Data from this systematic review suggest that the risk of VTE in Asian general surgery patients is low, even in the context of risk factors typically regarded as high risk.
Being one of the most common causes of the acute abdomen, acute appendicitis (AA) forms the bread and butter of any general surgeon’s practice. With the recent advancements in AA’s management, much controversy in diagnostic algorithms, possible differential diagnoses, and weighing the management options has been generated, with no absolute consensus in the literature. Since Alvarado described his eponymous clinical scoring system in 1986 to stratify AA risk, there has been a burgeoning of additional scores for guiding downstream management and mortality assessment. Furthermore, advancing literature on the role of antibiotics, variations in appendicectomy, and its adjuncts have expanded the surgeon’s repertoire of management options. Owing to the varied presentation, diagnostic tools, and management of AA have also been proposed in special groups such as pregnant patients, the elderly, and the immunocompromised. This article seeks to raise the critical debates about what is currently known about the above aspects of AA and explore the latest controversies in the field. Considering the ever-evolving coronavirus disease 2019 situation worldwide, we also discuss the pandemic’s repercussions on patients and how surgeons’ practices have evolved in the context of AA.
Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.
New Zealand (NZ) is a country that is renowned for its beautiful scenery and numerous activities for leisure. It also has a modern health system that is sometimes called upon to assist neighboring Pacific countries with advanced medical care. In this article, we discuss the different components of the NZ trauma system ranging from prehospital to governance. This may be of interest to practitioners involved in developing or upgrading their country's trauma systems.
Background: The coronavirus disease 2019 pandemic has led to the control of movement and diversion of medical resources in many countries. This affects the provision of care to critically injured patients.Methods: We analyzed data from the trauma registry of a regional trauma center in Singapore, looking at patient volume and the pattern of injuries over a 3-month period. This was compared with the same period in the preceding 2 years.Results: A total of 93 patients were admitted during this period, compared with 111 in 2019 and 118 in 2018, a drop of 15% to 20%. The proportion of severely injured patients and the mechanism of injury were largely unchanged.
Conclusion:Although there was a minor decrease in the absolute number of patients, the severity and pattern of injuries remained unchanged. Planners should consider this when planning for the diversion of medical and nursing resources.
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