Aim The aim of the present work was to perform an up‐to‐date review of the literature on endoluminal negative pressure therapy for colorectal anastomotic leak. Method An electronic search in PubMed and Google Scholar and a manual search without language restrictions were performed on 25 January 2019. Only original series reporting endoluminal negative pressure therapy in colorectal anastomotic leaks were included. The primary outcome was the success rate (complete closure of the abscess cavity). The secondary outcomes were the rates of complications and stoma closure. Results Nineteen series with a total of 295 cases were analysed. The median distance of the anastomosis from the anal verge and the size of the abscess were 5.65 cm (4.9–10) and 6.0 cm (5–8.1) respectively. In 84.5% (78%–91%) the stoma was created at the first intervention. Neoadjuvant therapy was performed in 48.6% (3%–60%). Median 7 sponges (2–34) were used with median negative pressure 150 mmHg (125–700) for a median of 31 days (14–127). The success rate was 85.4% (80%–91%) with ileostomy closure in 72.6%. Complications were observed in 19% (13%–25%): abscesses 11.5% and anastomotic stenosis 4.4%. Laparotomy was required in 15% of the complications. The stoma was the only significant predictor for the success of the therapy (0.007, SE 0.004, P = 0.040). Conclusions The initial experience looks promising with an 85% success rate, which precludes risky re‐resections with redo anastomosis or Hartmann's procedure. Despite the good initial results, definitive conclusions cannot be drawn because of the small sample size and the lack of high‐quality comparative studies.

The results clearly suggest the obvious advantage of VAC in comparison to the temporary abdominal closure without negative pressure in the cases with severe diffuse peritonitis. However, to a large extent, our results might be attributed to the combination of VAC with dynamic fascial closure.

Introduction Damage control surgery (DCS) is the classic approach to manage severe trauma and has recently also been considered an appropriate approach to the treatment of critically ill patients with severe intra-abdominal sepsis. The purpose of the present review is to evaluate the outcomes following DCS for Hinchey II–IV complicated acute diverticulitis (CAD). Methods A comprehensive systematic search was undertaken to identify all randomized clinical trials (RCTs) and observational studies, irrespectively of their size, publication status, and language. Adults who have undergone DCS for CAD Hinchey II, III, or IV were included in this review. DCS is compared with the immediate and definitive surgical treatment in the form of HP, colonic resection, and primary anastomosis (RPA) with or without covering stoma or laparoscopic lavage. We searched the following electronic databases: PubMed MEDLINE, Scopus, and ISI Web of Knowledge. The protocol of this systematic review and meta-analysis was published on Prospero (CRD42020144953). Results Nine studies with 318 patients, undergoing DCS, were included. The presence of septic shock at the presentation in the emergency department was heterogeneous, and the weighted mean rate of septic shock across the studies was shown to be 35.1% [95% CI 8.4 to 78.6%]. The majority of the patients had Hinchey III (68.3%) disease. The remainder had either Hinchey IV (28.9%) or Hinchey II (2.8%). Phase I is similarly described in most of the studies as lavage, limited resection with closed blind colonic ends. In a few studies, resection and anastomosis (9.1%) or suture of the perforation site (0.9%) were performed in phase I of DCS. In those patients who underwent DCS, the most common method of temporary abdominal closure (TAC) was the negative pressure wound therapy (NPWT) (97.8%). The RPA was performed in 62.1% [95% CI 40.8 to 83.3%] and the 22.7% [95% CI 15.1 to 30.3%]: 12.8% during phase I and 87.2% during phase III. A covering ileostomy was performed in 6.9% [95% CI 1.5 to 12.2%]. In patients with RPA, the overall leak was 7.3% [95% CI 4.3 to 10.4%] and the major anastomotic leaks were 4.7% [95% CI 2.0 to 7.4%]; the rate of postoperative mortality was estimated to be 9.2% [95% CI 6.0 to 12.4%]. Conclusions The present meta-analysis revealed an approximately 62.1% weighted rate of achieving GI continuity with the DCS approach to generalized peritonitis in Hinchey III and IV with major leaks of 4.7% and overall mortality of 9.2%. Despite the promising results, we are aware of the limitations related to the significant heterogeneity of inclusion criteria. Importantly, the low rate of reported septic shock may point toward selection bias. Further studies are needed to evaluate the clinical advantages and cost-effectiveness of the DCS approach.

The transition towards a circular economy requires fundamental changes to production and consumption systems, going well beyond resource efficiency and recycling waste.Circular economy is a closed cycle covering each of the three areas: the supply and responsible choice of the producers, the demand and the consumer behaviour and the waste management. It is a model aiming at preserving and increasing the value of resources used in production and consumption, while reducing their impact on the environment, during the whole life cycle of the products. Circular economy has as its immediate objective an optimal management of all resources (material resources, energy sources, water and land use being the main issues). The objectives are to be pursued: create new opportunities for growth and economic performance while reducing resource use, boost the competitiveness and limit the environmental impacts of resource use.This change was recognized in Europe, with the European Commission"s Communication "Roadmap to a Resource Efficient Europe", published in January 2011(COM(2011) 571). In the following years, many European Union and national public policies and programmes were designed and introduced in order to keep abreast of the profound changes the model of circular economy and society brings into our world. In order to successfully meet the EU's resource efficiency targets by 2030, the transition to a circular economy model should become a state priority. The aim of this paper is to draw out the differences and similarities between the EU countries regarding the transition to a circular economy model and to assess progress on this basis. Quantitative and qualitative research methods were employed for data collection and analysis: database research and analysis, descriptive statistics, cluster analysis. The survey results indicate the presence of too much heterogeneity among EU countries in the transition to a circular economy. This suggests that, in parallel with private sector initiatives, public authorities should coordinate, support and promote environmental, economic and social changes leading to accelerate this transition.

At the end of 2019, the European Commission presented its new long-term vision for the development of the EU. A strategy for growth, a fair environmental transition, a resource-efficient and low-carbon economy are the key highlights of this ambitious strategy for the next decade. Built on the Sustainable Development Goals (SDGs), this transformation goes through a complete change in the production and territorial infrastructure. It covers a whole set of activities, new practices and business models, interconnected and hierarchically ordered, according to their contribution to optimizing the use of raw materials and energy. The circular economy refers to the ability of an economy to grow while the use of resources decreases. The aim of this paper is to analyse the relationship between key indicators presenting the countries progress of transition to the circular economy, and a group of factors related to investment in R&D, green technologies and waste recovery and on this basis to outline the opportunities that the European Green Deal opens up for a faster and more efficient transformation of the economy from linear to circular. Comparative analysis between three clusters of EU countries is made. Time series analysis and correlation analysis along with comparative analysis are applied in the research. The conclusions reached point to the still existing connection with the linear model of development and the delay of the transition to a model of real circular economy. Efforts done till now have yielded results, but for the active "closure" of the circle active policies, synchronized actions by government, business and society are needed. This requires adequate measures taken by the public authorities and decisive reforms in the eco-innovation policy.