Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines
Authors: Coccolini Federico , Sartelli Massimo , Sawyer Robert , Rasa Kemal , Viaggi Bruno , Abu-Zidan Fikri , Soreide Kjetil , Hardcastle Timothy , Gupta Deepak , Bendinelli Cino , Ceresoli Marco , Shelat Vishal G. , Broek Richard ten , Baiocchi Gian Luca , Moore Ernest E. , Sall Ibrahima , Podda Mauro , Bonavina Luigi , Kryvoruchko Igor A. , Stahel Philip , Inaba Kenji , Montravers Philippe , Sakakushev Boris , Sganga Gabriele , Ballestracci Paolo , Malbrain Manu L. N. G. , Vincent Jean-Louis , Pikoulis Manos , Beka Solomon Gurmu , Doklestic Krstina , Chiarugi Massimo , Falcone Marco , Bignami Elena , Reva Viktor , Demetrashvili Zaza , Di Saverio Salomone , Tolonen Matti , Navsaria Pradeep , Bala Miklosh , Balogh Zsolt , Litvin Andrey , Hecker Andreas , Wani Imtiaz , Fette Andreas , De Simone Belinda , Ivatury Rao , Picetti Edoardo , Khokha Vladimir , Tan Edward , Ball Chad , Tascini Carlo , Cui Yunfeng , Coimbra Raul , Kelly Michael , Martino Costanza , Agnoletti Vanni , Boermeester Marja A. , De’Angelis Nicola , Chirica Mircea , Biffl Walt L. , Ansaloni Luca , Kluger Yoram , Catena Fausto , Kirkpatrick Andrew W. 
Published: July 2023

Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.