Surgery in the COVID-19 Era: A Narrative Review.

The coronavirus disease 2019 (COVID-19) pandemic affected the delivery of surgical care and services. This review article aims to appraise the impact of COVID-19 on surgical care. The authors discuss the literature on surgery and COVID-19 under the following themes: emergency case triaging, elective surgery triaging, operating on a COVID-19-positive patient, surgical smoke, management of scarce resources, and restarting elective surgery. Most of the large surgical societies recommended and most surgical departments all over the world implemented the cancellation of elective surgeries, while emergency surgeries proceeded as usual. Elective surgeries were triaged taking into consideration the COVID-19 infection rate in the locality, availability of resources, and the need for intensive care unit beds and ventilators. A COVID-19-positive patient should not be denied surgery if indicated, and the recommended precautions and use of personal protective equipment should be adhered to. The generation of surgical smoke occurs in both laparoscopic and open surgeries, and it has not been shown to contain this novel virus. Smoke generation should be minimized and laid down guidelines followed. Laparoscopic surgery seems to have an advantage over open surgery in this regard. In resuming elective surgeries, the local infection rates, bed occupancy rate, and availability of resources should be taken into cognizance. We should learn from this pandemic so as to be prepared for future occurrences, which is a significant possibility.

La pandémie de maladie à virus Corona 2019 (COVID-19) a affecté la prestation de soins et de services chirurgicaux. Cet examen dans notre article vise à évaluer l'impact des Covid-19 sur la chirurgie des soins. Les auteurs discutent de la littérature sur la chirurgie et Covid-19 sous les thèmes suivants: cas urgence triaging, la chirurgie élective triant, opérant sur un patient positif Covid-19, la fumée chirurgicale, la gestion des ressources rares et le redémarrage de la chirurgie élective. La plupart des grandes sociétés chirurgicales recommandaient, et la plupart des services de chirurgie du monde entier ont mis en oeuvre l'annulation des chirurgies électives tandis que les chirurgies d'urgence se déroulaient comme d'habitude. Sur électifs Guéries ont été triés en prenant en considération la Covid -19 taux d'infection dans la localité, la disponibilité des ressources et la nécessité d'I intensive C sont Unit (USI) lits et des ventilateurs. Un Covid -19 patients positif ne doit pas se voir refuser la chirurgie si cela est indiqué, et les précautions recommandées et l'utilisation d'Équipement de protection PERSONNEL LES (EPP) doivent être respectées. La génération de fumée chirurgicale se produit à la fois en chirurgie la périscopique et en chirurgie ouverte et il n'a pas été démontré qu'elle contenait ce nouveau virus. La production de fumée doit être réduite au minimum et des directives établies doivent être suivies. La chirurgie laparoscopie semble avoir un avantage sur la chirurgie ouverte dans ce domaine. En résumant les chirurgies électives, t- il des taux d'infection locale, le taux d'occupation des lits et la disponibilité des ressources devraient être prises en connaissance. Nous devons tirer les leçons de cette pandémie pour nous préparer à de futures occurrences, ce qui est une possibilité importante.

Presentation and outcomes of acute appendicitis during COVID-19 pandemic: lessons learned from the Middle East-a multicentre prospective cohort study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic had a striking impact on healthcare services in the world. The present study aimed to investigate the impact of the COVID-19 pandemic on the presentation management and outcomes of acute appendicitis (AA) in different centers in the Middle East. METHODS: This multicenter cohort study compared the presentation and outcomes of patients with AA who presented during the COVID-19 pandemic in comparison to patients who presented before the onset of the pandemic. Demographic data, clinical presentation, management strategy, and outcomes were prospectively collected and compared. RESULTS: Seven hundred seventy-one patients presented with AA during the COVID pandemic versus 1174 in the pre-COVID period. Delayed and complex presentation of AA was significantly more observed during the pandemic period. Seventy-six percent of patients underwent CT scanning to confirm the diagnosis of AA during the pandemic period, compared to 62.7% in the pre-COVID period. Non-operative management (NOM) was more frequently employed in the pandemic period. Postoperative complications were higher amid the pandemic as compared to before its onset. Reoperation and readmission rates were significantly higher in the COVID period, whereas the negative appendicectomy rate was significantly lower in the pandemic period (p = 0.0001). CONCLUSION: During the COVID-19 pandemic, a remarkable decrease in the number of patients with AA was seen along with a higher incidence of complex AA, greater use of CT scanning, and more application of NOM. The rates of postoperative complications, reoperation, and readmission were significantly higher during the COVID period.

Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis.

BACKGROUND: Non-operative management (NOM) of acute appendicitis has been assessed in several studies before COVID-19 pandemic. This systematic review aimed to assess the extent of adoption, efficacy, and safety of NOM of acute appendicitis in the setting of COVID-19. METHODS: This was a PRISMA-compliant systematic review of the literature. Electronic databases and Google Scholar were queried for studies that applied NOM of acute appendicitis during COVID-19. The main outcome measures were the rates of NOM application during the pandemic as compared to the pre-pandemic period, failure and complication rates of NOM. Failure was defined as the need for appendectomy during NOM and complications included development of appendicular mass or abscess. RESULTS: Fourteen studies (2140 patients) were included. The male to female ratio was 1.44:1 and median age was 34. Nine hundred fifty-nine (44.8%) patients had a trial of NOM. The weighted mean rate of NOM application was 50.1% (95%CI: 29.8-70.5%). The application of NOM during the pandemic was significantly more likely than its application before COVID-19 (OR = 6.7, p < 0.001). The weight mean failure rate of NOM was 16.4% (95%CI: 9.4-23.4). NOM failure was more likely in children and patients with complicated appendicitis. The weighted mean complication rate after NOM was 4.5% (95%CI: 1.4-7.7). NOM had significantly lower odds for complications than appendectomy (OR = 0.36, p = 0.03). There was no mortality after application of NOM. CONCLUSION: NOM of acute appendicitis in the setting of COVID-19 may be a safe, short-term alternative to surgery with acceptably low failure and complication rates.

Bariatric surgery during COVID-19 in the UK: a British Obesity and Metabolic Surgery Society (BOMSS) survey.

BACKGROUND: After the declaration of COVID-19 as a pandemic last March 2020, several adjustments in surgical services were implemented. Plans are now being formulated for restarting bariatric surgery. The aim of this survey is to capture the practice during the pandemic and the readiness to restart to provide a framework to deal with the backlog of bariatric cases. METHOD: A survey was delivered to consultant surgeon members of the British Obesity and Metabolic Surgery Society and non-bariatric surgery consultant members of the Association of Upper GI Surgeons. RESULTS: The survey elicited a response rate of 40% (n = 66) among bariatric surgeons and 15.5% (n = 34) between non-bariatric surgeons. The average question response rate was 93% (88-100%). Most of the elective bariatric surgeries and clinics were cancelled early after declaration of the pandemic. Remote technologies for patient education evolved and were used heavily during the pandemic. The average cancelled elective bariatric surgery operations per week was 9. Nearly a quarter of responders reported performing emergency bariatric surgery during the pandemic. Most of the bariatric surgeons reported being ready to restart the service within 1-2 months. Responders recommended using private sector beds to increase NHS capacity and using the link between obesity and poor COVID-19 outcomes to push for prioritisation of bariatric patients. CONCLUSION: This survey is an attempt to understand the impact of COVID-19 on UK bariatric service and the preparedness to restart. It expressed the bariatric surgery consultants' view of prioritisation of bariatric patients on clinical basis rather than the first-come-first-served basis.

A critical review of the safety of minimally invasive surgery in the era of COVID-19.

BACKGROUND: The Corona virus disease 2019 (COVID-19) pandemic has affected surgical practice around the world. While several abdominal emergencies can be managed effectively and safely using minimally invasive surgery (MIS), the safety of using MIS amid the COVID-19 pandemic has been debated. MIS, including laparoscopy and robotic surgery, is considered an aerosol-generating procedure and some recent research demonstrated possible spread of the virus through aerosol. This review assessed the available evidence on the safety of MIS in the COVID-19 era, explored the possible precautions to be taken when using MIS to prevent exposure of the operating team to infection, and highlighted the recommendations of several surgical societies in this regard. MATERIAL AND METHODS: Electronic databases, Google Scholar, and pre-print archives were searched for evidence on airborne transmission of COVID-19 and the safety of MIS amid the COVID-19 pandemic. Recommendations of recognized surgical societies were also searched. The available evidence was summarized in a narrative manner. RESULTS: Limited data on the possibility of airborne transmission of COVID-19 were found. The studies that reported on the presence of the SARS-COV-2 in the air samples of patients with COVID-19 had conflicting results. Several precautions to minimize the presumed risk of exposure of the operation room staff to COVID-19 were devised. CONCLUSION: According to the available evidence and recommendations of different surgical societies, MIS may be used in the treatment of acute abdominal emergency. However, considerable caution should be taken to avoid the presumed risk of aerosolization of the virus particles during the procedure, which may expose the operating staff to the risk of COVID-19.