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Background/Objectives: Abdominal sepsis remains a major contributor to morbidity and mortality among surgical and critically ill patients worldwide. Timely diagnosis is frequently hindered by the overlapping clinical and biochemical features of postoperative inflammatory responses and evolving intra-abdominal infections, which may resemble systemic sepsis. Conventional biomarkers, including C-reactive protein (CRP) and procalcitonin (PCT), are widely implemented in clinical practice but demonstrate suboptimal specificity in differentiating infectious from sterile inflammatory conditions in the early postoperative phase. Presepsin (soluble CD14 subtype, sCD14-ST), a circulating fragment released during monocyte–macrophage activation in response to bacterial endotoxins, has emerged as a biomarker reflecting innate immune engagement. This review aims to critically evaluate the current evidence regarding the diagnostic accuracy, prognostic relevance, and potential clinical role of presepsin in abdominal sepsis. Methods: A comprehensive narrative review of the biomedical literature was performed using MEDLINE (via PubMed) and supplementary academic sources. Studies assessing the diagnostic performance, prognostic associations, and clinical applicability of presepsin in abdominal infections, postoperative infectious complications, and sepsis were systematically examined. Where available, comparative analyses with established biomarkers such as CRP and PCT were evaluated to contextualize its incremental value within existing diagnostic frameworks. Results: The accumulated evidence indicates that presepsin concentrations increase early during bacterial infections and correlate with validated severity indices, organ dysfunction scores, and mortality outcomes. Across multiple surgical and intensive care settings, presepsin demonstrated moderate-to-high diagnostic performance, frequently comparable to and occasionally exceeding that of traditional inflammatory biomarkers, particularly in distinguishing septic from non-septic inflammatory states. Moreover, dynamic changes in circulating levels appear to provide additional prognostic information and may support longitudinal clinical assessment. Nonetheless, substantial heterogeneity in study design, patient populations, sampling strategies, and reported cut-off values limits direct cross-study comparability and constrains definitive clinical recommendations. Conclusions: Presepsin represents a biologically plausible and clinically promising biomarker for the early identification and risk stratification of abdominal sepsis. Although current findings are encouraging, further large-scale, methodologically standardized prospective investigations are required to define optimal diagnostic thresholds and to clarify their role within multimodal biomarker strategies in contemporary sepsis management.

Colorectal cancer (CRC) is a leading cause of cancer-related deaths and obesity is a known risk factor for its development and poor prognosis. Adipose tissue (AT) actively contributes to CRC progression and cachexia. Here, we investigated molecular crosstalk between tumor cells and different visceral AT depots (normal, intra- and peri-tumoral), focusing on metabolic and (epi)genetic alterations. Using WGS analysis, we explored VAT role in CRC progression, demonstrating how its proximity to the tumor impacts metabolic and phenotypic changes. Intra-VAT (within 5 cm of lesion), closest to the tumor, underwent significant metabolic remodeling, characterized by upregulation of markers of the white-brown AT transition (UCP-1, TMEM26), lipid metabolism (PON3) and a reduction in adipocyte turnover (Pref-1, adiponectin). Peri-VAT (within 15 cm) and HVAT (over 15 cm) exhibited progressively fewer alterations, suggesting a gradient effect of tumor on surrounding AT. Intra-VAT displayed increased fibrosis (TGF-β, collagen) and cachexia-related markers (IL-8), and mutations in key oncogenes (KRAS, HLA, MET), highlighting a direct interaction between tumor cells and AT driving CRC progression. Mutations in genes such as KRAS, HLA, and PIK3CA were shared between CRC and its Intra-VAT, indicating potential biomarkers for tumor progression and immune evasion. miRNA analysis revealed upregulation of miR-21 and miR-92a in Intra-VAT, with circulating miR-92a correlating with increased body fat and decreased lean mass in CRC patients, suggesting their involvement in both local metabolic remodeling and systemic changes. Altered PON3 DNA methylation patterns were also observed, correlating with metabolic parameters. Our findings underscore AT’s critical role in the CRC microenvironment as an active player in CRC progression and cachexia. Metabolic and genetic alterations decreased in VAT with increasing distance from the tumor. Intra-VAT may serve as a critical therapeutic target and biomarker for CRC progression, impacting surgical and postoperative strategies. Future studies should focus on targeting tumor-adipose crosstalk to improve treatment outcomes, including experimental validation of the identified genetic alterations and investigation of their functional roles in tumor progression and immune evasion.

Background Mild acute biliary pancreatitis (MABP) presents significant clinical and economic challenges due to its potential for relapse. Current guidelines advocate for early cholecystectomy (EC) during the same hospital admission to prevent recurrent acute pancreatitis (RAP). Despite these recommendations, implementation in clinical practice varies, highlighting the need for reliable and accessible predictive tools. The MINERVA study aims to develop and validate a machine learning (ML) model to predict the risk of RAP (at 30, 60, 90 days, and at 1-year) in MABP patients, enhancing decision-making processes. Methods The MINERVA study will be conducted across multiple academic and community hospitals in Italy. Adult patients with a clinical diagnosis of MABP, in accordance with the revised Atlanta Criteria, who have not undergone EC during index admission will be included. Exclusion criteria encompass non-biliary aetiology, severe pancreatitis, and the inability to provide informed consent. The study involves both retrospective data from the MANCTRA-1 study and prospective data collection. Data will be captured using REDCap. The ML model will utilise convolutional neural networks (CNN) for feature extraction and risk prediction. The model includes the following steps: the spatial transformation of variables using kernel Principal Component Analysis (kPCA), the creation of 2D images from transformed data, the application of convolutional filters, max-pooling, flattening, and final risk prediction via a fully connected layer. Performance metrics such as accuracy, precision, recall, and area under the ROC curve (AUC) will be used to evaluate the model. Discussion The MINERVA study aims to address the specific gap in predicting RAP risk in MABP patients by leveraging advanced ML techniques. By incorporating a wide range of clinical and demographic variables, the MINERVA score aims to provide a reliable, cost-effective, and accessible tool for healthcare professionals. The project emphasises the practical application of AI in clinical settings, potentially reducing the incidence of RAP and associated healthcare costs. Trial registration ClinicalTrials.gov ID: NCT06124989.

Purpose Although surgery is the most effective treatment for rectal prolapse, a risk of recurrence reported in literature is 6–27%. The aim of this meta-analysis is to compare the abdominal and perineal approach for surgical treatment of recurrent external rectal prolapse. Methods A systematic search of PubMed and Embase was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive literature search of PubMed and Embase was conducted from January 2000 to May 2024, for studies reporting surgery for recurrent external rectal prolapse. The primary outcome was the recurrence at the last available follow-up. Secondary endpoints included surgical complications and length of postoperative hospitalization. Results Nine studies, with a total of 531 patients, were included in the analysis. The overall recurrence rate among the studies was 26.3% at a mean follow-up time of 30.5 months. The proportional meta-analysis showed a recurrence rate of 27.9% (95% CI 22.54 to 33.85, I 2 75.1%, p  = 0.0012) after perineal surgery and of 15.6% (95% CI 11.43 to 20.64, I 2 63.7%, p  = 0.016) after abdominal surgery. Comparing the two approaches, the meta-analysis showed an OR of 0.66 (95% CI 0.41 to 1.17, I 2 66.5%, p  = 0.029). The OR for complications was 1.44 (95% CI 0.77 to 2.70, I 2 0.0%, p  = 0.945), while SMD for length of hospital stay was 0.49 (95% CI 0.20 to 0.79, I 2 - 67.9%, p = 0.077). Conclusions Our meta-analysis revealed that the recurrence rate for the perineal approach was almost double the recurrence rate for the abdominal approach. More randomized trials are needed to determine which is the best approach for patients with recurrent external rectal prolapse.

Purpose Acute appendicitis (AA) is the leading cause of acute abdomen worldwide, with an incidence of 90–100 cases per 100,000 individuals annually and a lifetime risk of 7–12%. Despite its prevalence, historical accounts of AA are limited, particularly when compared to conditions like haemorrhoids, likely due to the appendix’s internal location. This article traces the historical evolution of AA treatment from ancient times to the present, highlighting key contributions. Methods A review of common research databases and relevant literature on AA was conducted. Results Evidence from ancient Egypt suggests early recognition of the appendix, referring to it as the “worm of the bowel.” However, detailed anatomical descriptions and treatment approaches for AA did not emerge until the Renaissance, particularly with contributions from Leonardo da Vinci and Berengario da Carpi. The article traces the progression of AA management, including the first autopsies and surgeries, the development of surgical techniques predating anaesthesia and antisepsis, and advancements achieved from the nineteenth to the twenty-first century. The shift from conservative to surgical approaches is discussed, alongside innovations such as laparoscopic appendicectomy, single-incision laparoscopic surgery (SILS), natural orifice transluminal endoscopic surgery (NOTES), and endoscopic retrograde appendicitis therapy (ERAT). The impact of the COVID-19 pandemic on AA treatment, including adaptations in medical practices, is also explored. Conclusions This review highlights the significant historical developments in AA treatment and its pivotal role in advancing abdominal surgery.

Wearable devices are increasingly utilised to monitor patients perioperatively, allowing for continuous data collection and early complication detection. There is considerable variability in the types and usage settings of wearables, particularly within colorectal surgery. To address this, a scoping review was conducted to investigate current utilisation of wearable devices in colorectal surgery. A systematic search across MEDLINE and Embase was conducted following PRISMA Scoping Review guidelines. Results were synthesised narratively, categorised by perioperative phase (preoperative; postoperative; combination), and supplemented with descriptive statistics and tables. Out of 1525 studies initially identified, 20 were included, reporting data on 10 different wearable devices. Use of wearable devices varied across settings with those used preoperatively tending to focus on baseline physical status or prehabilitation, while postoperative use centred around monitoring and identification of complications. Wearable devices can enhance perioperative monitoring, enable proactive interventions, and promote personalised care for improved patient outcomes in colorectal surgery.

Purpose Crohn’s disease (CD) frequently requires surgery, with ileocolonic resection being the most common procedure. Postoperative endoscopic recurrence remains a major concern, and the role of anastomotic configuration is still debated. This systematic review and meta-analysis aimed to evaluate the impact of different anastomotic techniques on early endoscopic recurrence following ileocolonic resection for CD. Methods A systematic search of PubMed, Embase, and Web of Science was performed up to July 2025. Studies comparing stapled side-to-side anastomosis (SSA), handsewn end-to-end anastomosis (EEA), and Kono-S anastomosis (KSA) with postoperative endoscopic follow-up at 6–12 months were included. Study quality was assessed using the Newcastle–Ottawa Scale. Pooled analyses were conducted to compare recurrence rates across anastomotic types. Results Eleven studies were included (four comparing SSA vs. EEA; seven comparing KSA vs. SSA), for a total of 1505 patients. Most were retrospective, with three randomised controlled trials available. In pooled analysis, no significant difference was found between SSA and EEA (48.5% vs. 46.7%, test for overall effect Z = 0.41, p  = 0.6795). KSA showed a trend towards lower recurrences compared with SSA (31.8% vs. 39.8%, test for overall effect Z = −1.96, p  = 0.0495), although heterogeneity in study design, definitions, and postoperative management limits firm conclusions. Conclusions Current evidence does not support a difference in early endoscopic recurrence between SSA and EEA and a potential but weak overall association with lower recurrences for KSA compared to SSA. Large, high-quality prospective trials with standardised definitions, postoperative medical therapy, and follow-up protocols are warranted to clarify the true impact of anastomotic configuration on outcomes in CD.

Anal fissure is one of the most common proctological pathologies. It consists of the formation of a longitudinal tear in the anoderm, causing pain and bleeding during and after defecation. When chronic, it can significantly negatively impact the quality of life of the affected patient. Currently, multiple therapeutic options are available, both medical and surgical. The objective of this article is to highlight the historical evolution in the physiopathological understanding and treatment of this disease, underlining the key moments in this history. This is the first article to summarize the milestones in the treatment of anal fissure from ancient to current times.

Introduction Intra-abdominal abscesses complicating Crohn’s disease (CD) present an additional challenge as their presence can contraindicate immunosuppressive treatment whilst emergency surgery is associated with high stoma rate and complications. Treatment options include a conservative approach, percutaneous drainage, and surgical intervention. The current multicentre study audited the short-term outcomes of patients who underwent preoperative radiological drainage of intra-abdominal abscesses up to 6 weeks prior to surgery for ileocolonic CD. Methods This is a retrospective, multicentre, observational study promoted by the Italian Society of Colorectal Surgery (SICCR), including all adults undergoing ileocolic resection for primary or recurrent CD from June 2018 to May 2019. The outcomes of patients who underwent radiological guided drainage prior to ileocolonic resection were compared to the patients who did not require preoperative drainage. Postoperative morbidity within 30 days of surgery was the primary endpoint. Postoperative length of hospital stay (LOS) and anastomotic leak rate were the secondary outcomes. Results Amongst a group of 575 included patients who had an ileocolic resection for CD, there were 36 patients (6.2%) who underwent abscess drainage prior to surgery. Postoperative morbidity (44.4%) and anastomotic leak (11.1%) were significantly higher in the group of patients who underwent preoperative drainage. Conclusions Patients with Crohn’s disease who require preoperative radiological guided drainage of intra-abdominal abscesses are at increased risk of postoperative morbidity and septic complications following ileocaecal or re-do ileocolic resection.

Introduction Single-incision laparoscopic surgery (SILS) aims to minimize the surgical access trauma by reducing the number of abdominal incisions to a single site, potentially offering better cosmetic results and decreased postoperative pain. In this study, we compare the results of SILS ileocolic resection for Crohn’s disease (CD) to conventional laparoscopy and open surgery using a propensity score–matched analysis in a retrospective national multicentre study. Methods All consecutive patients undergoing elective SILS ileocaecal or redo ileocolic resection for primary and recurrent CD from 1 June 2018 to 31 May 2019 were included. Patients were matched 1:1:1 with laparoscopy and open surgery according to perianal disease, recurrent disease, penetrating phenotype of CD, history of previous abdominal surgery, preoperative medical treatment with steroids and anti-TNF. Postoperative morbidity within 30 days of surgery was the primary endpoint. Results Fifty-eight patients were included in each group, for a total of 174 patients. The conversion rate for SILS and laparoscopy was 10.3% and 12%, respectively, with no difference in the incidence of postoperative complications (13.8% and 12%, p = 0.77), whilst open surgery demonstrated a worse morbidity profile, with a complication rate of 25.9% ( p < 0.0001). Median length of hospital stay following SILS ileocolic resection was 5 days, significantly shorter compared to 7 days for laparoscopy and 9 for open surgery ( p < 0.0001). Conclusions SILS ileocolonic resection for CD demonstrated a comparable morbidity profile compared to laparoscopy in selected patients, with a reduced length of postoperative hospital stay.