Ospedale Civile di Vittorio Veneto

Aim: Indocyanine green (ICG) fluorescence is not routinely used in acute small bowel obstruction (SBO), and standardized methods for its use in assessing intestinal perfusion, particularly via laparoscopy, remain lacking. Therefore, we aimed to explore its role in acute SBO in elderly and frail patients undergoing operative management. Methods: In this single-center, prospective, non-randomized study, we included a case series of patients who underwent emergency laparoscopic surgery for SBO from January 2024 to January 2025 at an Italian community hospital. Patients included were those with acute SBO confirmed by computed tomography scan, who provided signed informed consent, had no allergy to ICG, and were ≥ 18 years old. In borderline cases of intestinal ischemia, we standardized the application of ICG fluorescence to help determine the need for intestinal resection: ICG dosage, timing of injection, timing of fluorescence imaging capture and assessment of the intestinal segment. The postoperative course and the need for re-intervention were evaluated. Results: ICG fluorescence was applied in 16 patients. Half of the cases were male, the median age was 72 years old, 63% presented an American Society of Anesthesiologists (ASA) Physical Status score of 3-4, and the median Charlson Comorbidity Index was 3. Conversion rate was 37%. Main causes of SBO were strangulated hernia, adhesive bands, adhesions and vascular ischemia. In 6 patients, ICG fluorescence showed a non-fluorescent or perivascular pattern, prompting an intestinal resection. Two patients needed re-intervention. Postoperative complications occurred in 43% of the patients. Conclusion: SBO often affects elderly and frail patients. ICG fluorescence serves as a useful and feasible tool in emergency laparoscopic surgery. It facilitates the surgical assessment in borderline cases of intestinal ischemia, thereby preventing unnecessary bowel resections.

Acute diverticulitis (AD) is a significant socioeconomic burden on healthcare systems, primarily due to elevated rates of hospital admissions and considerable healthcare expenditures. The aim of this systematic review is to update and summarise existing knowledge regarding the viability of conservative management in 2B stage cases (distant free extraluminal air) that remains a crucial condition for surgeons to decide for operative or non-operative management. Patients ages ranging between 52.2 and 60.5years. Male patients varied from 47 to 73.4%. BMI ranged from 25.7 to 27.1kg/m2, and ASA scores between I and III. Antibiotic regimens varied across studies, including mono-antibiotic or bi-antibiotic therapy (average duration from 7 to 21days). Percutaneous drainage was used in 3.5 to 27.6%. NOM failure ranged from 2.6 to 31.9%, with corresponding emergency surgery rates between 2.17 and 69%. Mortality was low overall. Follow-up durations ranged from 1 to 71months. Thirty-day readmission (7.7%) and recurrence (up to 27.8%) were inconsistently reported. The management of AD with distant extraluminal free air remains a complex and challenging topic, however, despite several limits due to the low level of evidence, our review reported that NOM may be feasible in carefully selected, hemodynamically stable individuals, knowing that failure rates can be variable. The ongoing COLD 2B study (ClinicalTrials.Gov ID Number NCT06388538), a multi-center prospective trial, promoted by research Emergency Surgery committee of the Italian Society of Endoscopic Surgery and New Technologies (SICE), was designed to provide high-quality evidence on this complex condition.

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.

Rectus Abdominis diastasis (RAD) is a prevalent condition, particularly in post-gravidic women, with functional and esthetic impact. This Delphi consensus, led by general surgeons, aimed to establish evidence-based recommendations for the diagnosis and management of RAD in post-gravidic women. A Delphi process was conducted under the auspices of the Italian Society of Hernia and Abdominal Wall Surgery (ISHAWS), the national chapter of the European Hernia Society (EHS). A steering committee supervised systematic literature reviews to evaluate the quality of evidence and formulate recommendations. Iterative rounds of voting involving 105 expert panellists were conducted, with Consensus defined as ≥ 70% agreement. Non-consensual recommendations were revised and discussed in a plenary session during the Italian Society of Surgery (SIC) Congress, 2024. Consensus was achieved on 12 recommendations covering RAD diagnosis, classification, and treatment. Key findings included the endorsement of radiological methods for accurate RAD assessment, the establishment of surgical thresholds (> 2.5cm inter-recti distance for symptom improvement), and the recommendation of minimally invasive linea alba plication for surgical management. Non-operative treatments, such as targeted exercise programs, were emphasized as first-line approaches. For RAD with concomitant hernias of the linea alba with defects > 1cm, mesh reinforcement was strongly recommended, with extraperitoneal placement preferred. The importance of tailoring approaches based on patient-specific factors and fostering shared decision-making was highlighted. This consensus provides a structured framework for RAD management, emphasizing accurate diagnosis, tailored treatments, and patient-centered care. Future multicenter studies are required to address remaining evidence gaps and refine these recommendations.