Federico Coccolini

Introduction: The 10th Albanian Congress of Trauma and Emergency Surgery (ACTES 2026), held on 25–26 September 2026 in Tirana, Albania, brought together surgeons, anesthesiologists, intensivists, radiologists, nurses and allied professionals to share current evidence and clinical experience in the care of injured and acutely ill surgical patients. Aim: To provide a structured, citable record of the scientific work presented at ACTES 2026 and to make it accessible to the international trauma and emergency surgery community. Methods: All abstracts accepted for oral or poster presentation were included. They were edited for format only, organized in a structured IMRAD layout with keywords, and their references were unified in Vancouver style. Author names and affiliations were checked for consistency. Results: The supplement contains 248 abstracts by more than 420 authors from 15 countries, mainly Albania, Italy, Germany, England, Ireland, Canada, Romania, Cyprus, Austria, Switzerland, North Macedonia, Greece, Israel, Turkey, and Kosovo. Retrospective clinical studies form the largest group (about one third), followed by narrative reviews, case reports, prospective studies, and systematic reviews or meta-analyses. Trauma care accounts for about 40% of the abstracts. Other topics include emergency general surgery, orthopedic trauma, vascular and cardiac emergencies, critical care and anesthesia, burns and reconstructive surgery, pediatric and oncologic emergencies, and trauma systems, education and digital health. Conclusions: The ACTES 2026 abstracts reflect growing regional and international collaboration in trauma and emergency surgery and provide a reference point for future research, training, and quality improvements in Albania, the region, and beyond...

BACKGROUND: Grading surgical complications and sequelae is of paramount importance for analyzing results and improving patient care and system performance and in optimizing resource allocation and use. Existing systems for surgical complication classification do not consistently account for baseline physiologic vulnerability and often conflate treatment intensity with clinical severity. This limitation reduces interpretability across diverse patient populations, particularly in emergency and elective general surgery. METHODS: A multidisciplinary expert panel conducted a modified Delphi process to develop a dual-axis classification system, the Extended Postoperative Complication Score (EPCS). This system stratifies patients preoperatively into three baseline classes (A, B, C) reflecting physiologic reserve and immunocompetence. Postoperative events are then graded by physiologic impact from Grade 0 (minor, no impact) to Grade IV (death). Sequelae, defined as anticipated events related to underlying pathology or chronic disease, are separately categorized. Representatives of the most relevant international emergency and trauma surgical associations were involved (World Society of Emergency Surgery, European Society for Trauma and Emergency Surgery, American Association for the Surgery of Trauma, Panamerican Trauma Society, EndoVascular and Trauma Management Society, Global Alliance for Infections in Surgery). RESULTS: The EPCS yields 18 mutually exclusive strata, combining five complication grades and three baseline classes, plus three sequelae codes. The matrix enables interpretable outcome reporting across settings, accounting for both event severity and host vulnerability. Expert consensus confirmed conceptual clarity and operational feasibility. The system allows applications to elective, urgent, and emergent operations, and is compatible with clinical audit, observational research, and pragmatic trials. CONCLUSIONS: The EPCS provides a structured, physiologically anchored method for postoperative complication stratification. Its dual-axis design may improve the validity of outcome comparisons and support real-world evaluation of surgical quality. Further validation is warranted through prospective multicenter implementation and time-bound observational methodologies. ( J Trauma Acute Care Surg . 2026;100:700–706. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.)

Background: Surgical sepsis, particularly secondary peritonitis, is a leading cause of ICU admissions, with mortality rates reaching 40%. In recent decades, several adjuvant therapies have been proposed in addition to standard of care to modulate the inflammatory response and support organ function. In our study, we aimed to evaluate the efficacy of IgM-enriched immunoglobulin (eIg) treatment on outcome of adult surgical patients with sepsis and septic shock. Methods: A single-center, retrospective, observational study was conducted from January 2016 to December 2019 in the Intensive Care Unit of Pisa University Hospital. Patients with sepsis or septic shock resulting from primary or postoperative infections undergoing surgical source control were included. The primary outcome was to investigate the impact of eIg administration on in-hospital mortality. The secondary outcomes were the ICU length of stay, days of ventilation, and vasoactive drug administration. A propensity score through inverse probability weighting was used to control for measured confounding variables. Results: A total of 108 patients, categorized into two groups based on whether they received eIg, were included during the study period. Compared to the untreated group, patients who received eIg showed a significant reduction in ICU mortality (ATE −0.17, 95% CI −0.33 to −0.03; p = 0.023) and in-hospital mortality (ATE −0.18, 95% CI −0.34 to −0.03; p = 0.022). However, the ICU length of stay and the duration of mechanical ventilation were significantly longer in the treated group (ATE + 7.1 days, 95% CI 3.1 to 11.1; p = 0.001 and ATE + 4.5 days, 95% CI 1.0 to 7.9; p = 0.011, respectively). No other statistically significant differences were observed. Conclusions: Despite the significant limitations of its observational nature, our study suggests that administering eIg may reduce ICU and in-hospital mortality in surgical patients with sepsis and septic shock.

Negative pressure therapy (NPT) has emerged as an important adjunct in managing the open abdomen (OA), and as part of a larger planned strategy that includes careful patient selection and anticipated timing and steps for primary fascial closure. There is a need to synthesize the information reported in international society guidelines, meta-analyses, comparative studies and case series into updated recommendations regarding the role of NPT in temporary abdominal closure (TAC). The purpose of this publication is to present recommendations developed by an expert panel, along with supporting evidence, to help guide adjunctive use of NPT in OA. An expert advisory panel of 14 surgeons, specialized in general, emergency, trauma, visceral, and/or hepato-pancreato-biliary surgery, convened in June 2023 to develop evidence-based recommendations for adjunctive use of NPT for TAC in the OA. The panel produced six expert panel recommendation statements. The statements identify NPT as the preferred TAC adjunct for managing the OA and include best practices for complete coverage of the viscera and applying adequate negative pressure. Recommended methodology and content for developing systematic training for all healthcare professionals involved in OA patient care with NPT are outlined. The recommendations emphasize the necessity of timely reexploration within 24–72 hours and the importance of achieving early definitive fascial closure, ideally within 7 days. The statements presented in this document provide an updated evidence-based general framework and a minimal set of guidelines for NPT use in all septic and non-septic OA management.

Chest trauma is a common consequence of traumatic events. It may be blunt or penetrating. A low number of patients with blunt chest trauma require surgical intervention; in contrast, penetrating ones frequently require surgery and are associated with higher mortality. Chest trauma due to its anatomical location and to its potential effects on different systems must be multidisciplinary, and emergency and trauma systems should be organized and prepared to face all aspects. The present paper describes the recommendations provided by World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST), about comprehensive management of thoracic trauma.

Malignant bowel obstruction caused by peritoneal carcinomatosis is a common complication that affects a large proportion of gastrointestinal and ovarian oncology patients and predicts poor longterm survival. The management strategy for these patients includes a variety of medical therapies and surgical options; however, how to choose the best treatment strategy remains a mystery. The purpose of this narrative review was to summarize the most recent evidence on multimodal malignant bowel obstruction treatment and determine whether or not progress had been made. We should work to establish consensus guidelines, where possible, to ensure that this unique patient group receives the appropriate treatment or compassionate care during this often terminal event.