Peri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. From 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odd ratio (95%CI) 4.1 (3.3–4.8), 3.9 (2.6–5.1) and 3.6 (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS‐CoV‐2 diagnosis was associated with a similar mortality risk to baseline (odd ratio (95%CI) 1.5 (0.9–2.1)). After a ≥ 7 week delay in undertaking surgery following SARS‐CoV‐2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS‐CoV‐2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

Telemedicine (TM) has emerged as a transformative tool in trauma care, enabling remote consultation and guidance for healthcare providers, especially in resource-limited settings. This review evaluates TM's effectiveness in trauma care by assessing its impact on clinical outcomes, mortality, injury severity, and healthcare resource utilization. A systematic literature search was performed across PubMed, Google Scholar, Science Direct, ProQuest, Medline, and Web of Science and included randomized controlled trials and cohort studies involving adult trauma patients. Extracted data encompassed demographics, injury characteristics, and clinical outcomes. Analysis of 25 studies (n = 45,097 patients) revealed that TM was associated with higher Injury Severity Scores (ISS), likely due to improved detection and documentation of severe injuries through specialist input. Increased blood transfusion rates were observed, which may reflect more accurate triage and timely intervention facilitated by TM, though confounding factors (e.g., case mix) cannot be ruled out. Both patient and physician satisfaction rates were high. However, TM demonstrated no statistically significant effect on mortality (p > 0.05), transfer times, or emergency department (ED) utilization-a finding consistent with some prior studies but warranting further investigation, given the heterogeneity in protocols. TM enhances trauma care coordination in rural and underserved areas by improving access to specialist expertise, which may explain observed benefits like higher ISS detection and transfusion rates. However, its inconsistent impact on mortality and resource use underscores the need for standardized implementation protocols. Future integration should optimize TM workflows (e.g., reducing decision delays) and pair them with targeted resource allocation to maximize outcomes.

The Charlson Comorbidity Index (CCI) has been validated as a predictor of overall survival and post-surgical mortality. CCI is adopted by Tokyo Guidelines as one of the main criteria in the management of acute cholecystitis. Our study evaluates the role of CCI in predicting difficult cholecystectomy. All patients who underwent cholecystectomy for acute cholecystitis between January 2017 and September 2019 were included. CCI, Emergency Surgery Score (ESS), and American Society of Anesthesiologists (ASA) score were calculated and analyzed to assess their predictive value for difficult cholecystectomy. A total of 96 patients were included and allocated to difficult and non-difficult cholecystectomy groups. CCI was found to be a significant predictor of difficult cholecystectomy (OR 1.59; 59% CI, 1.04. 2.42; p= 0.031). Similarly, ESS was found to be a predictor tool of difficult cholecystectomy (OR 1.42; 59% CI, 1.05. 1.93; p= 0.024). There was no significant difference in adverse outcomes between the two groups. CCI was able to predict a difficult cholecystectomy in our study population. However further studies are required to evaluate if it can be used as a predictor of adverse outcomes in the context of acute cholecystitis.

Introduction and importance: Obesity is a worldwide epidemic that carries significant morbidity and mortality. It is considered a major risk factor for many serious diseases. Therefore, different invasive and noninvasive therapeutic modalities are being used to help obese individuals to return to a healthy life. One of the nonsurgical modalities is the use of intragastric balloons (IGB). Case presentation: Our patient is a 17-years-old lady, with a body mass index of 48.8, medically and surgically free presented to the emergency with early signs of obstruction. CT abdomen showed small bowel obstruction secondary to IGB migration. Patient was admitted and operated on laparoscopically the same day of presentation. Patient recovered fully and was discharged in a stable condition. Case discussion: There are different types of IGB that vary in their composition (material), volume and contents. Some balloons can be excreted via digestive tract, while some need to be removed endoscopically. Complications are very common and vary in severity such as nausea, vomiting or gastric ulceration or perforation. Management options include endoscopic retrieval of balloon, manual passage of balloon through the GI tract or open/laparoscopic surgery. Conclusion: The initial approach to the treatment of migrated intragastric balloons causing small-bowel obstruction should be determined by the type of balloon used, location of impaction and degree of obstruction. Prompt and accurate treatment could prevent life-threatening complications. Highlights:

Introduction: Acute appendicitis is a disease with multifactorial etiology and frequently includes lumen obstruction. Appendicoliths can pose a challenge during the appendectomy procedure if not identified. Methods: This is a prospective case series at our academic institution involving two medically free patients with intra-abdominal abscess formation secondary to an overlooked appendicolith who were treated conservatively with a follow up period of one year for each patient. Results: Complications of a retained appendicolith are serious and include intra-abdominal abscess, perihepatic abscess, and delayed wound healing through fistula formation, most surgeons would undergo surgical removal with preoperative localization of the appendicolith using different modalities. In contrast, conservative management is an emerging approach to managing such conditions. The conservative approach involves percutaneous retrieval and the IR-guided draining of an intra-abdominal collection. In our cases, percutaneous drainage and intravenous antibiotics were a successful treatment, with no abscess recurrence in over a year. Conclusion: We suggest that patients with appendicoliths presenting with appendicitis should undergo appendicolith removal to prevent the risk of recurrent abscess formation. We also consider that the conservative management of patients with appendicoliths presenting with recurrent abdominal pain and abscesses after appendectomy is a better and safer approach than the surgical removal of a dropped appendicolith, as the risks of the surgical procedure complications can be avoided. Highlights:

Background: Whole blood is a product that contains all three blood components (plasma, red blood cells, and platelets). This systemic review and meta-analysis was conducted to identify barriers and obstacles to establishing whole blood transfusion protocols in civilian hospitals. Methods: The study was conducted using PRISMA guidelines with PROSPERO registration No. CRD42024519898. Traumatic patients who needed or received whole blood transfusion were included. A systematic literature review employed a comprehensive search strategy through the PubMed, Google Scholar, Web of Science, ScienceDirect, and ProQuest databases. Meta-analysis was utilized to analyze the outcomes. The risk of bias was assessed using the Newcastle–Ottawa Scale. Results: In total, 310 studies were identified, and 11 studies met the inclusion criteria. The following intervals were used to assess the prevalence of mortality: 6 h 12.15% (0.081, 95% CI [0.023, 0.139]), 24 h 14.08% (0.141, 95% CI [0.111, 0.171]), delayed mortality (28–30 days) 22.89% (0.284, 95% CI [0.207, 0.360]), and in-hospital 18.72%, with relative risk (0.176, 95% CI [0.114,0.238]). Conclusions: Traumatic patients can be effectively resuscitated and stabilized with whole blood transfusion (WBT), but it is essential to provide ongoing critical care, address logistical challenges, and prevent blood product wastage. We recommend utilizing WBT in the early stages of resuscitation for adult civilian trauma patients.