoperative complications were recorded. In addition, readmissions,length of stay and short-term oncological outcomes were analyzed.Results: Ten patients with median age 64 y (range, 36-83 y) were included. Four patients had roboticcomplete mesocolic resection for obstructing cancers. Six had colorectal resections for benign disease inemergency setting. All were R0 with a mean lymph node harvest of 54 ± 13. Mean operative time was249 ± 117 min, the median length of stay was 9.4 d (range, 5-22 d). Only one patient was given atemporary diverting ileostomy. There were no grade III/V complications and no 30-day mortality.Conclusions: Provided an experienced team and peri-operative planning, emergency robotic colorectalsurgery can achieve favorable outcomes with benefits of radical lymph node dissection in oncologicalcases and avoidance of diverting stoma.

关键词： emergency surgery Robotic colorectal surgery Minimally invasive surgery COVID-19

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Management of obstructed colorectal carcinoma in an emergency setting:An update

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 598-613页

作者： Efstathios T Pavlidis Ioannis N Galanis Theodoros E Pavlidis 2nd Propedeutic Department of surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Colorectal carcinoma is common,particularly on the left side.In 20%of patients,obstruction and ileus may be the first clinical manifestations of a carcinoma that has advanced(stage II,III or even IV).Diagnosis is based on clinical presentation,plain abdominal radiogram,computed tomography(CT),CT colonography and positron emission tomography/CT.The best management strategy in terms of short-term operative or interventional and long-term oncological outcomes re-mains unknown.For the most common left-sided obstruction,the first choice should be either emergency surgery or endoscopic decompression by self-expen-dable metal stents or tubes.The operative plan should be either one-stage or two-stage resection.One-stage resection with on-table bowel decompression and irrigation can be accompanied or not accompanied by proximal defunctioning stoma(colostomy or ileostomy).Primary anastomosis is more convenient but has increased risks of anastomotic leakage and morbidity.Two-stage resection(Hart-mann’s procedure)is safer and the most widely used despite temporally affecting quality of life.Damage control surgery in high-risk frail patients is less frequently performed since it can be successfully substituted with endoscopic stenting or tubing.For the less common right-sided obstruction,one-stage surgical resection is more beneficial than endoscopic decompression.The role of minimally invasive surgery(laparoscopic or robotic)is a subject of debate.emergency laparoscopic-assisted management is advantageous to some extent but requires much expertise due to inherent difficulties in dissecting the distended colon and the risk of rup-ture and subsequent septic complications.The decompressing stent as a bridge to elective surgery more substantially decreases the risks of morbidity and mortality than emergency surgery for decompression and has equivalent medium-term overall survival and disease-free survival rates.Its combination with neoadjuvant chemotherapy or radiation may have a positive effect on long-term oncological outcomes

关键词： Acute abdomen Obstructive ileus Colorectal carcinoma emergency surgery Colectomy Intraluminal metal stents

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emergency surgery in COVID-19 outbreak:Has anything changed?Single center experience

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World Journal of Clinical Cases 2020年第17期8卷 3691-3696页

作者： Francesco D'Urbano Nicolo Fabbri Margherita Koleva Radica Eleonora Rossin Paolo Carcoforo Department of Morphology Experimental Medicine and SurgerySection of General SurgeryUniversity of FerraraFerrara 44100Italy Unit of General surgery Azienda UnitàSanitaria Locale di FerraraFerrara 44100Italy

BACKGROUND The current coronavirus disease 19(COVID-19)pandemic is changing the organization of health care and has had a direct impact on the management of surgical patients.At the General surgery Department of Sant’Anna University Hospital in Ferrara,Italy,surgical activities were progressively reduced during the peak of the COVID-19 outbreak in Italy.During this period,only one operating room was available for elective cancer surgeries and another for emergency surgeries.Moreover,the number of beds for surgical patients had to be reduced to provide beds and personnel for the new COVID-19 wards.AIM To compare 2 different period(from March 9 to April 92019 and from March 9 to April 92020),searching differences in terms of number and type of interventions in emergency surgery of a main University Hospital in Ferrara,a city in Emilia Romagna region,North of Italy.METHODS This retrospective study was carried out at the General surgery Department of Sant’Anna University Hospital in Ferrara,Italy.We examined the number of emergency surgeries performed and patient outcomes during the peak of the COVID-19 outbreak in Italy and subsequent total lockdown.We then drew a comparison with the number of surgeries performed and their outcomes during the same period in 2019.The study examined all adult patients who underwent emergency surgery from March 9 to April 9,2019(n=46),and those who underwent surgery during the first month of the lockdown,from March 9 to April 9,2020(n=27).Analyses were adjusted for age,gender,American Society of Anesthesiologists classification scores and types of surgery.RESULTS A total of 27 patients underwent emergency surgery at Sant’Anna University Hospital in Ferrara during the first month of the lockdown.This represents a 41.3%reduction in the number of patients who were hospitalized and underwent emergency surgery compared to the same period in 2019.The complication rate during the pandemic period was substantially higher than it was during the analogous period in 2019:15 out of 27 cases from M

关键词： COVID-19 emergency surgery Outbreak

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Diagnosis and treatment of emergency surgeries in otorhinolaryngology, head and neck surgery during the covid-19 outbreak: A single center experience

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World Journal of Otorhinolaryngology-Head and Neck surgery 2020年第S1期6卷 S16-S21页

作者： Yu Sun Li Zhang Qing Cheng Yujuan Hu Hongjun Xiao Department of Otorhinolaryngology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China

The 2019 Novel Coronavirus(2019-nCoV,SARS-CoV-2)infection has already been assigned as a Class B infectious disease requiring Class A management strategy according to“the Law on the Prevention and Control of Infectious Diseases of the People’s Republic of China”and become a global pandemic.The incidence of emergencies in otorhinolaryngology,head and neck surgery such as foreign bodies in the esophagus and the respiratory tract,epistaxis,laryngeal obstruction with dyspnea,and head and neck trauma are relatively high.emergency surgeries are required as some of these diseases progress rapidly and probably be life-threatening.In this article,we drafted the recommendations for diagnosis and treatment of emergency surgeries in otorhinolaryngology,head and neck surgery in the epidemic area of novel coronavirus pneumonia based on“Novel Coronavirus Pneumonia Diagnosis and Treatment Plan(Provisional;7th Edition Revisions)”and WHO guidelines,combined with the experience of emergency surgeries in the Department of Otorhinolaryngology,Wuhan Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,which is at the center outbreak area of the SARS-CoV-2 pneumonia(COVID-19)in China,to improve the success rate of treatment for otorhinolaryngology,head and neck surgery emergency surgeries and to reduce the SARS-CoV-2 infection rate in the perioperative period.

关键词： 2019 novel coronavirus Otorhinolaryngology emergency surgery Diagnosis and treatment recommendations

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Retrospective Diagnosis of COVID-19 in an Asymptomatic Patient Undergoing emergency surgery

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Open Journal of Anesthesiology 2020年第8期10卷 277-283页

作者： Margaret Yanfong Chong Daphne Xin Ying Moo Department of Anaesthesiology and Intensive Care Changi General Hospital Singapore

Background: With reports of higher mortality and complications occurring in patients with perioperative 2019 novel coronarvirus disease (COVID-19), most elective surgeries have been postponed. However, evidence regarding emergency surgeries in patients with COVID-19 remains scarce. We report the case of a patient with asymptomatic perioperative COVID-19, presenting with an acute abdomen requiring surgery. Case: A 25-year-old male, with a prior nasopharyngeal swab that was negative for SARS-CoV-2, presented with classical signs and symptoms of acute appendicitis. Clinical examination and investigations were not suggestive of COVID-19 infection. He underwent laparoscopic appendicectomy with infection control precautions. Post-operatively, he was found to be positive for SARS-CoV-2 but remained asymptomatic and had an uneventful recovery. Conclusion: In asymptomatic individuals with higher risks, negative test results should be viewed cautiously. The benefits of urgent surgical interventions must be weighed against the risks of complications due to perioperative COVID-19 in these patients.

关键词： Coronavirus COVID-19 Asymptomatic emergency surgery Infection Control Pharyngeal Swab Personal Protective Equipment

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Observations on the Preventive Effects of Anti-infective Treatment on Wound Infection in emergency surgery

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Journal of Clinical and Nursing Research 2021年第1期5卷 30-32页

作者： Zhiyong Zhao Shanxi Bethune Hospital Shanxi Academy of Medical SciencesChina

Objective:To explore the preventive effects of anti-infective treatment on wound infection in emergency surgical trauma.Methods:180 patients in our hospital from 2019 to June to May 2020 were selected as subjects.The 180 patients were randomly divided into two groups.The control group had 90 cases and adopted the conventional treatment method,and the experimental group received anti-infective treatment.The wound healing,infection status,and patient satisfaction of the two groups of patients were analyzed.Results:The wound healing,infection status,and patient satisfaction of the experimental group were better than those of the control group.Conclusion:The application of anti-infective treatment to the prevention of wound infection in emergency surgical trauma can reduce the infection rate of the patients'incision and promote the recovery of patients.It is suitable for clinical applications.

关键词： Anti-infective treatment emergency surgery Surgical trauma incision infection Prevention

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Clinical presentation,management,screening and surveillance for colorectal cancer during the COVID-19 pandemic

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World Journal of Clinical Cases 2022年第26期10卷 9228-9240页

作者： Sami Akbulut Abdirahman Sakulen Hargura Ibrahim Umar Garzali Ali Aloun Cemil Colak Department of surgery Inonu University Faculty of MedicineMalatya 44280Turkey Biostatistics and Medical Informatics Inonu University Faculty of MedicineMalatya 44280Turkey Department of surgery Kenyatta University TeachingReferral and Research HospitalNairobi 00100Kenya Department of surgery Aminu Kano Teaching HospitalKano 700101Nigeria Department of surgery King Hussein Medical CenterAmman 11855Jordan

Management of colorectal cancer(CRC)was severely affected by the changes implemented during the pandemic,and this resulted in delayed elective presentation,increased emergency presentation,reduced screening and delayed definitive therapy.This review was conducted to analyze the impact of the coronavirus disease 2019(COVID-19)pandemic on management of CRC and to identify the changes made in order to adapt to the pandemic.We performed a literature search in PubMed,Medline,Index Medicus,EMBASE,SCOPUS,Reference Citation Analysis(https://***/)and Google Scholar using the following keywords in various combinations:Colorectal cancer,elective surgery,emergency surgery,stage upgrading,screening,surveillance and the COVID-19 pandemic.Only studies published in English were included.To curtail the spread of COVID-19 infection,there were modifications made in the management of CRC.Screening was limited to high risk individuals,and the screening tests of choice during the pandemic were fecal occult blood test,fecal immunochemical test and stool DNA testing.The use of capsule colonoscopy and open access colonoscopy was also encouraged.Blood-based tests like serum methylated septin 9 were also encouraged for screening of CRC during the pandemic.The presentation of CRC was also affected by the pandemic with more patients presenting with emergencies like obstruction and perforation.Stage migration was also observed during the pandemic with more patients presenting with more advanced tumors.The operative therapy of CRC was altered by the pandemic as more emergencies surgeries were done,which may require exteriorization by stoma.This was to reduce the morbidity associated with anastomosis and encourage early discharge from the hospital.There was also an initial reduction in laparoscopic surgical procedures due to the fear of aerosols and COVID-19 infection.As we gradually come out of the pandemic,we should remember the lessons learned and continue to apply them even after the pandemic passes.

关键词： COVID-19 pandemic Colorectal cancer Screening Surveillance Stage upgrading Elective surgery emergency surgery

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Huge gastric plexiform fibromyxoma presenting as pyemia by rupture of tumor:A case report

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World Journal of Clinical Cases 2022年第7期10卷 2253-2260页

作者： Rui Zhang Li-Gang Xia Kai-Bin Huang Nan-Di Chen The Second Clinical Medical College Shenzhen People’s HospitalJinan UniversityShenzhen 518020Guangdong ProvinceChina

BACKGROUND Plexiform fibromyxoma(PF)is a rare mesenchymal tumor,with limited case reports worldwide.Common clinical symptoms are abdominal discomfort and bleeding signs,which frequently present slow-onset in reported cases.Herein,we report a case of gastric PF presenting as acute onset and with pyemia accompanying tumor rupture.We resected the tumor as well as the distal gastric,bulbus duodeni and gallbladder for treatment in emergency surgery.Notably,before the onset of the disease,the patient received coronavirus disease 2019(COVID-19)vaccines.CASE SUMMARY A 26-year-old man was admitted to our hospital,due to abdominal pain and fever after having received COVID-19 vaccines.Laboratory examination indicated severe sepsis.Computed tomography scan revealed a large mass in the abdomen.Deformation of the gastrointestinal tract was seen during gastroscopy.After failure of anti-infective treatment and symptoms of shock developed,he received an emergency surgery.We found a huge and partly ruptured mass,with thick purulence.Microscopically,the mass was composed of spindle cells with clarified cytoplasm,accompanied by myxoid stroma and arborizing blood vessels.Immunohistochemistry showed the tumor cells as positive for smooth muscle actin and succinate dehydrogenase subunit B but negative for DOG-1 and CD117.Finally,the patient was diagnosed with gastric PF and discharged from the hospital.CONCLUSION Gastric PF manifesting as tumor rupture combined with pyemia is rare.Timely surgery is critical for optimal prognosis.

关键词： Gastric plexiform fibromyxoma Clinical manifestations Sepsis emergency surgery Pathology COVID-19 vaccines Case report

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