BACKGROUND & AIMS: :Risk prediction is an important part of the management of emergency laparotomy (EL) patients. This study aims to investigate the current use of and future directions for EL risk prediction scores. New Zealand members of the Royal Australasian College of Surgery (RACS), Australian and New Zealand College of Anaesthetists (ANZCA) and College of Intensive Care Medicine (CICM) were invited to participate in an anonymous online survey. Responses were received from 316 clinicians (45 RACS, 253 ANZCA and 19 CICM), with 73% of them having >10 years' experience as a consultant. Risk assessment scores were utilised by respondents for approximately 30% of EL cases. The most common EL risk scores used were Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality (P-POSSUM) and American College of Surgeons National Surgical Quality Improvement Programs (ACS-NSQIP). When used, respondents used risk assessment mostly preoperatively (RACS 100%, ANZCA 98% and CICM 78%), although P-POSSUM and ACS-NSQIP scores require intraoperative data (which can only be estimated crudely preoperatively by the clinician). Respondents on average 'somewhat agreed' that risk assessment scores should only include preoperative variables. The most common reasons for using P-POSSUM and ACS-NSQIP scores were familiarity and ease of use and availability of online/app calculators. The most important outcomes that the respondents would like to predict were quality of life and 30-day mortality rather than long-term impact from EL. These findings suggest that developing a new score may be required to improve utilisation and help in decision-making. This may require tailoring risk scores specifically for EL, and designing them to predict what is preferred by the clinicians making the decisions.

背景与目标： ：风险预测是​​急诊剖腹手术（EL）患者管理的重要组成部分。这项研究旨在调查EL风险预测分数的当前使用和未来发展方向。澳大利亚皇家外科学院（RACS）的新西兰成员，澳大利亚和新西兰麻醉师学院（ANZCA）和重症监护医学学院（CICM）的成员参加了一项匿名的在线调查。收到316位临床医生（45位RACS，253位ANZCA和19位CICM）的答复，其中73％的顾问经验超过10年。大约30％的EL案例中，受访者使用了风险评估分数。使用的最常见的EL风险评分是朴茨茅斯死亡率列举的生理和手术严重程度评分（P-POSSUM）和美国外科医生学院国家外科手术质量改善计划（ACS-NSQIP）。在使用时，尽管P-POSSUM和ACS-NSQIP评分需要术中数据（只能由术前粗略估计），但受访者大多在术前使用风险评估（RACS 100％，ANZCA 98％和CICM 78％）。受访者平均“有点同意”风险评估分数应仅包括术前变量。使用P-POSSUM和ACS-NSQIP分数的最常见原因是熟悉度，易用性以及在线/应用程序计算器的可用性。受访者希望预测的最重要结果是生活质量和30天死亡率，而不是EL的长期影响。这些发现表明，可能需要开发新的分数以提高利用率并帮助决策。这可能需要专门针对EL量身定制风险评分，并设计它们以预测临床医生在做出决定时的偏好。

BACKGROUND & AIMS: BACKGROUND:Fascial dehiscence (FD) occurs in up to 14.9% of high-risk patients undergoing emergency laparotomy. Although prophylactic mesh can prevent FD, its use in emergency operations remains controversial. STUDY DESIGN:A prospective randomized clinical trial was conducted at the Hospital das Clínicas from Faculdade de Medicina da Universidade de São Paulo in Brazil. It was performed among high-risk patients, defined according to Rotterdam risk model, undergoing midline emergency laparotomy. The patients were randomized into the suture group (SG), with slowly absorbable running sutures placed with a 36-mm-long needle at a suture-to-wound length ratio of 4:1, and the prophylactic mesh group (PMG), with fascial closure as in the SG but reinforced with onlay polypropylene mesh. The primary end point was incidence of FD at 30 days post operation. RESULTS:We analyzed 115 patients; 52 and 63 were allocated to the SG and PMG, respectively. In all, 77.4% of the cases were for colorectal resection. FD occurred in 7 (13.5%) patients in the SG and none in the PMG (p = 0.003). There was no difference between the groups in number of patients with surgical site occurrence (SSO) or SSO requiring procedural intervention. However, some specific SSOs had higher incidences in the mesh group: surgical site infection (20.6% versus 7.7%; p = 0.05), seroma (19.0% versus 5.8%; p = 0.03), and nonhealing incisional wound (23.8% versus 5.8%; p = 0.008). Of SSOs in the PMG and SG, 92.3% and 73.3%, respectively, resolved spontaneously or with bedside interventions. CONCLUSIONS:Prophylactic onlay mesh reinforcement in emergency laparotomy is safe and prevents FD. Surgical site infection, seroma, and nonhealing incisional wound were more common in the mesh group, but associated with low morbidity within 30 days post operation.

背景与目标： 背景：在进行急诊剖腹手术的高危患者中，发生开裂（FD）的发生率高达14.9％。尽管预防性网片可以预防FD，但其在紧急手术中的使用仍存在争议。
研究设计：前瞻性随机临床试验在巴西圣保罗大学医学院的dasClínicas医院进行。该手术是在根据鹿特丹风险模型定义的高危患者中线紧急剖腹手术中进行的。将患者随机分为缝合线组（SG），将可缓慢吸收的缝合线用36毫米长的针以4：1的缝合线与伤口的长度比例放置，而预防性网片组（PMG）如SG中的筋膜封闭，但用聚丙烯网覆盖。主要终点是术后30天的FD发生率。
结果：我们分析了115例患者。分别为SG和PMG分配了52和63。总共有77.4％的病例用于结直肠癌切除。 FD发生在SG的7名患者中（13.5％），而在PMG中没有发生（p = 0.003）。两组之间在手术部位发生（SSO）或需要手术干预的SSO患者之间没有差异。但是，网状组中一些特定的SSO发生率更高：手术部位感染（20.6％对7.7％; p = 0.05），血清肿（19.0％对5.8％; p = 0.03）和切开伤口不愈合（23.8％对5.8） ％； p ＝ 0.008）。在PMG和SG中，SSO分别自发地或在床旁干预下消退了，分别为92.3％和73.3％。
结论：在紧急剖腹手术中预防性铺网加固是安全的，可预防FD。网状组更常见手术部位感染，血清肿和切开伤口不愈合，但术后30天内发病率较低。

BACKGROUND & AIMS: BACKGROUND:In laparoscopic surgery, conversion to laparotomy is associated with worse clinical outcomes, especially if the conversion is due to a complication. Although apparently important, no commonly used definition of conversion exists. The aim of this study was to achieve multidisciplinary consensus on a uniform definition of conversion. METHODS:On the basis of definitions currently used in the literature, a web-based Delphi consensus study was conducted among members of all four Dutch endoscopic societies. The rate of agreement (RoA) was calculated; a RoA of >70% suggested consensus. RESULTS:The survey was completed by 268 respondents in the first Delphi round (response rate, 45.6%); 43% were general surgeons, 49% gynecologists, and 8% urologists. Average ± standard deviation laparoscopic experience was 12.5 ± 7.2 years. On the basis of the results of round 1, a consensus definition was compiled. Conversion to laparotomy is an intraoperative switch from a laparoscopic to an open abdominal approach that meets the criteria of one of the two subtypes: strategic conversion, a standard laparotomy that is made directly after the assessment of the feasibility of completing the procedure laparoscopically and because of anticipated operative difficulty or logistic considerations; and reactive conversion, the need for a laparotomy because of a complication or (extension of an incision) because of (anticipated) operative difficulty after a considerable amount of dissection (i.e., >15 min in time). A laparotomy after a diagnostic laparoscopy (i.e., to assess the curability of the disease) should not be considered a conversion. In the second Delphi round, a RoA of 90% was achieved with this definition. CONCLUSIONS:After two Delphi rounds, consensus on a uniform multidisciplinary definition of conversion was achieved within a representative group of general surgeons, gynecologists, and urologists. An unambiguous interpretation will result in a more reliable clinical registration of conversion and scientific evaluation of the feasibility of a laparoscopic procedure.

背景与目标： 背景：在腹腔镜手术中，转换为剖腹手术会导致较差的临床结果，尤其是如果转换是由于并发症引起的。尽管很重要，但不存在常用的转换定义。这项研究的目的是就统一的转换定义达成多学科共识。
方法：根据文献中当前使用的定义，在荷兰的四个内窥镜学会成员之间进行了基于网络的德尔菲共识研究。计算同意率（RoA）； RoA> 70％表示共识。
结果：该调查由268名受访者在第一轮德尔菲回合中完成（答复率为45.6％）；普通外科医师占43％，妇科医生占49％，泌尿科医师占8％。腹腔镜检查的平均±标准差为12.5±7.2年。根据第一轮的结果，编制了共识定义。转换为剖腹术是一种术中从腹腔镜手术转向开放腹腔手术的方法，符合两种亚型之一的标准：战略转换，一种标准的剖腹术，是在评估完成腹腔镜手术的可行性后立即进行的，并且由于预期的手术困难或后勤考虑；和反应性转换，由于并发症或（切口扩展）而需要进行剖腹手术，原因是在进行大量解剖后（即及时> 15分钟），由于（预期的）手术困难。诊断性腹腔镜检查（即评估疾病的可治愈性）后的剖腹手术不应视为转换。在第二轮德尔福回合中，使用此定义可以实现90％的RoA。
结论：经过两次德尔菲回合后，在一个由多名外科医生，妇科医生和泌尿科医师组成的代表小组中，就统一的多学科转换定义达成了共识。明确的解释将导致更可靠的临床转换注册，并对腹腔镜手术的可行性进行科学评估。

BACKGROUND & AIMS: BACKGROUND:The term 'emergency open abdominal surgery' covers a range of common procedures with high complication and mortality risks; however, previous studies have not included descriptive analyses of the patients undergoing the procedures. The aim of this study is to present a nationwide description of all patients who undergo an emergency bowel resection, ostomy placement or drainage involving laparotomy at Danish hospitals and to report the 30- and 365-day mortality risks. METHOD:We identified all of the patients in the Danish National Patient Register aged 18 + who underwent emergency open abdominal surgery in the form of a laparotomy during the period 2003-14. Using Poisson and logistic regression models, we analyzed incidence rates and mortality risk. RESULT:The sample consisted of 15,680 patients, with an overall open abdominal surgery incidence rate of 30.4 cases per 100,000 person-years. The 30-day mortality risk was 19.3% for both sexes, and increased with age (at 80-89, mortality risk was 39.4% for males and 34.5% for females). The 30-day mortality risk fell by 5.4% during the study period, from 22.2% to 16.7%. CONCLUSION:Open abdominal surgery is a common, high-risk procedure with a high incidence rate and mortality risk, especially for elderly patients. The incidence rate and mortality risk fell during the period studied. In Denmark, there is no standard post-discharge care program for patients who undergo emergency laparotomies. Our results support the need to investigate standardized post-operative follow-up and rehabilitation plans to reduce mortality.

背景与目标： 背景：“急诊开放性腹部手术”一词涵盖了一系列常见手术，具有很高的并发症和死亡风险；但是，以前的研究并未包括对接受手术的患者的描述性分析。这项研究的目的是对在丹麦医院进行了紧急肠切除，造口术或引流手术的所有患者进行全民描述，并报告30天和365天的死亡风险。
方法：我们在丹麦国家患者登记簿中确定了所有18岁以下的患者，这些患者在2003-14年期间以剖腹手术的形式接受了紧急的开放式腹部手术。使用泊松和逻辑回归模型，我们分析了发病率和死亡风险。
结果：该样本包括15680例患者，总体开放性腹部手术的发生率为每10万人年30.4例。男女的30天死亡风险为19.3％，并且随着年龄的增长而增加（在80-89岁时，男性的死亡风险为39.4％，女性为34.5％）。在研究期间，30天的死亡率降低了5.4％，从22.2％降低到16.7％。
结论：开腹手术是一种常见的高风险手术，具有较高的发病率和死亡风险，特别是对于老年患者。在研究期间，发病率和死亡风险下降。在丹麦，没有针对急诊剖腹手术的患者的标准出院后护理计划。我们的结果支持需要研究标准化的术后随访和康复计划以降低死亡率。

BACKGROUND & AIMS: :The use of negative pressure wound therapy (NPWT) for the treatment of wounds is not uncommon in modern health-care systems. However, use of NPWT as a wound prevention strategy, or 'well-wound therapy', is not so common. To date, papers that do discuss the use of NPWT in this way have focused mainly on orthopaedic and sternotomy wounds. This case study will present the use of NPWT with the goal of preventing laparotomy breakdown, utilising an innovative splinting technique.

背景与目标： ：在现代医疗保健系统中，使用负压伤口疗法（NPWT）来治疗伤口并不罕见。但是，使用NPWT作为伤口预防策略或“伤口治疗”并不那么普遍。迄今为止，确实讨论过以这种方式使用NPWT的论文主要集中在整形外科和胸骨切开术伤口上。本案例研究将介绍NPWT的使用，其目的是通过创新的夹板技术防止剖腹手术失败。

BACKGROUND & AIMS: BACKGROUND:Although patient-controlled analgesia for pain management after abdominal surgery is common, efforts to find alternative effective methods to control postoperative pain are continuing. The aim of this study was to compare postoperative pain levels following intermittent regional administration of bupivacaine via a catheter placed in the rectus sheath or subcutaneously at abdominal surgery through midline incisions. METHODS:Consecutive patients undergoing elective midline laparotomy were assigned randomly to a group with two catheters placed over the fascia (suprafascial group) before surgical wound closure or to a group with catheters placed between the two sheaths of each rectus muscle (interfascial group). Pain levels were determined every 12 h, both at rest and with movement, by means of a standard visual analogue scale (VAS) for 72 h after surgery. The amounts of administered opioid were recorded. RESULTS:Sixty patients were enrolled in the study (30 patients in each group).The median VAS score 36 h after surgery, both at rest and with movement, was significantly lower in the interfascial group than in the suprafascial group (P<0·050). Repeated-measures ANOVA also showed a significant difference in the postoperative VAS scores (P<0·007). The amount of self-administered morphine was significantly lower in the interfascial group, overall (P = 0·001) as well as on postoperative day 1 (P = 0·001) and day 2 (P = 0·016). Bowel sounds returned more quickly in the interfascial group (P = 0·040). CONCLUSION:Locoregional catheter administration of bupivacaine following midline laparotomy is more effective when the catheter is placed in the rectus sheath compared with suprafascial delivery. REGISTRATION NUMBER:IRCT138810142982N1 (http://www.irct.ir).

背景与目标： 背景：尽管腹部手术后通常采用患者自控镇痛以减轻疼痛，但仍在寻找替代的有效方法来控制术后疼痛的努力仍在继续。这项研究的目的是比较布比卡因通过放置在直肌鞘中的导管或通过中线切口在腹部手术中皮下进行间歇性局部给药后的术后疼痛水平。
方法：连续行择期中线剖腹手术的患者被随机分为两组，即在手术伤口闭合前在筋膜上放置两个导管的小组（修复组），或在每个直肌的两个鞘之间放置导管的小组（界面组）。术后72小时，通过标准视觉模拟量表（VAS）每12小时测定静止和运动时的疼痛水平。记录阿片类药物的给药量。
结果：该研究共纳入60例患者（每组30例）。无论是休息还是运动，手术后36 h的VAS评分中值均明显低于筋膜上组（P <0· 050）。重复测量的ANOVA也显示术后VAS评分存在显着差异（P <0·007）。筋膜间组，总体（P = 0·001）以及术后第1天（P = 0·001）和第2天（P = 0·016）的自用吗啡量均显着降低。跨界面组的肠鸣音恢复更快（P = 0·040）。
结论：中线剖腹手术后局部布比卡因导管的给药比经腹膜上分娩更有效。
注册号：IRCT138810142982N1（http://www.irct.ir）。

BACKGROUND & AIMS: INTRODUCTION:Pneumoperitoneum on chest radiograph (CXR) following abdominal stab wounds (SW) is generally considered as surrogate evidence of viscus perforation and an absolute indication for laparotomy. The exact yield of this radiographic finding is unknown. MATERIALS AND METHODS:A retrospective study was conducted on all patients who presented with abdominal SW with no peritoneal signs but had pneumoperitoneum alone who underwent mandatory laparotomy from December 2012 to October 2020 at a major trauma centre in South Africa. RESULTS:During the 8-year study period, 55 patients were included (91% male, mean age: 24 years). Laparotomy was positive in 67% (37/55). Of the 37 positive laparotomies, 28 (76%) were considered therapeutic and the remaining 9 (24%) were nontherapeutic. The negative laparotomy rate was 33%. A total of 52 organ injuries were identified at laparotomy in the 37 positive laparotomies. Twenty-five per cent (14/55) of patients experienced complications. The complication rate of the subgroup of 18 patients who had a negative laparotomy was 33% (6/18). Two per cent (1/55) of all 55 patients required intensive care admission. The mean length of hospital stay was 6 days. There were no mortalities in this cohort. CONCLUSIONS:Pneumoperitoneum alone in patients with no peritoneal signs on initial assessment following abdominal SW cannot be considered an absolute indication for operative exploration. Up to one third of patients have no intra-abdominal injuries. This specific subgroup of patients can potentially be managed by a selective non-operative management approach.

背景与目标： 简介：腹部刺伤（SW）后胸部X光片（CXR）气腹通常被认为是脏器穿孔的替代证据，是剖腹手术的绝对指征。射线照相结果的确切产量尚不清楚。
材料与方法：回顾性研究了2012年12月至2020年10月在南非一家主要创伤中心接受腹腔镜手术但无腹膜体征但仅进行气腹的患者。
结果：在为期8年的研究期内，纳入了55例患者（男性占91％，平均年龄：24岁）。开腹手术阳性率为67％（37/55）。在37例积极的腹腔镜手术中，有28例（76％）被认为是治疗性的，其余9例（24％）是非治疗性的。开腹手术阴性率为33％。在37例阳性剖腹手术中，在剖腹手术中共发现52例器官损伤。 25％（14/55）的患者出现并发症。剖腹手术阴性的18例患者亚组的并发症发生率为33％（6/18）。 55名患者中有2％（1/55）需要重症监护。平均住院时间为6天。在这个队列中没有人死亡。
结论：腹部SW术后初步评估时无腹膜体征的患者仅凭气腹不能视为手术探查的绝对指征。多达三分之一的患者没有腹腔内受伤。可以通过选择性的非手术管理方法来管理患者的这一特定亚组。

BACKGROUND & AIMS: :Because noninvasive methods like ultrasound scanning or computed tomography cannot detect small-volume residual tumor, second-look laparotomy has been recommended for evaluation of treatment response in ovarian cancer. The use of cancer antigen 125 to monitor the course of the disease during treatment is widely accepted. The tumor marker has prognostic value, but its ability to detect small volume of disease is limited. Second-look laparotomy appears to have a limited role in the management of ovarian cancer patients, especially in the context of ineffective second-line therapy.

背景与目标： ：由于无创方法（如超声扫描或计算机断层扫描）无法检测出小体积残留肿瘤，因此建议采用剖腹剖腹术来评估卵巢癌的治疗反应。在治疗期间使用癌症抗原125来监测疾病的过程已被广泛接受。肿瘤标志物具有预后价值，但其检测少量疾病的能力有限。剖腹手术似乎在卵巢癌患者的治疗中作用有限，尤其是在无效的二线治疗的情况下。

BACKGROUND & AIMS: :Intravenous fluid prescription is an essential part of postoperative care and may play a causal role in postoperative complications. The objective of the present study was to evaluate the relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of pediatric patients.This analysis included a retrospective review of 172 patients who underwent gastroenterological surgery from January 2012 to September 2018 at an academic tertiary care hospital. Patients were evaluated based on the median amount of corrected crystalloids and subsequently dichotomized as low (<25.89 mL/kg h) versus high (>25.89 mL/kg h). The primary outcome measure was the postoperative length of hospital stay (pLOS). Secondary outcome measures included the postoperative time to restore gastroenterological functions and postoperative complications.Patients who received larger amounts of crystalloids were more likely to have a lower intraoperative level of hemoglobin (P = .78) and an intraoperative blood transfusion (P = .27). There were trends toward lower incidence rates of hyperchloremic acidosis (P = .375) and metabolic acidosis (P = .54) in the high crystalloid administration cohort. The incidence of postoperative complications increased as the amount of administered fluid decreased (P = .046). The total length of hospital stay was shorter in patients who received high volumes of crystalloid fluid (19.5 [15.75-32.25] days) than in patients who received low volumes (22 [16-29.5] days, P = .283).Significant and multifaceted variability in crystalloid administration was noted among pediatric patients undergoing major surgery. High fluid administration was associated with favorable postoperative outcomes; these findings could be applied to improve patient safety and facilitate better quality of care.

背景与目标： ：静脉输液处方是术后护理的重要组成部分，可能在术后并发症中起因果作用。本研究的目的是评估大批儿科患者术中输注液体与术后结局之间的关系。该分析包括对2012年1月至2018年9月在学术三级医院接受胃肠外科手术的172例患者的回顾性回顾。医院。根据校正后的晶体的中位数评估患者，然后将其分为低（<25.89.mL/kg h）和高（> 25.89 mL / kg h）两类。主要结局指标是术后住院时间（pLOS）。次要结局指标包括术后恢复肠胃功能和术后并发症;接受较大量晶体的患者术中血红蛋白水平较低（P = .78）和术中输血（P = .27） 。在高晶状体给药人群中，高氯酸中毒（P = .375）和代谢性酸中毒（P = .54）的发生率有降低的趋势。术后并发症的发生率随输液量的减少而增加（P = .046）。接受大量晶体液（19.5 [15.75-32.25]天）的患者的总住院时间短于接受少量晶体液（22 [16-29.5]天，P = .283）的患者。在接受大手术的儿科患者中，晶体给药的多方面变异性被注意到。大量输液与良好的术后预后相关；这些发现可用于改善患者安全性并促进更好的护理质量。

BACKGROUND & AIMS: OBJECTIVE:To evaluate the short-term therapeutic outcome of myomectomy through conventional laparotomy in the treatment of uncomplicated uterine myomas compared with myomectomy through ultraminilaparotomy. DESIGN:Controlled, nonrandomized clinical study. SETTING:University-affiliated tertiary care referral center. PATIENT(S):One hundred thirteen patients with symptomatic and uncomplicated uterine myomas warranting surgical treatment, who expressed a strong desire to retain their uterus. Seventy-two patients underwent myomectomy by laparotomy and 41 by ultraminilaparotomy. INTERVENTION(S):Myomectomy through laparotomy or ultraminilaparotomy access. MAIN OUTCOME MEASURE(S):The outcome was measured by comparing blood loss, need for blood transfusion, operative time, postoperative febrile morbidity, time of flatus passage after operation, and postoperative pain (visual analogue scale score and anesthesia use) in both groups. RESULT(S):General characteristics of the patients were similar in both groups. There were no statistical differences in mean operative time, blood loss, febrile morbidity, insurance pay, and therapeutic efficacy (symptom relief) between the two groups. However, postoperative recovery seemed to be better and more rapid in the ultraminilaparotomy group compared with that in the laparotomy group, including rapid and early bowel movement, lower scores on the visual analogue scale, and shortened postoperative hospital stay. CONCLUSION(S):This study demonstrates the superiority of ultraminilaparotomy in treating uncomplicated uterine myomas, compared with laparotomy, during this 1-year short-term follow-up.

背景与目标： 目的：评估通过常规剖腹术进行子宫肌瘤切除术与单纯超小切口开腹术相比，在不并发症子宫肌瘤治疗中的短期治疗效果。
设计：受控的非随机临床研究。
单位：大学附属三级转诊中心。
患者：113例有症状且无并发症的子宫肌瘤，需要手术治疗，他们强烈希望保留子宫。 72例患者接受了剖腹术子宫切除术，41例接受了超小型开腹术。
干预：通过剖腹术或超小型开腹术进行子宫肌瘤切除术。
主要观察指标：通过比较两组的失血量，输血需求，手术时间，术后发热性发病率，术后肠胃气胀通过时间以及术后疼痛（视觉模拟量表评分和麻醉使用）来衡量结果。
结果：两组患者的总体特征相似。两组之间的平均手术时间，失血量，高热发病率，保险费和治疗效果（症状缓解）无统计学差异。然而，与剖腹手术组相比，超小型开腹手术组的术后恢复似乎更好，更快，包括快速和早期排便，视觉模拟量表评分较低以及术后住院时间缩短。
结论：该研究表明，在此为期1年的短期随访中，超小切口开腹术与开腹手术相比，在治疗无并发症的子宫肌瘤方面具有优势。

BACKGROUND & AIMS: PURPOSE:In peritoneal metastasis condition, the fact that most of the disease is limited to the peritoneal cavity laid the foundations for a surgical treatment, including intraperitoneal hyperthermic chemotherapy (HIPEC). The aim of this study was to evaluate the impact of the surgical procedures implied in open HIPEC technique, referred to laparotomy procedures followed by an intraperitoneal hyperthermic instillation (LIHI) on oxaliplatin tissue distribution and elimination. To delimit the influence of this procedure alone, oxaliplatin was administered as an intravenous (iv) bolus in both groups. METHODS:An experimental model in Wistar rats was employed, and LIHI was evaluated as a dichotomous covariate by using a population pharmacokinetic (PK) approach. Rats were randomized in two groups receiving 1.5 mg iv oxaliplatin alone or 1.5 mg iv oxaliplatin under LIHI conditions, carrying out a hyperthermic 5% dextrose instillation. The oxaliplatin plasma concentrations were characterized by an open two-compartment PK model. RESULTS:Results concluded that surgical conditions affect the oxaliplatin elimination and distribution from blood to peripheral tissues, increasing the systemic drug exposure. Concretely, oxaliplatin peripheral volume of distribution, and clearance decreased by 48.6% and 55.3%, respectively, compared to the control group that resulted in a two-fold increase of the area under the concentration time curve. CONCLUSIONS:Comparison in clinical practice of oxaliplatin PK parameters obtained after iv administrations with those obtained after HIPEC interventions must be done carefully. This would limit the use of iv PK parameters to simulate new scenarios for oxaliplatin in HIPEC.

背景与目标： 目的：在腹膜转移情况下，大多数疾病仅限于腹膜腔这一事实为包括腹膜内高温化学疗法（HIPEC）在内的外科治疗奠定了基础。这项研究的目的是评估开放式HIPEC技术所隐含的外科手术方法的影响，即开腹手术后腹膜内热滴注（LIHI）对奥沙利铂组织分布和消除的影响。为了单独限定该程序的影响，奥沙利铂以静脉内（iv）推注方式在两组中给药。
方法：采用Wistar大鼠实验模型，采用群体药代动力学（PK）方法将LIHI评估为二分协变量。在LIHI条件下，将大鼠随机分为两组，分别接受1.5 mg iv奥沙利铂或1.5 mg iv奥沙利铂，进行5％温热葡萄糖滴注。奥沙利铂血浆浓度由开放的两室PK模型表征。
结果：结果表明，手术条件影响奥沙利铂从血液到周围组织的清除和分布，增加了全身性药物暴露。具体而言，与对照组相比，奥沙利铂的外围分布体积和清除率分别降低了48.6％和55.3％，这导致浓度时间曲线下的面积增加了两倍。
结论：静脉给药后获得的奥沙利铂PK参数与HIPEC干预后获得的PK参数的临床实践比较必须谨慎。这将限制使用iv PK参数来模拟HIPEC中奥沙利铂的新方案。

BACKGROUND & AIMS: BACKGROUND:Emergency conditions requiring exploratory laparotomy (EL) can be challenging. The objective of this study is to describe indications, outcomes, and risk factors for perioperative mortality (POMR) after non-trauma EL. METHODS:This was a prospective study of patients undergoing non-trauma EL at four hospitals in Rwanda, South Africa, and the USA. Multivariate logistic regression was used to determine factors associated with POMR. RESULTS:Over one year, there were 632 EL with the most common indications appendicitis (n = 133, 21%), peptic ulcer disease (PUD) (n = 101, 16%), and hernia (n = 74, 12%). In Rwanda, the most common indications were appendicitis (n = 41, 19%) and hernia (n = 37, 17%); in South Africa appendicitis (n = 91, 28%) and PUD (n = 60, 19%); and in the USA, PUD (n = 16, 19%) and adhesions from small bowel obstruction (n = 16, 19%). POMR was 11%, with no difference between countries (Rwanda 7%, South Africa 12%, US 16%, p = 0.173). Risk factors associated with increased odds of POMR included typhoid intestinal perforation (adjusted odds ratio (aOR): 16.48; 95% confidence interval (CI): 4.31, 62.98; p value < 0.001), mesenteric ischemia (aOR: 13.77, 95% CI: 4.21, 45.08, p value < 0.001), cancer (aOR: 5.84, 95% CI: 2.43, 14.05, p value < 0.001), other diagnoses (aOR: 3.97, 95% CI: 3.03, 5.20, p value < 0.001), high ASA score (score ≥ 3) (aOR: 3.95, 95% CI: 3.03, 5.15, p value < 0.001), peptic ulcer disease (aOR: 2.82, 95% CI: 1.64, 4.85, p value < 0.001), age > 60 years (aOR: 2.32, 95% CI: 1.41, 3.83, p value = 0.001), and ICU admission (aOR: 2.23, 95% CI: 1.24, 3.99, p value = 0.007). Surgery in the US was associated with decreased odds of POMR (aOR: 0.41, 95% CI: 0.21, 0.80, p value = 0.009). CONCLUSIONS:Indications for EL vary between countries and POMR is high. Differences in mortality were associated with patient and disease characteristics with certain diagnoses associated with increased risk of mortality. Understanding the risk factors and outcomes for patients with EL can assist providers in judicious patient selection, both for patient counselling and resource allocation.

背景与目标： 背景：需要探索性剖腹术（EL）的紧急情况可能具有挑战性。这项研究的目的是描述非创伤性EL后围手术期死亡率（POMR）的适应症，结果和危险因素。
方法：这是一项对在卢旺达，南非和美国的四家医院接受非创伤性EL治疗的患者进行的前瞻性研究。多元logistic回归用于确定与POMR相关的因素。
结果：一年多来，有632例EL最常见的适应症是阑尾炎（n = 133，21％），消化性溃疡疾病（PUD）（n = 101，16％）和疝气（n = 74，12％） 。在卢旺达，最常见的适应症是阑尾炎（n = 41，19％）和疝气（n = 37，17％）。在南非的阑尾炎（n = 91，28％）和PUD（n = 60，19％）;在美国，PUD（n = 16，19％）和小肠梗阻引起的粘连（n = 16，19％）。 POMR为11％，国家之间无差异（卢旺达7％，南非12％，美国16％，p = 0.173）。与POMR几率增加相关的危险因素包括伤寒肠穿孔（调整后的比值比（aOR）：16.48; 95％置信区间（CI）：4.31，62.98; p值<0.001），肠系膜缺血（aOR：13.77，95％CI ：4.21，45.08，p值<< 0.001），癌症（aOR：5.84，95％CI：2.43，14.05，p值<< 0.001），其他诊断（aOR：3.97，95％CI：3.03，5.20，p值<< 0.001 ），高ASA评分（得分≥3）（aOR：3.95，95％CI：3.03，5.15，p值<< 0.001），消化性溃疡病（aOR：2.82，95％CI：1.64，4.85，p值<< 0.001） ，年龄> 60岁（aOR：2.32，95％CI：1.41，3.83，p值== 0.001），和ICU入院（aOR：2.23，95％CI：1.24，3.99，p值= 0.007）。在美国，手术与降低POMR几率相关（aOR：0.41，95％CI：0.21、0.80，p值== 0.009）。
结论：各国的EL指征不同，POMR较高。死亡率差异与患者和疾病特征有关，某些诊断与死亡风险增加有关。了解EL患者的危险因素和结果可帮助提供者明智地选择患者，包括患者咨询和资源分配。

BACKGROUND & AIMS: Experience with staging laparotomy in twenty-one children has produced minimal immediate postoperative morbidity. Sepsis in two patients after discharge has prompted the long-term use of penicillin. Confirmation or revision of clinical staging by laparotomy has proved to be an accurate means of determining therapy and prognosis in children.

背景与目标： 在21名儿童中进行剖腹手术的经验使术后的立即发病率降至最低。两名出院后败血症促使长期使用青霉素。经剖腹术证实或修订临床分期被证明是确定儿童治疗和预后的准确方法。

BACKGROUND & AIMS: :Uterus transplantation (UTx) is the first available treatment for absolute uterine factor infertility, a condition due to absence of the uterus or presence of a non-functional uterus. The proof-of-concept of UTx as an infertility treatment for this group of patients occurred in 2014 in Sweden by the first birth after human UTx. That and subsequent cases of the Swedish trial were live-donor UTx procedures with laparotomy of both donor and recipient. Although results of the initial Swedish clinical UTx trial were very favorable in terms of take-home-baby rate, the drawback was the long duration (>10 h) of donor surgeries and associated long recovery periods. There exist three later publications, with uterus procurements from live donors by laparotomy with a range of surgical durations of 5.3 hours to 13 hours. Our collaborative Swedish-French team has initiated efforts to introduce minimal invasive surgery in one trial in Sweden and one in France. The principle of these UTx trials is to use modern concepts of robotic-assisted laparoscopy primarily in the live donor. There also exists a small number of published UTx procedures with donor surgery by partial conventional laparoscopy and one published case with total robotic-assisted laparoscopy procedure. This review discusses open versus minimal invasive surgery in relation to the accumulated knowledge in the field. Moreover, we propose some future directions for the development of this surgery in UTx.

背景与目标： ：子宫移植（UTx）是第一种可用于绝对子宫因素不育的治疗方法，子宫绝对不育是由于子宫不存在或无功能性子宫而引起的疾病。 UTx作为这一组患者的不育治疗方法的概念验证于2014年在瑞典于人类UTx出生后第一胎诞生。瑞典试验的该案及后续案件均为活体供体UTx手术，供体和接受者均行剖腹手术。尽管最初的瑞典临床UTx试验结果在带回家率方面非常有利，但缺点是捐助者手术的持续时间较长（> 10小时），并且恢复期较长。后来有三本出版物，通过剖腹手术从活体捐献者那里获得子宫，手术时间为5.3小时至13小时。我们的瑞典－法国合作团队已开始努力，在瑞典的一项试验和法国的一项试验中引入微创手术。这些UTx试验的原理是主要在活体供体中使用机器人辅助腹腔镜检查的现代概念。还存在少数已公开的通过部分常规腹腔镜进行供体手术的UTx手术，以及一个已发表的采用全机器人辅助腹腔镜手术的病例。这篇综述讨论了与该领域积累的知识有关的开放式与微创手术。此外，我们为UTx手术的发展提出了一些未来的方向。

BACKGROUND & AIMS: INTRODUCTION:The complications of surgical wound closure in patients with risk factors significantly increases morbidity and mortality. The aim of the present study was to evaluate differences in abdominal wall closure in patients with risk factors with the same closure technique and slow-absorbable or non-absorbable sutures. MATERIAL AND METHODS:We performed a prospective, multicenter, comparative study of polydioxanone versus nylon sutures. Laparotomies performed for intestinal diseases and hepatobiliopancreatic procedures in patients with at least one risk factor were included. Exclusions criteria were eventrations, interventions for obesity, the need for reinforcement sutures, uncommon incisions, life expectancy of less than 1.5 years and deaths unrelated to the wound. Closure was performed with monoplane, extracutaneous, continuous, en bloc, loop sutures. Infection, evisceration, dehiscence, extrusion, sinus, eventration, intolerance, and pain were evaluated. Postoperative follow-up was performed at 10 and 30 days, 3 and 6 months, and at 1 and 1.5 years. RESULTS:A total of 770 patients were included (451 in the polydioxanone group and 319 in the nylon group). A total of 78.05% were midline incisions, with a mean length of 23.3 cm. Caliber 1 sutures were most frequently used (85.45%), and 1.7 sutures were used per patient. No complications occurred in 94.03% with no differences between groups (94.7% polydioxanone and 93.1% nylon). The results were similar throughout follow-up. The surgical infection rate was 10%. No differences were found in any of the follow-up assessments in any of the variables analyzed. CONCLUSIONS:Abdominal wall closure should be performed with continuous slow-absorption sutures such as polydioxanone since this type of suture has a similar complication rate to reabsorbable sutures and presents greater biocompatibility.

背景与目标： 简介：具有危险因素的患者手术伤口闭合的并发症显着增加了发病率和死亡率。本研究的目的是评估使用相同的闭合技术和慢吸收性或非吸收性缝合线的具有危险因素的患者的腹壁闭合性的差异。
材料与方法：我们对聚二氧杂环己酮和尼龙缝线进行了前瞻性，多中心，对比研究。包括对患有至少一种危险因素的患者进行的肠道疾病剖腹手术和肝胆胰手术。排除标准为：事件，肥胖症干预，需要加强缝合，切口不常见，预期寿命不到1.5年以及与伤口无关的死亡。用单平面，皮外，连续，整体，环形缝线进行闭合。评估感染，内脏脱落，裂开，挤压，鼻窦，事件，不宽容和疼痛。术后随访分别在10天和30天，3天和6个月以及1年和1.5年进行。
结果：共纳入770例患者（聚二恶烷酮组451例，尼龙组319例）。中线切口总数为78.05％，平均长度为23.3厘米。口径1的缝合线最常用（85.45％），每位患者使用1.7根缝合线。 94.03％的患者无并发症发生，各组之间无差异（94.7％的聚二恶烷酮和93.1％的尼龙）。整个随访结果相似。手术感染率为10％。在任何后续评估中，所分析的任何变量均未发现差异。
结论：应使用连续缓慢吸收的缝合线（例如聚二恶烷酮）进行腹壁封闭，因为这种缝合线的并发症发生率与可吸收缝合线相似，并且具有更大的生物相容性。