Kultanaruangnonth et al. recently reported a well-conducted double-blind randomized trial comparing intraoperative irrigation with 0.05
During the multidisciplinary Definitive Surgical and Anesthetic Trauma Care (DSATC) course, trauma specialists are trained to apply damage control principles to polytrauma patients. The course was redesigned in 2020 from a three-day, traditional format to a restructured two-day format combining online and traditional learning methods to enhance course quality and learning outcomes. Considering that learning opportunities on the work floor are scarce, continuous course evaluation is crucial to ensure benefits for medical professionals and their patients. This retrospective non-inferiority study compared self-assessed confidence in technical and non-technical skills between a cohort in the traditional DSATC course and a cohort in the redesigned DSATC course. Self-assessed confidence ratings were collected through quantitative pre-course and post-course questionnaires. Mean changes in confidence ratings were calculated and compared using independent samples t-tests with a non-inferiority margin of -0.5. Sub-analyses investigated differences between participants of the same profession, between physicians with different levels of experience, and the influence of individual preparation on self-assessed confidence in skills before on-site training. A total of 180 (21
Adhesions are a common complication following surgery, and they can cause significant morbidity. However, adhesions are not easily diagnosed with imaging, and often only become apparent when they cause intestinal obstruction symptoms. The pathophysiology of adhesion formation is complex, thus despite advances in surgical techniques and postoperative care, adhesions remain a persistent problem in clinical practice. Despite evidence for efficacy of some strategies in reducing adhesion formation question remain regarding the indications and impact on clinically relevant outcomes. The paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a thorough examination of the pathophysiological mechanisms underlying adhesion formation and assess the efficacy of existing preventive strategies to guide future research and clinical practice in the management of adhesions. Study design and Framework This position paper was developed in accordance with the World Society of Emergency Surgery (WSES) methodology for consensus-based guidelines. The objective was to synthesize current evidence on adhesion pathophysiology and translate it into a clinically applicable "Narrative". Expert Panel Selection and Composition: The expert panel was composed of international specialists in general, trauma, and emergency surgery. Experts were selected based on their clinical leadership and academic contributions to the fields of peritoneal surgery and postoperative complication management. The panel included senior representatives from major surgical departments in Singapore (Sengkang and Singapore General Hospital), The Netherlands (Radboud University), and Italy (University of Bologna and Bufalini Hospital). Literature Search and Evidence Synthesis: A comprehensive search was conducted across major medical databases (e.g., PubMed, Scopus, Cochrane Library) to identify literature concerning the pathophysiology and prevention of adhesions. The search strategy employed Medical Subject Headings (MeSH) descriptors and keywords including: "peritoneal adhesions," "postoperative adhesions," "adhesion prevention," "adhesion barriers," "carboxymethylcellulose," "hyaluronic acid," "icodextrin," "oxidized regenerated cellulose," "polyethylene glycol," "adhesive small bowel obstruction," "adhesiolysis". No language restrictions were applied to the search strategy. A total of 56 studies were selected, including systematic reviews, meta-analyses, randomized clinical trials (RCTs), and retrospective cohort studies. The panel focused on clinically relevant outcomes, specifically looking for evidence that connected interventions to reduced rates of adhesive small bowel obstruction (ASBO) and reoperation. Studies were screened based on their ability to address three specific pillars: surgical approach (MIS vs. Open), technical manoeuvres (haemostasis and tissue handling), and the use of mechanical or chemical adjuncts. Consensus Achievement and Formulation: The recommendations were developed through a structured, iterative revision process: Literature Synthesis: Lead authors performed the primary review and drafted the pathophysiological and preventative sections. Internal Peer Review: The manuscript underwent rigorous revision by the international expert panel to reach a consensus on the position statements. Final Validation: All authors reviewed and approved the final manuscript and the resulting "Bundle" recommendations to ensure they were supported by the cited data. A total of 56 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been included in this paper to be discussed. Surgical techniques, as well as chemical and mechanical barriers were discussed in depth in this paper to come up with the recommendation. The WSES expert panel suggests the following bundle to reduce postoperative peritoneal adhesions: Bundle 1: Whenever possible, opt for minimally invasive surgery (MIS) or laparoscopic procedures. Bundle 2: Good surgical techniques. Bundle 3: Utilise barriers.
A recent meta-analysis by Fanchulli et al. concluded that cholecystectomy (CC) is associated with lower mortality and readmission than percutaneous cholecystostomy (PC) for acute cholecystitis, but this interpretation is limited by confounding by indication to management. The pooled evidence in this article consists predominantly of observational cohorts where crude or minimally adjusted comparisons are vulnerable to case-mix imbalance; even the CHOCOLATE randomised trial, which supports laparoscopic cholecystectomy in selected high-risk but eligible patients (ASA III–IV, age ≥ 70 or comorbidity, excluding peritonitis/septic shock), does not validate interchangeability across the broader PC and CC populations synthesised in unadjusted meta-analyses. Future evidence synthesis should prioritise adjusted estimates, stratification by Tokyo severity/ASA class, and, where feasible, individual participant data meta-analysis; clinically, CC remains preferred for appropriate surgical candidates, whereas PC should be reserved as a bridge or salvage strategy in selected high-risk patients.
Abstract Introduction Malignant gastric outlet obstruction is the consequence of advanced cancer resulting in mechanical obstruction to gastric emptying. Traditionally, surgical bypass (GJ) is performed and is known for its durability but also for its high morbidity. In contrast, endoscopic stenting (ES) is less invasive option but carries a notable risk of stent dysfunction and the need for subsequent reinterventions. These patients usually have limited life expectancy with reduced quality of life. The aim of this study is to review the different treatment options and compare their safety and efficacy. Method We performed a systematic review and meta-analysis comparing GJ to ES for malignant gastric outlet obstruction (mGOO). Comprehensive search of electronic databases between January 2001 and December 2022 was performed to identify relevant studies. The primary outcomes assessed were length of stay, reintervention rate, procedure-related complications and secondary outcome was mortality. Results 32 articles were abstracted in this meta-analysis with a total of 3296 patients. The re-intervention pooled risk ratio was 0.34 (95% CI 0.22, 0.52), indicating the risk of reintervention was lower among patients who underwent GJ. However, the results were comparable between ES and GJ for procedure-related complications and mortality. The length of stay was higher among those who underwent GJ, with a weighted mean difference of 11.2 days (95% CI 4.4, 18.1). Conclusion GJ bypass was associated with lower risk of re-intervention and comparable mortality and procedure-related complications compared to ES in patients with malignant gastric outlet obstruction, despite also being associated with longer length of stay.
Small bowel obstruction (SBO) is a common surgical emergency, most often caused by adhesions, whereas congenital peritoneal bands (CPBs) represent a rare etiology in adults. Limited contemporary data exist, with most adult series reporting fewer than ten cases. This study describes seven adult patients treated for CPB-related SBO and compares their characteristics and outcomes with those in the literature. A retrospective review was conducted of adult patients presenting with SBO due to congenital bands at a single tertiary center between 2010 and 2022. Inclusion criteria were age ≥ 18 years, imaging-confirmed SBO, intraoperative confirmation of a congenital band, and a virgin abdomen. Clinical, radiologic, and operative data were collected. A narrative review of the literature was performed for comparison. Seven of 269 SBO admissions (2.6
Traumatic axillosubclavian arterial injuries are rare but associated with high morbidity and mortality. Endovascular repair (ER) has emerged as an alternative to open surgery (OS), yet comparative outcome data remain inconsistent. This systematic review and meta-analysis compared short-term outcomes of ER versus OS for these injuries. This study followed PRISMA guidelines and was registered in PROSPERO (CRD420251018150). PubMed, Embase, Cochrane Library, and Scopus were searched for studies. Eligible studies included adult patients with blunt or penetrating traumatic axillosubclavian arterial injuries treated with ER or OS. The primary outcome was short-term all-cause mortality (in-hospital or 30-day). Secondary outcomes included upper-extremity amputation, thrombosis of repair, and stroke. Pooled odds ratios with 95
Trauma is a leading cause of morbidity and mortality worldwide, particularly in younger populations. Early identification of high-risk trauma patients is critical for timely interventions and improved outcomes. Although artificial intelligence and machine learning have demonstrated promise in healthcare, their application in trauma mortality prediction has been limited. This study developed and validated machine learning models to predict mortality in trauma patients using a large public dataset from the National Community-Based Critical Injury Survey (South Korea, 2016–2020). Overall, 207,012 cases were analyzed. Six machine learning algorithms, including logistic regression, k-nearest neighbor, decision tree, random forest (RF), extreme gradient boosting (XGB), and multi-layer perceptron, were trained and evaluated. Their performance was assessed using the areas under the receiver operating characteristic curve (AUROC) and precision-recall curve (AUPRC), and other metrics. Shapley additive explanations (SHAP) scores were used to interpret feature importance. The XGB model demonstrated the highest performance (AUROC 0.985; AUPRC 0.957), followed closely by the RF model (AUROC 0.984; AUPRC 0.956). Performance remained stable during the COVID-19 period, supporting the model’s temporal robustness under systemic disruption. SHAP analysis identified clinically actionable features such as out-of-hospital cardiac arrest, injury severity score, age, and time to transfusion. Unlike many prior studies based on small or single-center datasets, our model was developed using a nationally representative cohort and prioritized interpretability, scalability, and generalizability. This study presents a high-performing, interpretable machine learning framework for early mortality risk stratification in trauma patients using nationwide registry data. The strong discrimination and temporal robustness of the model support its value as a system-level prediction tool; however, further calibration analyses, external validation, and prospective implementation studies are required before integration into clinical workflows.
Injury is a global health problem, especially in low- and middle-income countries (LMICs). Sustainable trauma registries in these settings require concise, locally relevant, and low-cost solutions. This methodology paper shares a minimal trauma registry dataset developed and tested over 7 years, together with its accompanying MS Access database, which is made freely available to help LMIC institutions establish locally owned trauma registries. Two prospectively tested registries were sequentially designed, implemented, analyzed, and refined in Al-Ain City, United Arab Emirates: a 200-variable single-center hospital registry and a 50-variable multicenter road traffic collision registry. Finally, an 80-variable Trauma and Emergency Research Group registry was developed. Variables were retained or removed according to feasibility, data completeness, clinical usefulness, prevention value, and demonstrated research utility. The first registry enrolled 2573 patients over 3 years and the second enrolled 1008 patients over 18 months. Experience from these registries generated 21 publications from the first registry, 13 from the second, 3 combined analyses, and 5 follow-up studies, which informed the final open-access registry. The resulting tool is a five-page, 80-variable minimal dataset organized into seven sections: personal details, trauma details, road trauma details, emergency department assessment, discharge summary, death details, and injuries and scores. It balances prevention variables such as crash mechanics, safety equipment, education level, and injury location with core outcome variables needed for benchmarking and system evaluation. A carefully selected minimal dataset can support clinically useful, prevention-oriented, and affordable trauma surveillance in resource-limited settings. Making the form and accompanying MS Access database freely available may help LMIC institutions establish locally owned trauma registries that are scalable, sustainable, and adaptable to national systems, provided that minimum resources for implementation, maintenance, governance, data quality, and reporting are planned.
The 2025 WSES Guidelines endorse nonoperative management (NOM) for uncomplicated acute appendicitis. However, the oncologic risks and methodological limitations of this approach require strict scrutiny. Applying the GRADE framework, admission computed tomography presents severe clinical indirectness, underestimating microperforations and failing to exclude occult appendiceal neoplasms in up to 3.2
Abstract Background Sigmoid volvulus stands out as a frequent surgical emergency, particularly in older adults. Initial management centers on prompt detorsion of the affected colon segment, coupled with strategies to avoid future episodes. Preventing recurrence remains a persistent clinical challenge. Advances in endoscopic technology have positioned this modality as a pivotal tool in volvulus care, offering the dual advantage of therapeutic detorsion and diagnostic evaluation of predisposing factors. Methods We prospectively included all patients who presented to the emergency department at Zagazig University Hospital with recurrent sigmoid volvulus from August 2024 to August 2025. Sixty-six participants were randomized equally (n = 33 per group) to percutaneous endoscopic fixation or surgical intervention (control group: open or laparoscopic sigmoidopexy or sigmoidectomy under general anesthesia) using sealed envelopes with third-party-generated random assignments. The protocol received prospective institutional review board approval from Zagazig University Faculty of Medicine (IRB #633/1-Sep-2024) and was registered retrospectively on ClinicalTrials.gov in September 2025 (NCT07155304). The trial was conducted under the code of ethics of the World Medical Association (Declaration of Helsinki) for studies involving human subjects. And all participants provided written informed consent. Reporting followed CONSORT guidelines. Results Procedure-related complications included small bowel injury, sigmoid perforation, skin necrosis, pulmonary infection, intra-abdominal abscess, peritonitis, fecal fistula, recurrence, and mortality. In the percutaneous endoscopic fixation group, rates were 1 (3%) for small bowel injury, 1 (3%) for sigmoid perforation, 2 (6%) for skin necrosis, 3 (9%) for pulmonary infection, 3 (9%) for abscess, 3 (9%) for peritonitis, 0 (0%) for fistula, 1 (3%) for recurrence, and 0 (0%) for mortality. Corresponding figures in the surgical cohort group 2 (6%), 0 (0%), 4 (12%), 5 (15%), 4 (12%), 4 (12%), 4 (12%), 1 (3%), and 3 (9%). Quality-of-life assessments categorized outcomes as excellent, good, or poor: endoscopic group, 24 (73%), 5 (15%), 4 (12%); surgical group, 17 (52%), 11 (33%), 5 (15%). Conclusion Percutaneous endoscopic fixation provides a lower-morbidity and mortality alternative approach for patients with recurrent sigmoid volvulus without the need for general anesthesia.
Abstract Purpose The role of prophylactic mesh reinforcement in emergency laparotomy closure remains controversial. While prophylactic mesh may reduce incisional hernia, its use in unstable and contaminated settings raises concerns regarding operative time, seroma development, and wound complications. This meta-analysis of randomized controlled trials (RCTs) evaluated the safety and efficacy of prophylactic mesh versus primary suture closure in emergency midline laparotomy. Methods A systematic search was performed for RCTs comparing prophylactic mesh with suture closure in adult patients undergoing emergency midline laparotomy. Primary outcomes were overall wound complications (OWC) and incisional hernia (IH). Secondary outcomes included superficial and deep surgical site infection, wound dehiscence (WD), seroma, hematoma, operative time, postoperative pain, quality of life, hospital and ICU stay, transfusion, and mortality. Results Seven RCTs comprising 643 patients were included. Mesh reinforcement reduced incisional hernia incidence, with significant reductions at 1 month (RR 0.29, 95% CI 0.12–0.68), 6 months (RR 0.11, 95% CI 0.01–0.86), 12 months (RR 0.21, 95% CI 0.09–0.49), and 24 months (RR 0.27, 95% CI 0.15–0.49). Mesh increased seroma risk (RR 2.45, 95% CI 1.38–4.35) and, was associated with higher overall wound complications (RR 1.50, 95% CI 1.04–2.18). No significant differences were found in SSI, wound dehiscence, hematoma, transfusion, ICU or hospital stay, pain, quality of life, or mortality. Operative time was longer with mesh (MD 26 min, 95% CI 15.9–36.9). Conclusion Prophylactic mesh in emergency laparotomy closure poses a clinical dilemma: it lowers the risk of incisional hernia but prolongs surgery and increases seroma and wound complications. Current evidence underscores the trade-off between long-term prevention and short-term morbidity. Larger, protocol-driven trials with long-term follow-up are needed to determine in which patients and wound classes mesh reinforcement is justified.
To date, emergency laparotomy outcomes have centred on mortality, while survivorship remains inadequately defined and underexplored. It is expected that survivors are likely to experience significant short- and long-term biopsychosocial challenges and research is key to improving our understanding and identifying areas for improvement. This study aims to describe the emergency laparotomy postoperative pathway and evaluate short- and long-term outcomes. This was a retrospective observational study across three NHS hospitals in Scotland, England and Wales. All patients had undergone emergency laparotomy between December 2017 and January 2019 according to the established National Emergency Laparotomy Audit criteria. Inpatient and post-discharge data were collected, including in-hospital complications, planned surgical follow-up, and unplanned follow-up (representation, readmission, and primary care referrals). Over the 14-month period, 557 patients were included (Scotland n = 199, Wales n = 252, and England n = 106), with 51.7
Seo and colleagues compared early (≤ 48 h) versus delayed (> 48 h) planned reoperation following damage control surgery (DCS) in trauma patients and reported higher rates of re-bleeding in the early reoperation group. While this addresses an important clinical question, interpretation of these findings requires caution. First, all included studies were observational, and reoperation timing was determined by clinical judgment, introducing systematic confounding by indication. Physiologically unstable patients are more likely to undergo early re-exploration, while more stable patients are deferred, particularly in resource-constrained settings where system-level triage further shapes timing decisions. Second, the use of a 48-hour cut-off imposes a binary framework on what is inherently a continuous biological process, as physiological recovery varies substantially between patients, injury patterns, and operative burden. Third, pooling heterogeneous DCS indications, including haemorrhage- and contamination-driven strategies, limits the biological plausibility of a single time-based reoperation algorithm across diverse clinical contexts. Taken together, the available evidence suggests that timing is not the true causal exposure; rather, physiological readiness is the key determinant of outcomes after DCS. Future research should shift from clock-based thresholds to physiology-guided frameworks using objective markers of recovery to better inform reoperation strategies in trauma care.
Traumatic diaphragmatic injuries are a significant cause of morbidity and mortality. Particular attention to isolated diaphragmatic injuries and not overlooking them is critical to preventing damage from hernias that may occur immediately or later. The use of a thoracic tube during repair of a diagnosed diaphragmatic injury should be considered a necessary routine procedure. Clearly, the current guidelines resulting from the WSES-AAST collaboration reiterate this traditional recommendation. However, selective tube use should be considered, and the “one-size-fits-all” approach should be discussed. This detail deserves reconsideration to minimize patient morbidity and discomfort.
BACKGROUND:Clinical practice guidelines recommend screening for blunt cerebrovascular injury (BCVI) based on the Denver Criteria. BCVI is typically treated with antithrombotic therapy, which may be high-risk in patients with concomitant brain or spine injuries. At our center, we often perform additional imaging in high-risk patients after positive initial screening for BCVI. Our study investigates how frequently follow-up imaging changes diagnosis and management of patients screening positive for BCVI. METHODS:A cross-sectional study of all trauma patients admitted to a level 1 trauma center with cervical spine or facial fractures between May 2019 and December 2022 was performed. Chart review was conducted to identify all patients who had a positive screening study for BCVI. Individual charts were reviewed for BCVI screening and additional imaging test modality and results, as well as timing and specifics of treatment recommendations. RESULTS:A total of 2668 patients met inclusion criteria. 1407 of these patients received BCVI screening, 11 with Magnetic Resonance Angiography (MRA) and 1396 with Computed Tomography Angiography (CTA). Of those screened, 254 (9.5%) had with positive or equivocal findings, of which 197 (77.6%) patients received a second study, including 2 patients who received multiple studies. Additional imaging studies resulted in a change in the diagnosis in 96 patients (48.7%), including 105 studies (53.3%) that found no injury or chronic findings. The results of additional studies changed patient management in in 64 (32.5%) cases. CONCLUSIONS:In our study, follow-up BCVI imaging frequently identified discordant findings in a third of screening tests. This suggests that starting antiplatelet or anticoagulation therapy based on screening studies alone could result in overtreatment in a high-risk patient population.
Hemodynamically unstable patients with pelvic fractures have a high mortality rate. Most bleeding from pelvic fractures originates from venous and bony sources; therefore, direct compression of the pelvic wall can be effective, and preperitoneal pelvic packing (PPP) should be considered as a first-line intervention. PPP can be performed in both the emergency department (ED) and the operating room (OR). However, outcomes according to the location of PPP have not been clearly established. This study evaluated the outcomes of ED-PPP and OR-PPP based on the location where the surgery was performed. This single-center, retrospective, observational study included patients who underwent PPP for pelvic fractures with an Abbreviated Injury Scale score of ≥ 4 from July 2015 to June 2025. Data were collected from a prospectively maintained trauma registry. Patients were categorized into ED-PPP and OR-PPP groups according to the site of PPP. Baseline characteristics, injury severity (Injury Severity Score, Revised Trauma Score, and Trauma and Injury Severity Score), and interventions, including ED thoracotomy, resuscitative endovascular balloon occlusion of the aorta, tranexamic acid administration, and time to PPP and transfusion, were compared. Mortality outcome measures were evaluated at 24 h, 7 days, and as overall in-hospital mortality and were risk-adjusted using W- and Z-statistic. Fifty patients were included, with 17 and 33 in the ED-PPP and OR-PPP groups, respectively. Patients in the ED-PPP group were more critically ill at presentation, with lower systolic blood pressure, lower Glasgow Coma Scale scores, and a higher incidence of cardiac arrest before PPP. Time from scene to PPP (114.4 ± 68.6 vs. 284.3 ± 186.9 min) and to transfusion (84.5 ± 53.3 vs. 126.3 ± 72.5 min) was shorter in the ED-PPP group. The W-statistic demonstrated a greater number of actual survivors than expected in the ED-PPP and OR-PPP groups at 24 h (38.31 vs. 29.69) and 7 days (26.55 vs. 17.57), despite the high crude mortality rates (76.5
Abstract Background Abdominal dehiscence (AD) is a serious postoperative complication associated with a high risk of morbidity. Traditional primary suture repair (PS) is a simple but biomechanically deficient procedure. This study compared the early and late outcomes of posterior component separation (CS) using the transversus abdominis release (TAR) technique with mesh augmentation (MA) and PS for AD management. Materials and methods This retrospective study included 252 patients who underwent surgical repair for complete AD Bjork Grade 1 A between January 2014 and September 2020. The patients were divided into two groups: CS + TAR+MA (Group A, n = 107) and primary suture (PS) repair (Group B, n = 145). The primary outcome was short-term morbidity (within 90 days), including surgical site occurrence (surgical site infection [SSI], hematoma, and seroma), pneumonia, ileus, and recurrent AD (RAD). The secondary outcomes were the incidence and risk factors of IH after AD repair. The patients were followed up for 5 years. Statistical analysis was performed using Kaplan-Meier survival analysis and multivariate logistic regression. Results The baseline characteristics of the two groups were comparable. Group A was associated with a longer median operative time (92 (88–100) vs. 89 (84–91) min, p < 0.001) and mean hospital stay (11.2 ± 1.9 vs. 5.8 ± 1.5 days, p < 0.001), and higher rates of seroma (22.4% vs. 11.0%, p = 0.01) and hematoma (3.7% vs. 0%, p = 0.01). The SSI rates were comparable between the two groups (7.5% vs. 4.1%, p = 0.2). The incidence of IH was significantly lower in Group A than in Group B (5.6% vs. 13.1%, p = 0.04). Kaplan-Meier analysis confirmed the superior long-term IH-free survival in Group A (log-rank test, p = 0.009). Group A also had a lower RAD rate (1.9% vs. 7.6%, p = 0.04). Multivariate analysis revealed that PS repair (OR 40.0, 95% CI 2.1–78.0; p = 0.01), SSI (OR 13.4, 95% CI 2.3–77.6; p = 0.004), pneumonia (OR 12.3, 95% CI 1.9–77.5; p = 0.007), high BMI (OR 2.9, 95% CI 1.06–4.1; p = 0.03), ileus (OR 16.6, 95% CI 2.2-121.9; p = 0.006), RAD (OR 10.7, 95% CI 1.5–73.3; p = 0.01), infected mesh (OR 14.6, 95% CI 1.8–117; p = 0.01), and old age (OR 1.07, 95% CI 1.006–1.15; p = 0.03) significantly increased the risk of IH after AD repair. Elevated serum albumin levels were protective (OR 0.1, 95% CI 0.0–0.7; p = 0.02). Conclusion Group A repair for AD was associated with a significantly reduced risk of IH and RAD compared to PS. Despite a higher rate of initial complications, such as seroma and hematoma, Group A provided more durable and definitive reconstruction. PS repair confers a 40-fold increased risk of IH and should be reconsidered in favor of tension-free Group A management of AD.
Splanchnic venous thrombosis (SVT) is a common complication in necrotizing pancreatitis (NP), contributing significantly to increased morbidity and mortality. The role of anticoagulant therapy in the management of SVT remains controversial. This study aims to identify the factors influencing SVT formation and recanalization in patients with NP and to evaluate the efficacy of anticoagulant treatment. A retrospective analysis was conducted on 121 patients diagnosed with NP between July-2013 and August-2022. Sociodemographic and clinical characteristics, comorbidities, anticoagulant use, and computed tomography findings at admission, first week, first month, third month, sixth month, and first-year follow-ups were evaluated. SVT was detected in 51 of 121 (42.1
Elevated intra-abdominal pressure (IAP) causes organ dysfunction, particularly acute kidney injury (AKI). Current intermittent IAP monitoring methods are inadequate for capturing the dynamic fluctuations. We hypothesize that the cumulative exposure to elevated IAP over time is a predictor of organ injury. We evaluated the feasibility of a novel capsular sensor (PressureDOT, PDT) for continuous IAP measurement in six anesthetized porcine subjects. Controlled intra-abdominal hypertension (IAH) was induced using progressive CO2 insufflation. We calculated the cumulative intra-abdominal pressure exposure (cIAPe), defined as the integrated area under the curve of IAP values exceeding 12 mmHg over time. Serial serum creatinine (Cr) estimated glomerular filtration rate (eGFR), and other organ markers were tracked. Continuous and high-resolution IAP monitoring was achieved in all subjects. Exposure to IAH significantly increased mean serum Cr (1.69 ± 0.19 to 2.16 ± 0.31 mg/dL; p = 0.01) and reduced eGFR (41.33 to 25.00 mL/min; p < 0.001). A linear correlation was demonstrated between increasing cIAPe and rising Cr ratio (R2 ranging from 0.84 to 0.97). Critically, changes in Cr and eGFR reduction were statistically significant across progressive cIAPe phases (p = 0.048 and p < 0.001, respectively). The use of continuous IAP monitoring by PDT is feasible in this controlled porcine model. Our findings suggest that cIAPe may be a quantifiable marker associated with early renal impairment. Although early detection of physiological renal impairment consistent with early AKI criteria is promising, validation in larger animal studies and future human trials is necessary to determine clinical relevance.
