One of the most common and significant complication of acute diverticulitis is visceral perforation. Current clinical guidelines suggest conservative medical therapy can be adopted for selected patients with perforation, especially those with pericolic air, while its role remains less clear in cases of distant air. The aim of our study is to evaluate the role of non-operative management (NOM) in case of pericolic and distant air. The authors conducted a comprehensive literature review; this search yielded 23 studies (17 retrospectives, 5 prospective and 1 randomized control trial), including 2689 patients. Conservative management of patients with air in perforated diverticulitis was safe and feasible, with a overall pooled success rate of 90.2

Appendiceal abscesses are a heterogeneous manifestation of acute appendicitis, with diverse pathological substrates and imaging phenotypes. The lack of standardized definitions hampers cross-study comparability and consistent diagnostic pathways. The Italian Society of Surgical Research (SIRC) and the Italian Society of Emergency Surgery and Trauma (SICUT) conducted a four-round modified Delphi, culminating in an in-person consensus conference (Rome, November 6, 2025). A multidisciplinary panel refined the statements on pathological definitions, classifications, and imaging correlates. Consensus was reached on 22 statements. Part 1 reports seven statements that delineate the spectrum from uncomplicated to complicated appendicitis (phlegmonous, gangrenous, and perforated) and distinguishes appendiceal abscesses from appendiceal masses. An imaging framework centered on CT descriptors was used to support consistent radiology–pathology correlations. These statements provide a unified taxonomy and diagnostic framework for appendiceal abscesses and related entities, improving interdisciplinary communication, and enabling cross-study comparability.

BACKGROUND:The management of appendiceal abscess remains a challenging area in emergency surgery because of heterogeneity in anatomic presentation, inflammatory severity, and patient physiologic reserve. The absence of standardized pathologic definitions, imaging-based grading systems, and clear escalation criteria has contributed to substantial variability in clinical practice. A unified, physiology-driven framework is therefore needed to support transparent and reproducible decision-making. METHODS:This study represents the management-focused component of the Italian Society of Research in Surgery-Italian Society of Emergency and Trauma Surgery consensus initiative on appendiceal abscess. A modified Delphi methodology was applied, including 3 rounds of anonymous remote voting, followed by a final in-person consensus meeting. Standardized pathologic definitions and an imaging-based grading classification developed within the same initiative were adopted as reference standards. Agreement thresholds were predefined: ≥80% indicating consensus and ≥95% strong consensus. RESULTS:Early appendectomy was considered the most definitive treatment for grade 1 phlegmons and small abscesses, although a short, closely monitored trial of conservative management may be acceptable in clinically stable, low-risk patients. For abscesses larger than 3-4 cm, image-guided percutaneous drainage was selectively recommended as a temporizing bridge in high-risk surgical candidates rather than as definitive therapy. Mesenteric abscesses were identified as particularly high risk because of limited anatomic containment and rapid progression, and early surgical source control was considered the most reliable strategy. Clinical instability or generalized peritonitis represented absolute indications for immediate surgery, regardless of abscess morphology. The panel also addressed salvage surgery, the selective role of interval appendectomy, and the optimal timing of delayed surgery, supporting a risk-stratified rather than routine approach. CONCLUSION:This consensus provides a reproducible, physiology-driven framework for the management of appendiceal abscess, integrating anatomic patterns, radiologic grading, and explicit escalation criteria. These recommendations aim to reduce unwarranted variability and improve the consistency and quality of care.

Background: Sigmoid volvulus is a time-critical cause of large-bowel obstruction. While endoscopic detorsion (ED) is the primary intervention for rapid decompression and the assessment of mucosal viability, reported success, recurrence, and mortality rates vary significantly across the literature, complicating evidence-based clinical decision-making. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines (protocol submitted to PROSPERO). MEDLINE/PubMed and Embase were searched from inception to 20 October 2025, supplemented by manual reference screening. We included original prospective or retrospective studies (n ≥ 5) reporting outcomes after ED for sigmoid volvulus, specifically technical success, post-ED recurrence, or mortality. Pooled proportions were estimated using a DerSimonian-Laird random-effects model on the logit scale, with heterogeneity quantified using I2 statistics. Administrative database studies were summarized descriptively and excluded from the quantitative synthesis to minimize selection bias. Results: Nineteen studies (2004-2025) met the inclusion criteria from an initial 890 records. Fifteen studies (n = 1738) contributed to the analysis of technical success, yielding a pooled estimate of 80.0% (95% CI: 75.0-83.0%; I2 = 87.5%). Seventeen studies (n = 3285) reported recurrence following initially successful ED, with a pooled rate of 33.9% (95% CI: 19.5-52.1%; I2 = 97.5%). Sixteen studies (n = 2790) reported mortality; the pooled estimate was 22.6% (95% CI: 18.7-26.4%; I2 = 99.6%). This extreme heterogeneity likely reflects variations in patient comorbidities (case-mix) and differing outcome reporting windows rather than procedural risk in isolation. Conclusions: ED is an effective first-line stabilizing intervention for uncomplicated sigmoid volvulus; however, recurrence rates remain high, and outcome estimates exhibit significant heterogeneity. ED should be integrated within a structured clinical pathway that prioritizes standardized mucosal assessment, post-procedural decompression, and the timely planning of definitive management when feasible.

Non-operative management (NOM) has become the default for haemodynamically stable liver trauma, yet pathway-level performance and bedside predictors of mortality warrant contemporary appraisal in University trauma centres. We conducted a single-centre retrospective cohort study of consecutive adults (≥ 18 years) with blunt or penetrating hepatic injury managed within a protocolised, physiology- and CT-guided pathway (1 Jan 2018–30 Apr 2025). The primary endpoint was in-hospital mortality. Secondary endpoints included NOM failure, liver-specific complications, and era-level outcomes (2018–2021 vs. 2022–2025). Independent predictors of mortality were assessed with multivariable logistic regression; discrimination was evaluated by ROC analysis. Among 350 patients, NOM was initiated in 304 (86.9

Background The management of appendiceal abscess remains a challenging area in emergency surgery due to heterogeneity in anatomical presentation, inflammatory severity, and patient physiological reserve. The absence of standardized pathological definitions, imaging-based grading systems, and clear escalation criteria has contributed to substantial variability in clinical practice. A unified, physiology-driven framework is therefore needed to support transparent and reproducible decision-making. Methods This study represents the management-focused component of the SIRC–SICUT consensus initiative on appendiceal abscess. A modified Delphi methodology was applied, including three rounds of anonymous remote voting followed by a final in-person consensus meeting. Standardized pathological definitions and an imaging-based grading classification developed within the same initiative were adopted as reference standards. Agreement thresholds were predefined: ≥80% indicating consensus and ≥95% strong consensus. Results Early appendectomy was considered the most definitive treatment for Grade 1 phlegmons and small abscesses, although a short, closely monitored trial of conservative management may be acceptable in clinically stable, low-risk patients. For abscesses larger than 3–4 cm, image-guided percutaneous drainage was selectively recommended as a temporizing bridge in high-risk surgical candidates rather than as definitive therapy. Mesenteric abscesses were identified as particularly high risk because of limited anatomical containment and rapid progression, and early surgical source control was considered the most reliable strategy. Clinical instability or generalized peritonitis represented absolute indications for immediate surgery regardless of abscess morphology. The panel also addressed salvage surgery, the selective role of interval appendectomy, and the optimal timing of delayed surgery, supporting a risk-stratified rather than routine approach. Conclusions This consensus provides a reproducible, physiology-driven framework for the management of appendiceal abscess, integrating anatomical patterns, radiological grading, and explicit escalation criteria. These recommendations aim to reduce unwarranted variability and improve the consistency and quality of care.

BACKGROUND:Imaging plays a pivotal role in the diagnosis and stratification of appendiceal abscess, a distinct phenotype of complicated appendicitis. Persistent heterogeneity in anatomic terminology, radiological grading, and diagnostic pathways continues to hinder reproducibility, clinical decision-making, and cross-study comparability. A standardized, imaging-centered framework integrating reproducible anatomic descriptors, validated severity grading, and evidence-based imaging strategies is therefore urgently needed. METHODS:Under the auspices of the Italian Society of Research in Surgery and the Italian Society of Emergency and Trauma Surgery, a multidisciplinary expert panel conducted a 4-round modified Delphi process, culminating in an in-person consensus conference held in Rome on November 6, 2025. Statements were iteratively refined through anonymous voting, achieving predefined thresholds for consensus (≥80%) and strong consensus (≥95%). RESULTS:The panel endorsed (1) mandatory anatomotopographic classification of appendiceal abscess (pelvic, mesenteric, retrocecal/retrocolic, and anterior with abdominal wall involvement); (2) adoption of the Jeffrey radiological grading system (grades 1-3: phlegmon/small abscess ≤3 cm; well-circumscribed abscess >3 cm; and extensive/poorly defined with multicompartment extension); and (3) structured imaging recommendations. These include contrast-enhanced computed tomography as the reference modality in adults, with selective use in suspected malignancy, particularly in patients >50-55 years, ultrasound-first/magnetic resonance imaging-second pathways during pregnancy, and symptom-driven follow-up after conservative management. CONCLUSION:This consensus establishes a unified and imaging-guided diagnostic framework that harmonizes anatomotopographic localization with reproducible radiological stratification and pathway-oriented recommendations. Standardized definitions and structured reporting are expected to reduce practice variability, enhance interpretative consistency, and enable reliable cross-institutional and cross-study comparisons. These statements complement, rather than replace, clinical judgment and are aligned with recent international updates, including the 2025 World Society of Emergency Surgery Jerusalem Guidelines. Prospective multicenter validation is warranted to assess their impact on clinical outcomes, drainage success, recurrence prediction, and the prognostic performance of the integrated anatomotopographic-Jeffrey approach.

AIM:The importance of lateral lymph node dissection (LLND) for advanced low rectal cancer is still questioned, but selected patients might benefit from this procedure. The purpose of this study was to compare robotic LLND (R-LLND) versus laparoscopic LLND (L-LLND) to identify the safety, feasibility, and advantages of R-LLND. METHODS:PubMed, Scopus, and Cochrane databases were searched for studies assessing the benefit of R-LLND over L-LLND. Pooled odds ratios (OR) and weighted mean difference (WMD) were obtained using models with random effects. The risk of bias was evaluated with the Newcastle-Ottawa scale. RESULTS:Six studies were included in our analysis for a total of 652 patients (316 robotic and 336 laparoscopic). The R-LLND group had a longer operative time (WMD 60.46, p = 0.02) and less blood loss (WMD -22.33, p = 0.01). Differences were found in the postoperative length of stays (7 days ± 1.2 and 14 ± 5.2 versus 7 days ± 0.3 and 16 ± 18.5, WMD -1.30, p = 0.03) and in the mean time to regular diet (3 days ± 0.5 and 5 ± 2.3 versus 3 days ± 1.2 and 6 ± 3.8, WMD -0.60 p = 0.01); a slightly higher number of harvested lateral lymph nodes was present in the L-LLND group (WMD 1.23, p = 0.02). CONCLUSIONS:Our work demonstrates a slight benefit from the robotic approach when performing LLND in terms of intra- and peri-operative outcomes, despite not reaching statistical significance a trend in favor of robotic surgery is evident in almost all the analyzed topic.

Background: Looking for anomalies and vascular control gains a central role in colon cancer surgery. Complete mesocolic excision (CME) presents technical challenges, primarily due to the considerable variability in the arterial configuration of the right colon. The importance of understanding colonic vascular anatomy has become more prominent with the adoption of this surgical technique. The aim of this study is to systematically review the vascular anatomical variations in the superior mesenteric artery (SMA) in the setting of extended lymphadenectomy for CME in right colon cancer and to show its impact in clinical practice. Methods: A systematic review of the literature on Medline (PubMed), Web of Science (WOS), and Scopus was performed according to PRISMA guidelines. The following criteria were set for inclusion: (1) studies reporting minimally invasive (robotic, laparoscopic, and hybrid techniques) or open CME/D3 lymphadenectomy; (2) studies reporting patients with right-sided colon cancer; (3) studies reporting the description or illustration of SMA variations. The methodological quality of all included studies was evaluated using the Newcastle–Ottawa Scale (NOS). Results: After the literature search, 800 studies were recorded, 31 studies underwent full-text reviews, and 9 studies met the inclusion criteria. All studies reported vascular variations in SMA, and the total number of patients was 813. No intraoperative complications were reported. In 6.4% of patients, post-operative bleeding occurred. Conclusions: Vascular anatomical variations are not a rare entity. In experienced centers, vascular anomalies are not associated with an increase in complications, both in traditional open and minimally invasive surgery (MIS). However, in MIS, full access to central vessels and intraoperative vascular control, moderate retraction, safety maneuvers, and accurate vascular dissection are mandatory.

Background: Renal trauma accounts for approximately 3–5% of all trauma cases, predominantly affecting young males. The most common etiology is blunt trauma, particularly due to road traffic accidents, and it frequently occurs as part of polytrauma involving multiple organ systems. Management strategies are primarily dictated by hemodynamic stability, overall clinical condition, comorbidities, and injury severity graded according to the AAST classification. This study aimed to evaluate the effectiveness of non-operative management (NOM) in high-grade renal trauma (AAST grades III–V), beyond its established role in low-grade injuries (grades I–II). Secondary endpoints included the identification of independent prognostic factors for NOM failure and in-hospital mortality. Methods: We conducted a retrospective observational study including patients diagnosed with blunt renal trauma who presented to the Emergency Department of Policlinico Umberto I in Rome between 1 January 2013 and 30 April 2024. Collected data comprised demographics, trauma mechanism, vital signs, hemodynamic status (shock index), laboratory tests, blood gas analysis, hematuria, number of transfused RBC units in the first 24 h, AAST renal injury grade, ISS, associated injuries, treatment approach, hospital length of stay, and mortality. Statistical analyses, including multivariable logistic regression, were performed using SPSS v28.0. Results: A total of 244 patients were included. Low-grade injuries (AAST I–II) accounted for 43% (n = 105), while high-grade injuries (AAST III–V) represented 57% (n = 139). All patients with low-grade injuries were managed non-operatively. Among high-grade injuries, 124 patients (89%) were treated with NOM, including observation, angiography ± angioembolization, stenting, or nephrostomy. Only 15 patients (11%) required nephrectomy, primarily due to persistent hemodynamic instability. The overall mortality rate was 13.5% (33 patients) and was more closely associated with the overall injury burden than with renal injury severity. Multivariable analysis identified shock index and active bleeding on CT as independent predictors of NOM failure, whereas ISS and age were significant predictors of in-hospital mortality. Notably, AAST grade did not independently predict either outcome. Conclusions: In line with the current international literature, our study confirms that NOM is the treatment of choice not only for low-grade renal injuries but also for carefully selected hemodynamically stable patients with high-grade trauma. Our findings highlight the critical role of physiological parameters and overall ISS in guiding management decisions and underscore the need for individualized assessment to minimize unnecessary nephrectomies and optimize patient outcomes.

BACKGROUND:The management of high-surgical-risk patients with moderate to severe acute cholecystitis is challenging in clinical practice. Early laparoscopic cholecystectomy is considered the gold standard for patients who do not respond to conservative treatment. However, for those unfit for surgery due to high risk, alternative treatment options, such as percutaneous cholecystostomy (PC), are available. There are no clear guidelines regarding the management of patients following PC. The primary aim of this study was to propose indications for PC in high-surgical-risk patients with acute cholecystitis and to establish management strategies for gallbladder drainage, either as a bridge to surgery or as a definitive treatment, according to available literature. MATERIALS AND METHODS:After a targeted literature review, International and Italian experts in the field from the Italian Society of Research in Surgery (SIRC) and the Italian Society of Emergency Surgery and Trauma (SICUT) were consulted to provide their evidence-based opinions on the topic. Statements were proposed during subsequent rounds using the Delphi methodology. Ten statements were provided, and the final agreement is presented in this study. RESULTS:Patients with moderate acute cholecystitis, a Charlson Comorbidity Index (CCI) ≥ 6, and American Society of Anesthesiologists-Performance Status (ASA-PS) ≥ 3 who fail conservative treatment should undergo laparoscopic cholecystectomy as the first-line approach. For those with severe acute cholecystitis at high-surgical risk, percutaneous cholecystostomy is recommended to relieve symptoms within 24-48 hours. Once the infection is controlled, we should assess which patients may be candidates for interval laparoscopic cholecystectomy. For patients selected for surgery, laparoscopic cholecystectomy is recommended at least six weeks after PC placement. In patients not suitable for surgery, such as those with CCI ≥ 6 and ASA-PS ≥ 4, percutaneous cholecystostomy should remain in place for at least three weeks, after which, following radiographic confirmation of biliary tree patency, the tube may be removed. CONCLUSIONS:This consensus, developed through a multidisciplinary collaboration of interventional radiologists, gastroenterologists, and surgeons, provides a clear and practical guide for managing high-risk surgical patients with acute cholecystitis.

Background and Objectives: Trauma, particularly uncontrolled bleeding, is a major cause of death. Recent evidence-based guidelines recommend the use of a tourniquet when life-threating limb bleeding cannot be controlled with direct pressure. Prehospital hemorrhage management, according to the XABCDE protocol, emphasizes the critical role of tourniquets in controlling massive bleeding. The aim of this systematic review and meta-analysis was to summarize data from the available scientific literature on the effectiveness of prehospital tourniquet use for extremity bleeding. Materials and Methods: A systematic review and meta-analysis was performed between March 2022 and March 2024, adhering to PRISMA guidelines, to determine whether prehospital tourniquets are clinically effective. The protocol was published on PROSPERO (ID number: CRD42023450373). Results: A comprehensive literature search yielded 925 articles and 11 studies meeting the inclusion criteria. The analysis showed a non-statistically significant reduction in mortality risk with tourniquet application (4.02% vs. 6.43%, RR 0.70, 95% CI 0.46–1.07). Analysis of outcomes of amputation of the traumatized limb indicated a statistically higher incidence of initial amputation in the tourniquet group (19.32% vs. 6.4%, RR 2.07, 95% CI 1.21–3.52), while delayed amputation showed no difference (9.39% vs. 3.66%, RR 0.93, 95% CI 0.42–2.07). Tourniquet use demonstrated a non-significant reduction in the number of blood components transfused (MD = −0.65; 95% CI −5.23 to 3.93 for pRBC, MD = −0.55; 95% CI −4.06 to 2.97 for plasma). Conclusions: Despite increasing use in civilian settings, this systematic review and meta-analysis showed no significant reduction in mortality or blood product use associated with prehospital tourniquet use. Further research, including high-quality randomized controlled trials, is required, as well as awareness and education campaigns relating to proper tourniquet use in the prehospital setting.

Background: The clinical significance of serum potassium levels at admission in patients with blunt hepatic trauma remains insufficiently defined. This study aimed to evaluate the prevalence and prognostic value of admission hypokalemia in this patient population. Methods: We conducted a retrospective analysis of 164 patients with radiologically confirmed blunt liver trauma admitted between 2016 and 2023. Preoperative, intraoperative, and postoperative data were collected to assess the association between serum potassium levels and trauma severity (AAST grade—American Association for the Surgery of Trauma, ISS—Injury Severity Score), in-hospital morbidity, mortality, and length of stay. Univariate and multivariate analyses were performed, including checks for normality and multicollinearity. Results: Serum potassium levels showed a significant positive correlation with age (p = 0.0064), and an inverse correlation with liver injury severity (AAST grade; p = 0.01). Lower potassium levels were associated with longer hospital stays (p = 0.0459) and higher morbidity (p = 0.022). In multivariate analysis, only age (p = 0.036) and AAST grade (p = 0.014) were independent predictors of serum potassium concentration. Potassium levels were not independently associated with mortality. Conclusions: Admission hypokalemia is a common finding in blunt liver trauma and correlates with injury severity and adverse clinical outcomes. Potassium concentration may serve as a readily available, low-cost biomarker for early risk stratification in these patients. Further prospective studies are warranted to confirm its prognostic utility.

Background: Electric motorized rental scooters (ES) were introduced in Italy in 2019 as an alternative form of urban transportation, aiming to reduce traffic congestion and air pollution. As their popularity has grown, a parallel increase in ES-related injuries has been observed. This study aims to investigate the types and patterns of ES-related injuries and to identify potentially modifiable risk factors. Methods: We conducted a retrospective analysis of all consecutive patients admitted to the Emergency Department of Policlinico Umberto I in Rome between January 2020 and December 2022 following ES-related trauma. Collected data included demographics, injury mechanisms and types, helmet use, Injury Severity Score (ISS), blood alcohol levels, and patient outcomes. Results: A total of 411 individuals presented to the Emergency Department due to ES-related injuries, either as riders or pedestrians. The mean age was 31 years (range: 2–93); 38 patients (9%) were under 18 years of age. Fifty-six accidents (14%) occurred during work-related commutes. Only three riders (0.7%) wore helmets, and nine patients (2%) had blood alcohol levels > 0.50 g/L. Cranial injuries (134 cases, 32%) and upper limb fractures (93 cases, 23%) were the most frequently reported serious injuries. The mean ISS was 4.5; 17 patients (4%) had an ISS ≥ 16. A total of 270 orthopedic injuries and 118 (29%) maxillofacial injuries were documented. Head trauma was reported in 115 patients (28%), with 19 cases classified as severe traumatic brain injuries. Twenty-three patients (5.5%) were hospitalized, three (0.7%) required intensive care, and one patient (0.2%) died. Conclusions: ES-related injuries are becoming increasingly common and present a significant public health concern. A nationwide effort is warranted to improve rider safety through mandatory helmet use, protective equipment, alcohol consumption control, and stricter enforcement of speed regulations.

A textiloma or gossypiboma is a rare but serious iatrogenic complication, caused by the retention of surgical sponges or gauze within the body after surgery. Often underreported, it may remain undetected for years, leading to diagnostic challenges with significant clinical and medicolegal implications. Our study reviewed the clinical and legal aspects of textilomas. We conducted a review by searching the terms "textiloma" and "post-surgery" in a single database (PubMed) from 2014 to 2024. After excluding non-iatrogenic cases and article with no forensic or surgical interest, 25 relevant articles were found and analyzed. Clinical presentation of textilomas is variable, depending on the surgical site. Seventy percent of cases occurred after abdominal surgery, with all patients requiring further surgeries. In some cases, the foreign body migrated to other organs, and diagnosis was often delayed due to the ability of textilomas to mimic tumors, complicating differential diagnoses. Medicolegal consequences are significant: healthcare professionals may face criminal charges for negligence, even years after the index surgery. In cases of multiple surgeries, identification of the origin of the retained foreign body can be challenging, though modern tissue tracing methods may assist in identifying hospital sources. Professionally, physicians can be held liable for personal injury or patient death, leading to career damage and malpractice claims. Given that textilomas occurrence is a preventable event, they pose not only a professional and legal concern but also a public health issue, emphasizing the importance of effective prevention and risk management strategies.

Background: The application of intermittent intraoperative neuromonitoring (I-IONM) and continuous intraoperative neuromonitoring (C-IONM) has been widely accepted to improve surgical outcomes after thyroid surgery. This observational study aimed to evaluate the impact of vocal cord paralysis (VCP) in thyroid surgery conducted with I-IONM and C-IONM. Materials and Methods: From January 2018 to December 2022, 147 patients operated on with I-IONM and C-IONM for thyroid surgery were analyzed. Variations in the rates of the occurrence of temporary and permanent vocal cord paralysis between the two groups were compared. A p-value < 0.05 was considered statistically significant. Results: In total, 147 patients were eligible for inclusion in the study. Of these, 96 (65%) patients underwent thyroid surgery with I-IONM, 52 patients (35%) underwent surgery with C-IONM by a single surgeon. The percentage of temporary VCP was 4.1% (4 patients) in the I-IONM group; no patients had permanent VCP. In the C-IONM group, two patients (3.9%) had permanent vocal cord paralysis, and temporary vocal cord paralysis was observed in other two patients (3.9%), who recovered their nerve function after speech therapy. No statistically significant differences were found in the two groups. Conclusions: In our study, both I-IONM and C-IONM proved effective in predicting VCP, and no significant differences were observed between the two techniques in our series.

BACKGROUND:Laparoscopic cholecystectomy is the gold standard in the treatment of symptomatic gallstones. The large number of gallbladders removed every year is not fully consistent with the excessively high incidence of iatrogenic bile duct injury (IBDI). Several strategies have been suggested to reduce this risk. Among them, the use of extra biliary anatomic structures, such as the Rouvière's sulcus, as a landmark to guide the surgeon during dissection has been proposed as a means to prevent IBDI. The main aim of the present paper is the evaluation of the prevalence of Rouvière's sulcus (RS) and its anatomic variants in a given population. MATERIALS AND METHODS:This observational, cross-sectional, and multicenter study has been conducted at the Department of Digestive and Emergency Surgery of the "Azienda Ospedaliera Santa Maria," Terni (Italy), at the Department of Surgical Sciences of the "Azienda Ospedaliera Perugia," Perugia (Italy) and at the Department of Emergency and Trauma Surgery of the "Policlinico Umberto I," Rome (Italy). Intraoperative images of 111 patients undergoing laparoscopic cholecystectomy were analyzed to identify the presence and type of RS, according to the Singh-Prasad classification and the Dahmane classification. RESULTS:RS was present in 93 (83.8%) patients. Singh-Prasad type 1A is present in 48.4% of patients, type 1B in 25.8%, type 2 in 12.9% and type 3 in 12.9%. Dahmane's open type is present in 48.4% of patients and fused type in 51.6%. CONCLUSION:Due to its high prevalence, RS can be used as an anatomic landmark and probably reduces the incidence of IBDI during laparoscopic cholecystectomy.

There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these. We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. 1874 patients from 159 centres across 52 countries were included. 78.3

Abstract Background Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions After 100 years since the first Hartmann’s procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment’s choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception.