Salomone Di Saverio

Cambridge University Hospitals NHS Foundation Trust · Department of Surgery (Addenbrooke)

Background Ideal surgical treatment for acute duodenal injuries should offer a definitive treatment, with low morbidity and mortality. It should be simple and easily reproducible by acute care surgeons in an emergency. Duodenal injury, due to major perforated or bleeding peptic ulcers or iatrogenic/traumatic perforation, represents a surgical chal...

Laparoscopy is increasingly being used for trauma patients. This study demonstrates how this technique is safe and feasible in selected patients for both diagnostic and therapeutic purposes. However, these results need to be correlated with the level of the center and the expertise of the surgeon. Indications, procedures and techniques are provided...

This video very well details and discusses the difficulties of laparoscopic suturing for intracorporeal anastomoses in colorectal surgery. It proposes a nice modification in order to better align sutures and better offset the limitations of rigid laparoscopic instrumentation. It is associated with a text under submission for publication in the jour...

A 59-year-old hemodynamically stable female is admitted following a domestic fall with blunt left sided thoraco-abdominal trauma. She lived alone and had multiple comorbidities including hepatitis C virus positive splenomegaly, chronic psychosis with a history of opioid and alcohol abuse. A CT-scan of thorax and abdomen with IV contrast showed left...

A 73 years-old gentleman presented to ED complaining of colicky abdominal pain and subacute bowel obstruction with nausea and unable to pass stools for a couple of days. Abdomen was distended, painful at deep palpation, with no guarding. AXR showed colonic distension of the right and proximal transverse colon. Left colonic section was not visible.

There is no consensus regarding the definition of acute nonspecific abdominal pain (NSAP); however, it accounts for 5–10% of all admissions to the emergency department (ED). The underlying conditions of NSAP comprise a spectrum of undiagnosed conditions, both somatic and functional, but its diagnosis remains a “diagnosis of exclusion.” In general,...

Despite the increasing trend in liver resections for non-colorectal non-neuroendocrine liver metastases (NCNNLM), the role of surgery for these liver malignancies is still debated. Registries are an essential, reliable tool for assessing epidemiology, diagnosis, and therapeutic approach in a single hub, especially when data are dispersive and incon...

Emergency Resuscitative Thoracotomy (ERT) is a lifesaving procedure in selected patients. Outcome mostly in blunt trauma is believed to be poor. The primary aim of this study was to determine the predictors of postoperative mortality following ERT. We retrospectively reviewed 34 patients ≥ 18 years who underwent ERT at San Camillo—Forlanini Hospita...

The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons’ practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants’ demographics and, 27 questions about their clinical practice. B...

Appendiceal adenocarcinoma was first described by Berger in 1882 [1], whereas a tumor arising from neuroendocrine cells [neuroendocrine tumors (NETs)] was reported by Masson in 1928 [2]. Primary appendiceal tumors (ATs) are rare entities, occurring in <2% of all appendectomies, with an age-adjusted incidence of 0.12 cases per million people per yea...

Purpose Emergency treatment of acute diverticulitis remains a hazy field. Despite a number of clinical studies, randomized controlled trials (RCTs), guidelines and surgical societies recommendations, the most critical hot topics have yet to be addressed. Methods Literature research from 1963 until today was performed. Data regarding the principal...

BACKGROUND: The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during th...

Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive su...

Background Sigmoid Volvulus is the consequence of the rotation of the superior mesosigmoid. Initial management in patients without signs of peritoneal irritation is endoscopic devolvulation with a flexible colonoscope. Laparoscopic sigmoidectomy with primary anastomosis after colonoscopy is a feasible procedure. It has shown reduction in morbidity...

Importance: Considering the lack of equipoise regarding the timing of cholecystectomy in patients with moderately severe and severe acute biliary pancreatitis (ABP), it is critical to assess this issue. Objective: To assess the outcomes of early cholecystectomy (EC) in patients with moderately severe and severe ABP. Design, settings, and partic...

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 bo...

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 bo...

Background Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. Methods A bibliographic search using major databases was performed using the terms “emergency surgery” “diaphragmatic hernia,” “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia.” GR...

Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues require...

Objective: To generate an up-to-date bundle to manage acute biliary pancreatitis using an evidence-based, artificial intelligence (AI)-assisted GRADE method. Summary background data: A care bundle is a set of core elements of care that are distilled from the most solid evidence-based practice guidelines and recommendations. Methods: The resear...

We would like to thank our colleagues for their interest in our work (1). They rightly mentioned that there is a discrepancy in the evaluation of guidelines in recently published paper (2). However, this topic is discussed in detail in our manuscript and we make particular reference to this in the discussion

Many countries are facing an aging population. As people live longer, surgeons face the prospect of operating on increasingly older patients. Traditional teaching is that with older age, these patients face an increased risk of mortality and morbidity, even to a level deemed too prohibitive for surgery. However, this is not always true. An active 9...

Lower gastrointestinal (GI) bleeding occurs from lesions distal to the ligament of Treitz and poses a huge burden on healthcare systems worldwide. It results in significant morbidity, but its mortality is low and usually in patients with advanced age and multiple co-morbidities. Initial assessment should focus on history, examination, assessment of...

Acute appendicitis (AA) is one of the most common causes of lower abdominal pain and admissions to the emergency department. Ninety percent of AA occurs in children and young adults. However, recent statistics have shown that AA accounts for 15% of all emergency room visits for acute abdominal pain in patients over 60 years of age. AA is burdened b...

Background This study aimed to compare the short- and long-term outcomes of robotic (RRC-IA) versus laparoscopic (LRC-IA) right colectomy with intracorporeal anastomosis using a propensity score matching (PSM) analysis based on a large European multicentric cohort of patients with nonmetastatic right colon cancer.Methods Elective curative-intent RR...

Background: The treatment of the primary tumour in colorectal cancer with unresectable liver and/or lung metastases but no peritoneal carcinomatosis is still a matter of debate. In the absence of clear evidence and guidelines, our survey was aimed at obtaining a snapshot of the current attitudes and the rationales for the choice of offering resect...

Sigmoid volvulus is a common surgical emergency, especially in elderly patients. Patients can present with a wide range of clinical states: from asymptomatic, to frank peritonitis secondary to colonic perforation. These patients generally need urgent treatment, be it endoscopic decompression of the colon or an upfront colectomy. The World Society o...

Background Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option...

Purpose Hemorrhoidal disease (HD) is a common condition, and several surgical techniques have been proposed to date without being able to achieve definitive consensus on their use and indications. Laser hemorrhoidoplasty (LHP) is a minimally invasive procedure for HD treatment determining the shrinkage of the hemorrhoidal piles by diode laser limit...

Background: There are no specific recommendations regarding optimal management of this group of patients. The WSES suggested a non-operative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or w...

Background Less invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative...

The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult pa...

The greatest advantages of laparoscopy, when compared to open surgery, are already recognized: less post-operative pain, faster and better postoperative recovery, shorter hospital stay, earlier discharge, and earlier return to normal daily, activity, such as physical exercise, and cost of the hospital stay. Nevertheless, laparoscopy today represent...

Background: Haemorrhoids are a very common disease and many professional societies have produced guidelines for their treatment. The aim of this study is to appraise the quality of the existing guidelines in the management of haemorrhoids. Methods: A systematic search of the literature was conducted in the EMBASE, Google Scholar, Cochrane library,...

Background This meta-analysis aims to compare morbidity, mortality, oncological safety, and survival outcomes after laparoscopic multi-visceral resection (MVR) of the locally advanced primary colorectal cancer (CRC) compared with open surgery. Materials and methods A systematic search of multiple electronic data sources was conducted, and all stud...

· Background: Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic opt...

Dear Colleague, The ACIE (Association of Italian Surgeons in Europe) is launching this 2-step survey to get a snapshot of the work conditions of the general surgeons worldwide during the on-call shift to detect differences, strengths and limitations among different national health systems. The baseline data obtained will help us to inform future im...

Purpose This study aimed to assess the prevalence and progression of lower urinary tract symptoms following laparoscopic surgery for deep-infiltrating endometriosis of the rectosigmoid and identify preoperative factors associated with worse postoperative outcomes. Methods Prospective, observational study. Settings: single-center, referral hospital...

Introduction: The burden of rectal cancer in the elderly population continues to increase. The aim of this narrative review is to assess evidence updates on the management of elderly patients with rectal cancer. Evidence acquisition: The subject of rectal cancer in patients ≥70 years old was divided into different topics and, based on the resear...

Background Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinio...

Background Frailty is associated with poor post-operative outcomes in emergency surgical patients. Shared multidisciplinary models have been developed to provide a holistic, reactive model of care to improve outcomes for older people living with frailty. We aimed to describe current perioperative practices, and surgeons’ awareness and perception of...

In recent years, the issue of source control in septic patients has been debated and discussed both in guidelines and randomized trials. Source control may include drainage of an abscess, debriding infected necrotic tissue, removal of a potentially infected device, or definitive control of a source of ongoing microbial contamination. The timing and...

Background: The risk of conversion to open surgery is inevitably present during any minimally invasive colorectal surgical procedure. Conversions have been associated with adverse postoperative and oncologic outcomes. No previous study has evaluated the specific causes and consequences of conversion during a minimally invasive right colectomy (MIS-...

Aim: The choice to perform protective ileostomy (PI) after anterior resection (AR) is mainly guided by risk factors (RFs) responsible for anastomotic leakage (AL) development. However, clear guidelines about PI creation are still lacking in the literature and this is often decided according to the surgeon's preferences, experiences, or feelings. T...

Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods: Data were prospectively c...

BackgroundLess invasive alternatives than Early Cholecystectomy (EC) for Acute Calculous Cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-Risk score in predicting postoperative c...

Background Less invasive alternatives than Early Cholecystectomy (EC) for Acute Calculous Cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-Risk score in predicting postoperative...

This article was updated to correct Alessandro Montedori’s name. Collaborative authorship: The GAP Consortium: Yasser Sami Abdel Dayem, Luca Bertolaccini, Pablo Alonso-Coello, Elie Akl, Manish Chand, John J. Como, Gert J. de Borst, Salomone Di Saverio, Sameh Emile, Bang Wool Eom, Ramon Gorter, George Hanna, Kaisa Immonen, Quirino Lai, Nicolaas Lum...

Following publication of the original article [1], the co-author “Nikolaos Pararas” has misspelled wrongly as “Nikolaos Parasas”. The original article has been corrected.

Background/objectives: Reports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines.

Introduction: Splenic injuries are one of the commonest occurrences in abdominal trauma. Nonoperative management (NOM) is the treatment of choice in hemodynamically stable patients with low grade injuries in the absence of vascular injury on CT; however, in some cases, NOM can fail and surgery is required. Traditionally, splenectomy is performed v...

Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical...

Background Frailty is associated with poor post-operative outcomes in emergency surgical patients. Shared multidisciplinary models have been developed to provide a holistic, reactive model of care to improve outcomes for older people living with frailty. We aimed to describe current perioperative practices, and surgeons’ awareness and perception of...

Background In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved. Methods Using a modified Delphi method, we sought to explore ongoing areas of contro...

ABSTRACT Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors, thought to arise from the interstitial cells of Cajal. Almost all GISTs have1mutations in the oncogenic tyrosine protein kinase KIT or platelet-derived growth factor receptor-alfa. GISTs are mostly formed in the stomach and the small intestine. GISTs are often asymptomatic, bu...

Background Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complicat...

Introduction Aim of this manuscript is to illustrate a new method permitting total cholecystectomy in terms of safety with respect to the CBD. Methods The core of this new technique is the identification of the continuity of the cystic duct with the infundibulum. The cystic duct is identified between internal gallbladder wall and external inflamed...

Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontr...

The liver is the second most commonly solid organ injured in blunt abdominal trauma. Liver injuries are classified according to the American Association for the Surgery of Trauma Injury Scale. The choice of Non-Operative Management is based on generalized clinical patients' conditions combined with the evidence on CT scan imaging. To date, there ar...

Background Peptic ulcer perforation is a common surgical emergency and a major cause of death especially in elderly patients, despite the fact of the presence of effective drug treatments and an increased understanding of its etiology. Giant duodenal perforations, in particular, pose a significant challenge and there is scarce data regarding their...

Background Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. “Temporary” colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy foll...

Objectif La chirurgie minimale-invasive est couramment utilisée pour la résection du cancer du côlon droit. Cette étude a pour objectif de comparer les résultats à court et à long terme de la colectomie droite avec anastomose intracorporelle robotique (RRC-IA) vs laparoscopique (LRC-IA). Méthodes Sur la base de données européenne du Minimally inva...

Background/objectives: Reports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines.