Browsing by Author "Balogh, Zsolt J"

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    Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group
    (2018-06-19) ten Broek, Richard P G; Krielen, Pepijn; Di Saverio, Salomone; Coccolini, Federico; Biffl, Walter L; Ansaloni, Luca; Velmahos, George C; Sartelli, Massimo; Fraga, Gustavo P; Kelly, Michael D; Moore, Frederick A; Peitzman, Andrew B; Leppaniemi, Ari; Moore, Ernest E; Jeekel, Johannes; Kluger, Yoram; Sugrue, Michael; Balogh, Zsolt J; Bendinelli, Cino; Civil, Ian; Coimbra, Raul; De Moya, Mark; Ferrada, Paula; Inaba, Kenji; Ivatury, Rao; Latifi, Rifat; Kashuk, Jeffry L; Kirkpatrick, Andrew W; Maier, Ron; Rizoli, Sandro; Sakakushev, Boris; Scalea, Thomas; Søreide, Kjetil; Weber, Dieter; Wani, Imtiaz; Abu-Zidan, Fikri M; De’Angelis, Nicola; Piscioneri, Frank; Galante, Joseph M; Catena, Fausto; van Goor, Harry
    Abstract Background Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups. Methods The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion. Recommendations Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO. Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention. Discussion This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.
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    Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (the COOL trial): study protocol for a randomized controlled trial
    (2018-06-22) Kirkpatrick, Andrew W; Coccolini, Federico; Ansaloni, Luca; Roberts, Derek J; Tolonen, Matti; McKee, Jessica L; Leppaniemi, Ari; Faris, Peter; Doig, Christopher J; Catena, Fausto; Fabian, Timothy; Jenne, Craig N; Chiara, Osvaldo; Kubes, Paul; Manns, Braden; Kluger, Yoram; Fraga, Gustavo P; Pereira, Bruno M; Diaz, Jose J; Sugrue, Michael; Moore, Ernest E; Ren, Jianan; Ball, Chad G; Coimbra, Raul; Balogh, Zsolt J; Abu-Zidan, Fikri M; Dixon, Elijah; Biffl, Walter; MacLean, Anthony; Ball, Ian; Drover, John; McBeth, Paul B; Posadas-Calleja, Juan G; Parry, Neil G; Di Saverio, Salomone; Ordonez, Carlos A; Xiao, Jimmy; Sartelli, Massimo
    Abstract Background Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. Principles of treatment include early antibiotic administration and operative source control. A further therapeutic option may be open abdomen (OA) management with active negative peritoneal pressure therapy (ANPPT) to remove inflammatory ascites and ameliorate the systemic damage from SCIAS. Although there is now a biologic rationale for such an intervention as well as non-standardized and erratic clinical utilization, this remains a novel therapy with potential side effects and clinical equipoise. Methods The Closed Or Open after Laparotomy (COOL) study will constitute a prospective randomized controlled trial that will randomly allocate eligible surgical patients intra-operatively to either formal closure of the fascia or use of the OA with application of an ANPTT dressing. Patients will be eligible if they have free uncontained intra-peritoneal contamination and physiologic derangements exemplified by septic shock OR a Predisposition-Infection-Response-Organ Dysfunction Score ≥ 3 or a World-Society-of-Emergency-Surgery-Sepsis-Severity-Score ≥ 8. The primary outcome will be 90-day survival. Secondary outcomes will be logistical, physiologic, safety, bio-mediators, microbiological, quality of life, and health-care costs. Secondary outcomes will include days free of ICU, ventilation, renal replacement therapy, and hospital at 30 days from the index laparotomy. Physiologic secondary outcomes will include changes in intensive care unit illness severity scores after laparotomy. Bio-mediator outcomes for participating centers will involve measurement of interleukin (IL)-6 and IL-10, procalcitonin, activated protein C (APC), high-mobility group box protein-1, complement factors, and mitochondrial DNA. Economic outcomes will comprise standard costing for utilization of health-care resources. Discussion Although facial closure after SCIAS is considered the current standard of care, many reports are suggesting that OA management may improve outcomes in these patients. This trial will be powered to demonstrate a mortality difference in this highly lethal and morbid condition to ensure critically ill patients are receiving the best care possible and not being harmed by inappropriate therapies based on opinion only. Trial registration ClinicalTrials.gov , NCT03163095 .
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    The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections
    (2017-07-10) Sartelli, Massimo; Chichom-Mefire, Alain; Labricciosa, Francesco M; Hardcastle, Timothy; Abu-Zidan, Fikri M; Adesunkanmi, Abdulrashid K; Ansaloni, Luca; Bala, Miklosh; Balogh, Zsolt J; Beltrán, Marcelo A; Ben-Ishay, Offir; Biffl, Walter L; Birindelli, Arianna; Cainzos, Miguel A; Catalini, Gianbattista; Ceresoli, Marco; Che Jusoh, Asri; Chiara, Osvaldo; Coccolini, Federico; Coimbra, Raul; Cortese, Francesco; Demetrashvili, Zaza; Di Saverio, Salomone; Diaz, Jose J; Egiev, Valery N; Ferrada, Paula; Fraga, Gustavo P; Ghnnam, Wagih M; Lee, Jae G; Gomes, Carlos A; Hecker, Andreas; Herzog, Torsten; Kim, Jae I; Inaba, Kenji; Isik, Arda; Karamarkovic, Aleksandar; Kashuk, Jeffry; Khokha, Vladimir; Kirkpatrick, Andrew W; Kluger, Yoram; Koike, Kaoru; Kong, Victor Y; Leppaniemi, Ari; Machain, Gustavo M; Maier, Ronald V; Marwah, Sanjay; McFarlane, Michael E; Montori, Giulia; Moore, Ernest E; Negoi, Ionut; Olaoye, Iyiade; Omari, Abdelkarim H; Ordonez, Carlos A; Pereira, Bruno M; Pereira Júnior, Gerson A; Pupelis, Guntars; Reis, Tarcisio; Sakakushev, Boris; Sato, Norio; Segovia Lohse, Helmut A; Shelat, Vishal G; Søreide, Kjetil; Uhl, Waldemar; Ulrych, Jan; Van Goor, Harry; Velmahos, George C; Yuan, Kuo-Ching; Wani, Imtiaz; Weber, Dieter G; Zachariah, Sanoop K; Catena, Fausto
    Abstract Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.