Stefano Piero Bernardo Cioffi

Blunt traumatic hollow viscus and mesenteric injuries (THVMI) are uncommon but carry high morbidity if diagnosis is delayed. The Niguarda Score, based on six predefined computed tomography (CT) findings, was originally developed in 2020 to aid early identification of surgically relevant THVMI. This study aimed to perform a critical appraisal and temporal validation of the score. The data of all adult blunt trauma patients consecutively admitted to our trauma center from 2010 to 2021, who underwent contrast-enhanced CT-scan on admission, were collected and retrospectively analyzed. Patients admitted between 2010 and 2018 represented the cohort used to build the original score, and their data were re-analyzed for a critical appraisal of the Niguarda score. The data of patients admitted from 2019 to 2021 were used for temporal validation in an independent cohort from the same institution. Six CT findings-free intraperitoneal air, free fluid without solid organ injury, gastrointestinal wall alteration, mesenteric alteration, intra-mesenteric fluid, and mesenteric blushing-were scored 0-6, with one point for each present finding. The primary outcome was THVMI requiring surgical repair. Model performance was assessed in the derivation and temporal validation cohorts for discrimination (C-index), calibration slope, and overall accuracy (Brier score). Cut-offs were identified using ROC-based methods. In the derivation cohort, the score achieved AUC 0.925 (95% CI 0.874-0.976), Nagelkerke R² 0.662, and Brier score 0.111, with a calibration slope of ≈1. Internal bootstrap validation yielded optimism-corrected C-index 0.930. Temporal validation demonstrated preserved discrimination (AUC 0.914, 95% CI 0.807-1.000). The optimal cut-off in correspondence of one or more findings present gave a sensitivity of 81.8% and a specificity of 90.0%. After critical re-evaluation of the original tool, a remarkable diagnostic and predictive performance was confirmed for the Niguarda scoring model. The model also showed excellent diagnostic accuracy and calibration in the temporal validation cohort, supporting its utility as a simple and reproducible tool to guide early operative decision-making in blunt THVMI.

Blunt adrenal gland injuries (BAGI) are rare and typically reflect high-energy trauma. Despite suggestions that BAGI may be a marker of increased injury se

The optimal tube size for managing traumatic hemothorax, pneumothorax, or hemopneumothorax remains debated. While large-bore chest tubes (LCTs—≥

Background Trauma remains a principal cause of mortality across all age groups, particularly in cases of major abdominal trauma and hemorrhage, which can lead to the 'lethal triad' of coagulopathy, metabolic acidosis, and hypothermia. This systematic review explores the efficacy of Damage Control Laparotomy (DCL) compared to definitive surgery (DEF) in major abdominal trauma. Methods A systematic literature search following PRISMA and MOOSE guidelines was conducted across Medline, Cochrane Library, and Embase databases. Results Seven studies were found, including one randomized controlled trial (RCT) and six observational studies (OS). Mortality rates varied, with one observational study indicating higher 24-h mortality in the DCS group (OR 1.49, 95% CI 0.48, 4.68, I² = 86%), while the RCT showed a significantly lower 30-day mortality rate (OR 0.05 (95% CI 0.00, 0.99 P = 0.010). Notably, major complications did not differ significantly between the two approaches (RCT OR 0.75, 95% CI 0.20, 2.77; OS OR 0.75, 95% CI 0.20, 2.77). The overall certainty of evidence was rated low, reflecting heterogeneous outcomes and inconsistent reporting. Conclusion Although DCS is frequently utilized in trauma care, its superiority over definitive surgery remains unestablished, with ethical considerations complicating randomized trials. This review suggests that while DCS may be beneficial under specific conditions, robust multicentric studies are essential to clarify its impact on mortality and health outcomes compared to conventional surgery in abdominal trauma.

Introduction Laparoscopic Appendectomy (LA) allows residents to get early exposure to minimally invasive techniques. Despite its importance, involving residents as primary surgeons is a complex process, influenced by more than just clinical factors. Mentorship, environment, and perceptions play crucial roles. This study aimed to explore rates of residents' involvement in LA, the factors influencing the decision-making, and how surgeons and residents perceive the process. Methods We analyzed data from the REsiDENT-1 trial, covering 653 LA performed between 2019 and 2023 in 24 hospitals affiliated with the University of Milan. Adults with intraoperative acute appendicitis were included. Univariable analysis and multivariable logistic regression explored factors impacting residents’ involvement and clinical outcomes. A survey captured the perspectives of surgeons and residents. Results Residents approached 35.9% of the procedures, with longer operative times 67.14 (± 28.1) vs 71.68 (± 24.44), p = 0.001. Trainees were more involved in academic hospitals and emergency surgery units and less complex cases with lower complication rates. Residents' involvement was hampered by patients’ complexity in the multivariable analysis. Surgeons prioritized non-technical factors such as punctuality and reliability, whereas residents highlighted clinical complexity as a key consideration for the decision-making of the operator. Both groups agreed that structured feedback systems could improve the educational and training experiences. Conclusion LA remains a crucial procedure for surgical training, balancing hands-on learning with patient safety. Structured mentorship in academic and emergency settings could allow safe resident involvement. Future improvements should focus on clear feedback processes, better access to simulations, and standardized competency-based training to prepare residents for independent practice.

Purpose Our study explores the utilization of objective tools for preoperative assessment of elderly patients by Emergency General Surgeons (EGS). Methods A descriptive cross-sectional survey was conducted via the European Society for Trauma and Emergency Surgery (ESTES) Research Committee. EGS were invited through the ESTES members’ mailing list and social media platforms. The survey included two sections: (1) clinical scenarios involving elderly patients with varying chronic conditions, and (2) participant characteristics. Data collection lasted 12 weeks, with reminders sent every 4 weeks. Statistical analyses were performed using Microsoft Excel and EasyMedStat. Results One hundred and seven surgeons responded to the survey. Median respondent age was 41 years, with a male prevalence (72.9%). Most participants were from Europe (85%). Key-findings included that 62.6% reported using one or more risk assessment tools (RATs), while 35.5% used one or more frailty scores. Additionally, 4.7% were unaware of any RATs, and 35.5% were unaware of any frailty scores. Decision-making strategies leveraging personal experience with minimal impact from RATs predominated. Conclusions Preoperative risk assessment tool and frailty score use for elderly patients requiring emergency surgery remains limited among ESTES surgeons. Our study highlights the need for focused education and tool workflow integration to improve risk stratification, decision-making and outcomes. Institutional approaches coupled with targeted educational interventions using implementation science principles are recommended to bridge this knowledge-to-action gap. Future research should focus on developing comprehensive, user-friendly tools and evaluating their impact on patient-centered outcomes.

Background: The current standard of care for mild acute biliary pancreatitis (MABP) involves early laparoscopic cholecystectomy (ELC) to reduce the risk of recurrence. The MANCTRA-1 project revealed a knowledge-to-action gap and higher recurrence rates in patients admitted to medical wards, attributable to fewer ELCs being performed. The project estimated a 35% to 70% probability of narrowing this gap by 2025. This study evaluates the safety of suboptimal ELC implementation and identifies risk factors for recurrent acute biliary pancreatitis (RAP) in patients not undergoing ELC after an MABP episode. Methods: We conducted a post-hoc analysis of the MANCTRA-1 registry, including MABP patients who did not undergo ELC during the index hospitalization, excluding those with related complications. The primary outcome was the 30-day hospital readmission rate due to RAP. We performed multivariable logistic regression to find risk factors associated with the primary outcome. Results: Between January 2019 and December 2020, 1920, MABP patients from 150 centers were included in the study. The 30-day readmission rate due to RAP was 6%. Multivariable logistic regression found the admission to a medical ward (internal medicine or gastroenterology) (OR = 1.95, p = 0.001) and a positive COVID-19 test (OR = 3.08, p = 0.029) as independent risk factors for RAP. Conclusion: Our analysis offers valuable insights into the management of MABP, particularly in centers where ELC cannot be fully implemented due to logistical and clinical constraints, worsened by the COVID-19 pandemic. Regardless of the admitting ward, prompt access to surgical care is crucial in reducing the risk of early recurrence, highlighting the need to implement surgical consultation pathways within MABP care bundles.

Around five billion people globally lack access to safe, timely, and affordable surgical facilities and care in low-income and middle-income countries (LMICs). Global initiatives have been launched, including efforts led by organizations. Also, regional efforts have shed light on the unique challenges faced by different areas within LMICs. Despite these efforts, many countries still face significant challenges, including inadequate infrastructure, limited availability of trained surgical personnel, lack of essential medical equipment, and insufficient financial resources allocated to healthcare and their related possible factors. Here is that we aim to identify the progress made in areas such as capacity building, training programs, infrastructure development, and policy reforms, as well as highlight the gaps that persist, providing a foundation for future research. Such a comprehensive scoping review will be crucial to enhance surgical care services and ultimately improve health outcomes in LMICs. A comprehensive literature search up to November 2024 will be conducted across six major databases. PubMed, Scopus, Ovoid, Web of Science, Cochrane Central, CNKI (China National Knowledge Infrastructure) database. The methodology will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. The first version of this project will not include a quality appraisal.