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  • 1.
    Ansaloni, Luca
    et al.
    1st Unit of General Surgery, Ospedali Riuniti di Bergamo, Italy .
    Andersson, Roland E.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Bazzoli, Franco
    Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
    Catena, Fausto
    Unit of General, Emergency and Transplant Surgery, St Orsola-Malpighi University Hospital, Bologna, Italy.
    Cennamo, Vincenzo
    Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
    Di Saverio, Salomone
    Acute Care and Trauma Surgery Unit, Maggiore Hospital Trauma Center, Bologna, Italy.
    Fuccio, Lorenzo
    Department of Internal Medicine and Gastroenterology, University of Bologna, Italy .
    Jeekel, Hans
    Department of Surgery, ZNA Middelheim, Antwerp, Belgium.
    Leppaniemi, Ari
    Department of Surgery, Helsinki University Hospital, Helnsiki, Finland.
    Moore, Ernest
    Department of Surgery, Denver Health Medical Center, University of Colorado Denver, CO, USA.
    Pinna, Antonio D.
    Unit of General, Emergency and Transplant Surgery, St Orsola-Malpighi University Hospital, Bologna, Italy.
    Pisano, Michele
    1st Unit of General Surgery, Ospedali Riuniti di Bergamo, Italy.
    Repici, Alessandro
    Department of Gastroenterology, Digestive Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milano, Italy.
    Sugarbaker, Paul H.
    The Washington Cancer Institute, Washington Hospital Center.
    Tuech, Jean-Jaques
    Department of Digestive Surgery, Rouen University Hospital, Rouen, France.
    Guidelines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society2010In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 5, p. 29-Article, review/survey (Refereed)
    Abstract [en]

    Background: Obstructive left colon carcinoma (OLCC) is a challenging matter in terms of obstruction release as well of oncological issues. Several options are available and no guidelines are established. The paper aims to generate evidenced based recommendations on management of OLCC. Methods: The PubMed and Cochrane Library databases were queried for publications focusing on OLCC published prior to April 2010. A extensive retrieval, analyses, and grading of the literature was undertaken. The findings of the research were presented and largely discussed among panellist and audience at the Consensus Conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society held in Bologna July 2010. Comparisons of techniques are presented and final committee recommendation are enounced. Results: Hartmann's procedure should be preferred to loop colostomy (Grade 2B). Hartmann's procedure offers no survival benefit compared to segmental colonic resection with primary anastomosis (Grade 2C+); Hartmann's procedure should be considered in patients with high surgical risk (Grade 2C). Total colectomy and segmental colectomy with intraoperative colonic irrigation are associated with same mortality/morbidity, however total colectomy is associated with higher rates impaired bowel function (Grade 1A). Segmental resection and primary anastomosis either with manual decompression or intraoperative colonic irrigation are associated with same mortality/morbidity rate (Grade 1A). In palliation stent placement is associated with similar mortality/morbidity rates and shorter hospital stay (Grade 2B). Stents as a bridge to surgery seems associated with lower mortality rate, shorter hospital stay, and a lower colostomy formation rate (Grade 1B). Conclusions: Loop colostomy and staged procedure should be adopted in case of dramatic scenario, when neoadjuvant therapy could be expected. Hartmann's procedure should be performed in case of high risk of anastomotic dehiscence. Subtotal and total colectomy should be attempted when cecal perforation or in case of synchronous colonic neoplasm. Primary resection and anastomosis with manual decompression seems the procedure of choice. Colonic stents represent the best option when skills are available. The literature power is relatively poor and the existing RCT are often not sufficiently robust in design thus, among 6 possible treatment modalities, only 2 reached the Grade A.

  • 2.
    Di Saverio, Salomone
    et al.
    AUSL, Italy.
    Birindelli, Arianna
    University of Bologna, Italy.
    Kelly, Micheal D.
    Canberra Hospital, Australia.
    Catena, Fausto
    Maggiore Hospital Parma, Italy.
    Weber, Dieter G.
    Trauma and Gen Surgeon Royal Perth Hospital, Australia; University of Western Australia, Australia.
    Sartelli, Massimo
    Macerata Hospital, Italy.
    Sugrue, Michael
    Letterkenny Hospital, Ireland.
    De Moya, Mark
    Harvard Medical Sch, MA USA.
    Augusto Gomes, Carlos
    University of Gen Juiz de Fora, Brazil.
    Bhangu, Aneel
    University Hospital Birmingham NHS Fdn Trust, England.
    Agresta, Ferdinando
    Civil Hospital, Italy.
    Moore, Ernest E.
    Denver Health Medical Centre, CO USA.
    Soreide, Kjetil
    Stavanger University Hospital, Norway.
    Griffiths, Ewen
    University Hospital Birmingham NHS Fdn Trust, England.
    De Castro, Steve
    OLVG, Netherlands.
    Kashuk, Jeffry
    University of Jerusalem, Israel.
    Kluger, Yoram
    Rambam Health Care Campus, Israel.
    Leppaniemi, Ari
    University of Helsinki, Finland.
    Ansaloni, Luca
    Papa Giovanni XXIII Hospital, Italy.
    Andersson, Manne
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Coccolini, Federico
    Papa Giovanni XXIII Hospital, Italy.
    Coimbra, Raul
    UCSD Health Syst, CA USA.
    Gurusamy, Kurinchi S.
    UCL, England.
    Cesare Campanile, Fabio
    San Giovanni Decollato Andosilla Hospital, Italy.
    Biffl, Walter
    University of Hawaii, HI USA.
    Chiara, Osvaldo
    Osped Niguarda Ca Granda, Italy.
    Moore, Fred
    University of Florida, FL USA.
    Peitzman, Andrew B.
    University of Pittsburgh, PA USA.
    Fraga, Gustavo P.
    University of Estadual Campinas, Brazil.
    Costa, David
    Alicante, Spain.
    Maier, Ronald V.
    University of Washington, WA USA.
    Rizoli, Sandro
    St Michaels Hospital, Canada.
    Balogh, Zsolt J.
    John Hunter Hospital, Australia.
    Bendinelli, Cino
    John Hunter Hospital, Australia.
    Cirocchi, Roberto
    University of Perugia, Italy.
    Tonini, Valeria
    University of Bologna, Italy.
    Piccinini, Alice
    AUSL, Italy.
    Tugnoli, Gregorio
    AUSL, Italy.
    Jovine, Elio
    AUSL, Italy.
    Persiani, Roberto
    Catholic University, Italy.
    Biondi, Antonio
    University of Catania, Italy.
    Scalea, Thomas
    R Adams Cowley Trauma Centre, MD USA.
    Stahel, Philip
    Denver Health Medical Centre, CO USA.
    Ivatury, Rao
    Virginia Commonwealth University, VA USA.
    Velmahos, George
    Harvard Medical Sch, MA USA.
    Andersson, Roland
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis2016In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 11, no 34Article, review/survey (Refereed)
    Abstract [en]

    Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

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