Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines

Area of Science:

• Infectious Diseases
• Surgical Critical Care
• Gastroenterology

Background:

• Intra-abdominal infections (IAI) are a significant global health challenge, often stemming from gastrointestinal tract disruption.
• Despite advanced treatments, high morbidity and mortality persist, largely due to the critical need for effective source control.
• Historically surgical, source control for IAI is evolving with less invasive interventional procedures and open abdomen techniques.

Purpose of the Study:

• To present current opinions and recommendations on the concepts and adequacy of source control in intra-abdominal infections.
• To highlight the evolving, multidisciplinary nature of source control in managing IAI.
• To address the lack of universally accepted definitions and the complexities in assessing source control adequacy.

Main Methods:

• Review of current literature and expert consensus from leading surgical infection societies.
• Analysis of the multifaceted definition of source control, including causative factors, microbial aspects, and patient condition.
• Exploration of advanced techniques and the integration of microbiome and systemic pathobiology understanding.

Main Results:

• Source control is paramount in IAI management, yet its definition and adequacy remain poorly described and lack universal acceptance.
• Effective source control requires a shift from purely surgical interventions to a multidisciplinary, multimodality approach.
• Understanding the microbiome and systemic biomediators is essential for optimizing source control and preventing multi-system organ failure.

Conclusions:

• Adequate source control in IAI is a complex, evolving concept demanding a coordinated, multidisciplinary strategy.
• Future research should focus on defining and standardizing source control techniques and their adequacy assessment.
• Integrating insights into the microbiome and systemic inflammation is key to improving outcomes in intra-abdominal infections.