The AIR score is accurate at excluding appendicitis in those deemed low risk and more accurate at predicting appendicitis than the Alvarado score in those deemed high risk. Its use as the basis for selective CT imaging in those deemed medium risk should be considered.

The prevalence of pancreatic diseases needing surgical intervention is continuously rising. Distal pancreatectomy is performed in the case of pathologies affecting the left side of the pancreas. More and more sophisticated surgical techniques have appeared and an increasing number of published articles discuss the possibilities for closure of the pancreatic remnant. However, the optimum solution is still under debate, as none of the examined techniques have been proven superior in reducing the incidence of the most common surgical complication, the formation of a postoperative pancreatic fistula (PF). Fistula rates have been stationary at 20-30% in the past decades despite the apparent advancement of medicine. This review presents a survey of the relevant articles examining different closure strategies and risk factors to reduce fistula formation rate. International medical publication database search and assessment was carried out to include the findings of studies investigating the efficacy of pancreatic remnant closure techniques to gain a clearer view on the complexity of pancreas fistulas. Emphasis is on indications for surgery, risk factors for postoperative fistula formation and strategies to seal the pancreatic remnant to avoid leakage. Findings suggest that careful patient selection, meticulous surgical techniques are equally important to reduce fistula rates. Ideal closure of the pancreatic remnant is still to be developed, as none of the widespread techniques (hand-sewn suture or staple closure) proved to be statistically significantly superior. Additional closure and covering methods (seromuscular patch, falciform ligament patch, pancreatico-enteric anastomosis, reinforced staplers, fibrin glue etc.) can have profitable effect but strong evidences are yet to come due to small case numbers. The recent introduction of standardized classification of PFs and future prospective randomized trials are more likely to be susceptible to determine if any of the standard or experimental closure techniques is more beneficial than the others.

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Background There is no consensus regarding the role of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (OABP) in reducing postoperative complications in colorectal surgery. The aim of this study was to examine the effect of OABP given in addition to MBP in the setting of a prospective randomized trial. Methods Patients awaiting elective colorectal surgery in four Hungarian colorectal centres were included in this multicentre, prospective, randomized, assessor-blinded study. Patients were randomized to receive MBP with or without OABP (OABP+ and OABP– groups respectively). The primary endpoints were surgical-site infection (SSI) and postoperative ileus. Secondary endpoints were anastomotic leak, mortality, and hospital readmission within 30 days. Results Of 839 patients assessed for eligibility between November 2016 and June 2018, 600 were randomized and 529 were analysed. Trial participation was discontinued owing to adverse events in seven patients in the OABP+ group (2.3 per cent). SSI occurred in eight patients (3.2 per cent) in the OABP+ and 27 (9.8 per cent) in the OABP– group (P = 0.001). The incidence of postoperative ileus did not differ between groups. Anastomotic leakage occurred in four patients (1.6 per cent) in the OABP+ and 13 (4.7 per cent) in the OABP– (P = 0.02) group. There were no differences in hospital readmission (12 (4.7 per cent) versus 10 (3.6 per cent); P = 0.25) or mortality (3 (1.2 per cent) versus 4 (1.4 per cent); P = 0.39). Conclusion OABP given with MBP reduced the rate of SSI and AL after colorectal surgery with anastomosis, therefore routine use of OABP is recommended.

Introduction: Blunt or penetrating pancreatic trauma represents only 0.2-2% of all trauma cases and approximately 3-12% of all abdominal injuries. While treatment protocol debates of other intra-abdominal and thoracic organ injuries seem to reach comforting conclusions, satisfying evidence-based recommendations regarding the pancreas have not been released yet. However, high grade trauma of the pancreas can lead to substantial morbidity and mortality. The question is, when and how to treat it conservatively or operatively. Objectives/Methods: This study is a review of contemporary literature on children and adult pancreatic trauma management strategies and findings. The purpose is to evaluate current classifications and the efficacy of subsequent non-operative and operative treatments. We list the established grading systems starting from physical examination, imaging diagnosis, to indications for surgery or conservative management, followed by post-treatment morbidity and mortality rates. Conclusions: Current operative or non-operative management strategies are not based on randomized -or even, in fact, on prospective -clinical trials. Most of the available publications demonstrate small retrospective patient cohorts and expert opinions. To date, no convincing high level (at least Level III) evidence-based recommendations have been published in terms of treatment of these injuries. There is a general agreement, that the injury of the main pancreatic duct is the thin red line, dividing conservative and operative strategies. Low grade pancreatic injury can be treated conservatively not significantly different from protocols developed for mild pancreatitis of other origin. Pancreatic duct damage in adults requires either minimal invasive intervention or exploration and reconstruction/resection via laparotomy. Treatment strategies of high grade paediatric pancreatic injuries remain controversial. Associated organ injuries can mask the symptoms of pancreatic trauma. Missed main pancreatic duct injuries pose a clinically challenging situation with serious complications and considerable mortality. Pancreatic injury in polytrauma poses the highest risk. Present perspectives for survival of pancreatic injury as mono trauma varies between 95-100%, while as a part of polytrauma, the mortality rate is as high as 30-35%. Multicentre prospective, randomized clinical trials would be ideal to support optimal decision making. Heterogeneity of cases and relative rarity of the pathology makes the creation of such a database highly unlikely.Pancreatic injury makes up a relatively small proportion of trauma cases: the pancreas is affected in 0.2-2% of all trauma patients and in 2-12% of all