Background Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28–66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4–10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO 2 ) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0–1, 22.7% for those who had scores of 2–3, 46.8% for those who had scores of 4–5, and 86.7% for those who have scores of 7–8. Conclusions The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.

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 collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands. Graphical abstract

Abdominal sepsis (AS) is one of the most important problems in modern abdominal surgery. Prediction of AS and complications remains a challenge for modern surgery. The aim of the study is to evaluate the prognostic and diagnostic value of clinical and laboratory parameters in order to substantiate the prognostic complex for patients with AS and to improve existing systems for assessing the severity of patients by modification aimed on adapting to the capabilities of clinics.The proposed modification of the severity scoring scale APACHE II, based on the analysis of clinical and laboratory data obtained in 183 patients with acute peritonitis and abdominal sepsis. The complex of physiological parameters and their prognostic significance in AS was determined by in-depth statistical analysis and determination of predicting values.Most of the analyzed indicators had a likely positive prognostic value in the diagnosis and prognosis of AS. At the same time, the predictive value of the qSOFA scale at low values is negligible. Statistically insufficient prognostic value was obtained for increased temperature above 38,0 °C. The data obtained formed the basis for the development of a digital AS and complications prediction system by modifying the APACHE II scale.The proposed patient' severity scale is accessible and sufficiently informative for use in patients with peritonitis and AS. It is recommended that at least two systems for assessing the severity of a patient's condition be combined. Keywords. Acute peritonitis, abdominal sepsis, physiological parameters, prognosis, diagnosis, risk ratio, modification of APACHE score.

In this work, changes in the cytokine profile in patients with common forms of peritonitis with enteral insufficiency were studied. The obtained results were compared in patients who survived after surgery and programmed peritoneal sanation and patients who died in the early postoperative period. The aim of the study was to investigate the dynamics of cytokine profile of patients with common forms of peritonitis complicated by enteral insufficiency in order to determine their prognostic value. Material and methods. The object of the study was the blood of 23 patients with common forms of peritonitis and 17 healthy volunteers. To assess the condition of patients performed a dynamic determination in a comprehensive examination of laboratory markers of endogenous toxemia and systemic inflammatory response syndrome: immunological changes in patients by examining blood cells expressing clusters of CD11a+, CD162+, CD95+, CD16+, and molecules of the main histocompatibility complex HLA-DR+ and the level of interleukins IL-2, IL-4, IL-6. Results. During the study in patients with widespread peritonitis complicated by enteral insufficiency, at the time of hospitalization, there was a six-fold decrease in blood levels of CD11a+ cells and the content of CD162+ and CD16+ cells, respectively, 2,8 and 2 times, compared with healthy people. It has been shown that a single remediation programmed relaparotomy within two weeks effectively corrects these changes except for expression on CD16+ cells, which indicates a low effect of this type of surgery on the elimination of immune complexes. It was found that the concentration in plasma IL-2 increased 5 times and was 27,1% higher than that in almost healthy individuals. At the same time, the level of IL-4 in the blood decreased sharply – 4 times. Plasma IL-6 content also reduced. One week after relaparotomy, the expression of HLA-DR + molecules on immunocompetent cells increased again and was 1,8 times higher than the control parameters. In addition, the content of cytokines in the blood plasma increased sharply: the level of IL-2 exceeded the control by 2,4 times, IL-4 by 4 times, and IL-6 by 2 times. Conclusions. 1. Progressive and noticeable decrease in IL-2 content occurs in patients with widespread peritonitis complicated by enteral insufficiency in the complete absence of IL-4 in the blood on the background of a permanent and significant increase in plasma concentrations of IL-6. 2. Under conditions of suppression of the immune response, due to intoxication of the patient's body, the mechanism of endogenous inhibition of the immune response "IL-6 – corticoliberin – corticotropin – corticosteroids" is additionally realized.

Summary. Inguinal hernioplasty is the most frequently performed surgical operation in the world, but the level of complications still reaches 11 % and of recurrences — 5 %. According to some authors, the reason may be in chronic inflammatory changes of the hernia sac and perihernial tissues. Aim. To study the pathohistological changes of the hernia sac and perihernial tissues of patients with inguinal hernias for development of adequate methods of complications prophylactics. Material and methods. The pathohistological examination of fragments of hernial sac and perihernial tissues of 24 patients with groin hernias was performed. Results and discussion. The investigation detected the signs of chronic inflammation in fragments of tissue of hernial sac in all patients. In 8 (33,3 %) patients the signs of inflammation were found only in fragments of hernial sac, and in 16 (66,7 %) – they were combined with the inflammation of perihernial tissues. Among them, the pronounced signs of chronic inflammation were found in 6 (25,0 %) patients with recurrent groin hernias, they were combined with the pronounced scarring changes of hernial sac and perihernial tissues. Conclusions. 1. Chronic inflammatory changes of the hernia sac and perihernial tissues are among the reasons for the development of postoperative complications and recurrences. 2. An important component of prevention of complications can be use of antibacterial and anti-inflammatory drugs.