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1.
BMC Surg ; 22(1): 168, 2022 May 10.
Article in English | MEDLINE | ID: covidwho-1833304

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused a global health crisis in 2020. This pandemic also had a negative impact on standard procedures in general surgery. Surgeons were challenged to find the best treatment plans for patients with acute cholecystitis. The aim of this study is to investigate the impact of the COVID-19 pandemic on the outcomes of laparoscopic cholecystectomies performed in a tertiary care hospital in Germany. PATIENTS AND METHODS: We examined perioperative outcomes of patients who underwent laparoscopic cholecystectomy during the pandemic from March 22, 2020 (first national lockdown in Germany) to December 31, 2020. We then compared these to perioperative outcomes from the same time frame of the previous year. RESULTS: A total of 182 patients who underwent laparoscopic cholecystectomy during the above-mentioned periods were enrolled. The pandemic group consisted of 100 and the control group of 82 patients. Subgroup analysis of elderly patients (> 65 years old) revealed significantly higher rates of acute [5 (17.9%) vs. 20 (58.8%); p = 0.001] and gangrenous cholecystitis [0 (0.0%) vs. 7 (20.6%); p = 0.013] in the "pandemic subgroup". Furthermore, significantly more early cholecystectomies were performed in this subgroup [5 (17.9%) vs. 20 (58.8%); p = 0.001]. There were no significant differences between the groups both in the overall and subgroup analysis regarding the operation time, intraoperative blood loss, length of hospitalization, morbidity and mortality. CONCLUSION: Elderly patients showed particularly higher rates of acute and gangrenous cholecystitis during the pandemic. Laparoscopic cholecystectomy can be performed safely in the COVID-19 era without negative impact on perioperative results. Therefore, we would assume that laparoscopic cholecystectomy can be recommended for any patient with acute cholecystitis, including the elderly.


Subject(s)
COVID-19 , Cholecystectomy, Laparoscopic , Cholecystitis, Acute , Cholecystitis , Acute Disease , Aged , COVID-19/epidemiology , Cholecystectomy, Laparoscopic/methods , Cholecystitis/epidemiology , Cholecystitis/surgery , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/surgery , Communicable Disease Control , Germany/epidemiology , Humans , Pandemics , Retrospective Studies , Tertiary Care Centers , Treatment Outcome
2.
BJS Open ; 6(3)2022 05 02.
Article in English | MEDLINE | ID: covidwho-1821686

ABSTRACT

BACKGROUND: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. METHODS: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. RESULTS: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). CONCLUSION: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic.


Subject(s)
COVID-19 , Cholecystitis, Acute , COVID-19/epidemiology , Cholecystectomy , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/surgery , Humans , Pandemics , SARS-CoV-2
3.
Surg Endosc ; 36(2): 871-880, 2022 02.
Article in English | MEDLINE | ID: covidwho-1640854

ABSTRACT

OBJECTIVE: To acquaint with the presentation and management of the cystic artery aneurysm by enriching the reviewed literature with our own experience. BACKGROUND: Cystic artery pseudoaneurysm is an uncommon entity with varied clinical presentation. Inflammation and trauma are associated with most of the cases. Limited experience with the condition challenges the management of individual cases. MATERIALS AND METHODS: We retrieved all the reported cases of cystic artery pseudoaneurysm, published up to December 2019, from the PubMed database and excluded those arising as postoperative complications. A total of 59 cases were analyzed, and we also included our experience of managing a case of cystic artery pseudoaneurysm. RESULTS: Abdominal pain (77.9%) was the most common presentation followed by upper GI bleed (64.4%), while 19 patients (32.2%) had presented with classic Quincke's Triad. Most of the cases were diagnosed following the rupture of the pseudoaneurysm (n = 49, 83.05%). Fifteen patients presented with shock. Hyperbilirubinemia (59.3%) and anemia (55.9%) were the commonest laboratory findings. Although CT angiogram remains the investigation of choice, a conventional angiogram is the gold standard and sufficed as the definitive management in 20 cases. Cholecystectomy formed the definitive management in the rest of the cases. We successfully managed a middle-aged female patient of cystic artery aneurysm with xanthogranulomatous cholecystitis by open cholecystectomy. CONCLUSION: Cystic artery pseudoaneurysms are amenable to successful management with careful evaluation and timely cholecystectomy or angioembolization or a combination of both.


Subject(s)
Aneurysm, False , Cholecystitis, Acute , Cholecystitis , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Aneurysm, False/surgery , Cholecystectomy , Cholecystitis/surgery , Cholecystitis, Acute/complications , Cholecystitis, Acute/surgery , Female , Hepatic Artery/surgery , Humans , Middle Aged
4.
Rev Assoc Med Bras (1992) ; 67(11): 1681-1686, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1502148

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has affected the health care system in an unpredictable way. In this study, we aimed to analyze the effects of the pandemic process on the disease severity on admission, management strategies, and outcomes of patients. METHODS: The medical records of the patients who applied to the emergency department and consulted to the general surgery clinic from March 2020 until January 2021 were retrospectively reviewed as the pandemic period. For the control group, patients' medical records in the same time interval of 2019 were evaluated as the pre-pandemic period. RESULTS: A total of 88 patients in the pre-pandemic period and 89 patients in the pandemic period were treated for acute cholecystitis. There was no statistically significant difference between the two groups in terms of the treatment strategies and length of hospital stay between the two periods (p=0.087 and p=0.587, respectively). CONCLUSIONS: In the pandemic period, it is thought that postponing and bridging treatments may replace surgery for reducing the risk of contamination of both patients and health care workers.


Subject(s)
COVID-19 , Cholecystitis, Acute , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/surgery , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
6.
Asian J Endosc Surg ; 15(1): 128-136, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1381104

ABSTRACT

INTRODUCTION: The covid-19 pandemic has had a drastic impact on all medical services. Acute cholecystitis is a serious condition that accounts for a considerable percentage of general surgical acute admissions. Therefore, the Royal College of Surgeons' Commissioning guidance' recommended urgent admission to secondary care and early cholecystectomy. During the first wave of hospital admissions associated with COVID-19, most guidelines recommended conservative treatment in order to limit the admission rates and free up spaces for COVID-19-infected patients. However, reviews of this approach have not been widely done to assess the results and, in turn, planning our future management approach when future pressures on in-patient admissions are inevitable. METHODS: Our study included all acute cholecystitis patients who needed surgical intervention in one Centre in the UK over three distinct periods (pre-COVID-19, during the first lockdown, and lockdown ease). Comparison between these groups were done regarding intraoperative and postoperative results. RESULTS: The conservative management led to a high rate of readmission. Moreover, delayed cholecystectomy was associated with increased operative difficulties such as extensive adhesions, intraoperative blood loss, and/or complicated gall bladder pathologies such as perforated or gangrenous gall bladder (29.9%, 16.7%, and 24.8%, respectively). The resulting postoperative complications of surgical and nonsurgical resulted in a longer hospital stay (13.5 d). CONCLUSION: The crisis approach for acute cholecystitis management failed to deliver the hoped outcome. Instead, it backfired and did the exact opposite, leading to longer hospital stays and extra burden to the patient and the healthcare system.


Subject(s)
COVID-19 , Cholecystectomy, Laparoscopic , Cholecystitis, Acute , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/surgery , Communicable Disease Control , Egypt/epidemiology , Humans , Length of Stay , Pandemics , SARS-CoV-2 , Treatment Outcome
7.
Eur J Trauma Emerg Surg ; 47(3): 677-682, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1212849

ABSTRACT

PURPOSE: To evaluate and analyze the impact of lockdown strategy due to coronavirus disease 2019 (COVID-19) on emergency general surgery (EGS) in the Milan area at the beginning of pandemic outbreak. METHODS: A survey was distributed to 14 different hospitals of the Milan area to analyze the variation of EGS procedures. Each hospital reported the number of EGS procedures in the same time frame comparing 2019 and 2020. The survey revealed that the number of patients during the COVID-19 pandemic outbreak in 2020 was reduced by 19% when compared with 2019. The decrease was statistically significant only for abdominal wall surgery. Interestingly, in 2020, there was an increase of three procedures: surgical intervention for acute mesenteric ischemia (p = 0.002), drainage of perianal abscesses (p = 0.000285), and cholecystostomy for acute cholecystitis (p = 0.08). CONCLUSIONS: During the first COVID-19 pandemic wave in the metropolitan area of Milan, the number of patients operated for emergency diseases decreased by around 19%. We believe that this decrease is related either to the fear of the population to ask for emergency department (ED) consultation and to a shift towards a more non-operative management in the surgeons 'decision making' process. The increase of acute mesenteric ischaemia and perianal abscess might be related to the modification of dietary habits and reduction of physical activity related to the lockdown.


Subject(s)
Abscess , Anus Diseases , COVID-19 , Cholecystitis, Acute , Infection Control , Mesenteric Ischemia , Surgical Procedures, Operative , Abscess/epidemiology , Abscess/surgery , Adult , Anus Diseases/epidemiology , Anus Diseases/surgery , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/surgery , Emergency Service, Hospital/statistics & numerical data , Female , General Surgery/trends , Health Services Misuse/statistics & numerical data , Humans , Incidence , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Mesenteric Ischemia/epidemiology , Mesenteric Ischemia/surgery , SARS-CoV-2 , Surgery Department, Hospital/statistics & numerical data , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/statistics & numerical data
8.
Ulus Travma Acil Cerrahi Derg ; 27(3): 296-302, 2021 May.
Article in English | MEDLINE | ID: covidwho-1197689

ABSTRACT

BACKGROUND: The purpose of the study was to review the efficacy, safety, and outcomes of percutaneous cholecystostomy (PC) in elderly patients with acute calculous cholecystitis (ACC), high comorbidity, and COVID-19. METHODS: The hospital registry data were examined of patients aged >65 years who were diagnosed with ACC and COVID-19 between March 2020 and June 2020 and who underwent PC treatment in the interventional radiology unit. RESULTS: A total of 18 patients were diagnosed with ACC and COVID-19, then underwent PC. The patients comprised 14 (78%) males and 4 (22%) females with an average age of 73.4 years (range, 67-81 years). In 17 (94%) patients, symptoms associated with acute cholecystitis decreased within 48-72 h of the PC treatment and a clinical improvement was determined. The success rate of PC was 100% and no complications. In 3 (16.6%) patients followed up with intubation in intensive care after the procedure, mortality developed due to COVID-19-associated pneumonia and subsequent acute respiratory distress syndrome, and 15 (83.4%) patients were discharged with an elective cholecystectomy plan. CONCLUSION: COVID-19 infection can be fatal especially in patients over 65 years of age due to additional comorbidities. PC treatment, which can be performed under local anesthesia as a minimally invasive procedure, is an alternative treatment option in this patient group. PC can also act as a bridge in transition to elective surgery in this process management.


Subject(s)
COVID-19/complications , Cholecystitis, Acute , Cholecystostomy , Aged , Aged, 80 and over , Cholecystitis, Acute/complications , Cholecystitis, Acute/surgery , Comorbidity , Female , Humans , Male , Retrospective Studies , Treatment Outcome
9.
BMC Surg ; 21(1): 180, 2021 Apr 06.
Article in English | MEDLINE | ID: covidwho-1169960

ABSTRACT

BACKGROUND: COVID-19 pandemic has impacted the Italian National Health Care system at many different levels, causing a complete reorganization of surgical wards. In this context, our study retrospectively analysed the management strategy for patients with acute cholecystitis. METHODS: We analysed all patients admitted to our Emergency Department for acute cholecystitis between February and April 2020 and we graded each case according to 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. We focused on patients submitted to cholecystostomy during the acute phase of pandemic and their subsequent disease evolution. RESULTS: Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II, 8 grade III). According to Tokyo Guidelines (2018), patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage (PC) and laparoscopic cholecystectomy (LC) in 29.7%, 21.6% and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to bedside percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous cholecystostomy was of 87.5%. The mean post-procedural hospitalization length was 9 days, and no related adverse events were observed apart from transient parietal bleeding, conservatively treated. Once discharged, two patients required readmission because of acute biliary symptoms. Median time of drainage removal was 43 days and only 50% patients thereafter underwent cholecystectomy. CONCLUSIONS: Percutaneous cholecystostomy has shown to be an effective and safe treatment thus acquiring an increased relevance in the first phase of the pandemic. Nowadays, considering we are forced to live with the SARS-CoV-2 virus, PC should be considered as a virtuous, alternative tool for potentially all COVID-19 positive patients and selectively for negative cases unresponsive to conservative therapy and unfit for surgery.


Subject(s)
COVID-19 , Cholecystitis, Acute , Disease Outbreaks , COVID-19/epidemiology , COVID-19/surgery , Cholecystitis, Acute/surgery , Cholecystostomy , Hospitals , Humans , Italy/epidemiology , Retrospective Studies , Treatment Outcome
10.
Ulus Travma Acil Cerrahi Derg ; 27(1): 34-42, 2021 01.
Article in English | MEDLINE | ID: covidwho-1041556

ABSTRACT

BACKGROUND: Acute cholecystitis (AC), a common complication of gallstones, is responsible for a significant part of emergency applications, and cholecystectomy is the only definitive treatment method for AC. Early cholecystectomy has many reported advantages. Operation-related morbidity and mortality have increased during the COVID-19 pandemic. In this study, our aim is to present our general clinical approach to patients who were diagnosed with AC during the pandemic and our percutaneous cholecystostomy experience during this period. METHODS: This study included 72 patients who were presented to our hospital's emergency room between March 11 and May 31, 2020, with AC. Patients were divided into three groups based on their treatment: outpatients (Group 1), inpatients (Group 2) and patients undergoing percutaneous cholecystostomy (Group 3). These three groups were compared by their demographic and clinical characteristics. RESULTS: There were 36 (50%) patients in Group 1, 25 (34.7%) patients in Group 2, and 11 (15.3%) patients in Group 3. The demographic characteristics of the patients were similar. The CRP and WBC levels of the patients in Group 3 were significantly higher compared to the other groups. Moreover, the wall of the gallbladder was thicker and the size of the gallbladder was larger in Group 3. Patients had percutaneous cholecystostomy at the median of 3.5 days and the length of hospital stay was longer compared to Group 2 (3.9 days versus 9.2 days, p=0.00). The rate of re-hospitalization after discharge was similar in Group 2 and Group 3, but none of the patients in Group 1 required hospitalization. None of 72 patients developed an emergency condition requiring surgery, and there was no death. CONCLUSION: Although many publications emphasize that laparoscopic cholecystectomy (LC) can be performed with low morbidity at the first admission in acute cholecystitis, it is a clinical condition that can be delayed in the COVID-19 pandemic and other similar emergencies. Thus, percutaneous cholecystostomy should be effectively employed, and its indications should be extended if necessary (e.g., younger patients, patients with lower CCI or ASA). This approach may enable us to protect both patients and healthcare professionals that perform the operation from the risk of COVID-19.


Subject(s)
Ambulatory Surgical Procedures/statistics & numerical data , COVID-19 , Cholecystectomy , Cholecystitis, Acute , Hospitalization/statistics & numerical data , Cholecystectomy/methods , Cholecystectomy/statistics & numerical data , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/surgery , Emergency Service, Hospital , Humans , Pandemics , SARS-CoV-2
11.
Ulus Travma Acil Cerrahi Derg ; 27(1): 89-94, 2021 01.
Article in English | MEDLINE | ID: covidwho-1044212

ABSTRACT

BACKGROUND: Laparoscopic cholecystectomy (LC) is the accepted standard treatment for acute cholecystitis (AC) in patients eligible for surgery. Percutaneous cholecystostomy (PC) can provide a permanent treatment for high-risk patients for surgery or act as a bridge for later surgical treatment. This study is an evaluation of the use of PC during the current coronavirus 2019 (COVID-19) pandemic at a single hospital. METHODS: Fifty patients with AC were admitted as of the start of the COVID-19 pandemic in Turkey through June 2020. Patients with pancreatitis, cholangitis, and/or incomplete data were excluded from the study. Data of the remaining 36 patients included in the study were recorded and a descriptive statistical analysis was performed. The patients were divided into three groups: PC (n=14), only conservative treatment with antibiotherapy (OC) (n=14), and LC (n=8). The findings were compared with a group of 70 similar patients from the pre-pandemic period. RESULTS: The mean age of the pandemic period patients was 53 years (range: 26-78 years). The female/male ratio was 1.11. PC was preferred in eight (11%) patients in the same period of the previous year, whereas 14 (39%) patients underwent PC in the pandemic period. Four of the 36 pandemic patients were positive for COVID-19, including one member of the PC group. There was one (7.1%) mortality in the pandemic-period PC group due to cardiac arrest. The length of hospital stay between the groups based on the type of treatment was not statistically significant. CONCLUSION: LC is not recommended during the pandemic period; PC can be an effective and safe alternative for the treatment of AC.


Subject(s)
COVID-19 , Cholecystitis, Acute , Cholecystostomy , Adult , Aged , Cholecystectomy, Laparoscopic , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/surgery , Cholecystostomy/adverse effects , Cholecystostomy/methods , Cholecystostomy/mortality , Cholecystostomy/statistics & numerical data , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Turkey
12.
Eur Rev Med Pharmacol Sci ; 24(22): 11919-11925, 2020 11.
Article in English | MEDLINE | ID: covidwho-962025

ABSTRACT

OBJECTIVE: The pandemic from SARS-CoV-2 is having a profound impact on daily life of a large part of world population. Italy was the first Western country to impose a general lockdown to its citizens. Implications of these measures on several aspects of public health remain unknown. The aim of this study was to investigate the effects of the lockdown on surgical emergencies volumes and care in a large, tertiary referral center. MATERIALS AND METHODS: Electronic medical records of all patients visited in our Emergency Department (ED) and admitted in a surgical ward from February 21st 2020 to May 3rd 2020 were collected, analyzed and compared with the same periods of 2019 and 2018 and a cross-sectional study was performed. RESULTS: Number of surgical admissions dropped significantly in 2020 with respect to the same periods of 2019 and 2018, by almost 50%. The percentage distribution of admissions in different surgical wards did not change over the three years. Time from triage to operating room significantly reduced in 2020 respect to 2019 and 2018 (p<0.001). CONCLUSIONS: The lockdown in Italy due to SARS-CoV-2 pandemic arguably represents the largest social experiment in modern times. Data provided by our study provide useful information to health authorities and policymakers about the effects of activity restriction on surgical accesses and changing epidemiology due to an exceptional external event.


Subject(s)
COVID-19 , Cholecystitis, Acute/epidemiology , Gastrointestinal Diseases/epidemiology , Hospitalization/trends , Surgical Procedures, Operative/trends , Adult , Appendicitis/epidemiology , Appendicitis/surgery , Cholecystitis, Acute/surgery , Diverticulitis/epidemiology , Diverticulitis/surgery , Emergencies , Emergency Service, Hospital , Female , Gastrointestinal Diseases/surgery , Gastrointestinal Hemorrhage/epidemiology , Gastrointestinal Hemorrhage/surgery , Hernia/epidemiology , Herniorrhaphy/trends , Humans , Intestinal Obstruction/epidemiology , Intestinal Obstruction/surgery , Intestinal Perforation/epidemiology , Intestinal Perforation/surgery , Italy/epidemiology , Male , Middle Aged , Rectal Diseases/epidemiology , Rectal Diseases/surgery , Surgery Department, Hospital , Tertiary Care Centers , Time-to-Treatment/trends
13.
J Laparoendosc Adv Surg Tech A ; 31(4): 455-457, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-759898

ABSTRACT

Background: COVID-19 era has put laparoscopic surgery a risk procedure because of theoretical risk of viral transmission of COVID-19. However, safe evacuation of stagnant air during laparoscopic surgery is also necessary to safeguard health care warriors. Methods: We are reporting experience of 24 laparoscopic surgeries using a closed smoke evacuation/filtration system using a ultra low-particulate air (ULPA) filtration capability (ConMed AirSeal® System) at a single center between March 22, 2020, and May 30, 2020. All surgeries were either urgent or emergency in nature. Results: Totally, 17 males and 7 females who required urgent surgery. Most common indication for laparoscopic intervention was acute cholecystitis and complications related to acute cholecystitis. Owing to the closed smoke evacuation system, low intra-abdominal pressure was maintained during all surgeries. Of all procedures, only 0.8 time per procedure, the laparoscope taken out for cleaning. Mean time for completion of surgery was 58 minutes. Compliance of surgical staff was high due to the deemed safe smoke evacuation system. Mean of postoperative pain score was low. Mean hospital stay was 4.9 days. Conclusions: We propose to use a closed smoke evacuation/filtration system with ULPA filtration capability or similar devices in each minimally invasive surgery to reduce risks of transmission as minute as possible until we have enough knowledge about the pattern of disease transmission.


Subject(s)
COVID-19/prevention & control , Digestive System Surgical Procedures/instrumentation , Health Personnel , Laparoscopy/instrumentation , Occupational Exposure/prevention & control , Cholecystitis, Acute/complications , Cholecystitis, Acute/surgery , Digestive System Surgical Procedures/adverse effects , Emergencies , Female , Humans , Laparoscopy/adverse effects , Length of Stay , Male , Middle Aged , Operating Rooms , Operative Time , Pain, Postoperative/etiology , Pneumoperitoneum, Artificial , SARS-CoV-2
16.
Int J Surg ; 80: 157-161, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-644648

ABSTRACT

BACKGROUND: during the COVID-19 pandemic, the number of Acute Care Surgery procedures performed in Spanish hospitals decreased significantly. The aim of this study was to compare Acute Care Surgery activity during the COVID-19 pandemic and during a control period. MATERIAL AND METHODS: a multicenter retrospective cohort study was performed including patients who underwent Acute Care Surgery in three tertiary care hospitals in Spain during a control (11th March 2019 to 21st April 2019) and a pandemic (16th March 2020 to 26th April 2020) period. Type of surgical procedures, patients' features and postoperative complications were compared. RESULTS: two hundred and eighty-five and 117 patients were included in each group. Mean number of patients who underwent Acute Care Surgery during the control and pandemic periods was 2.3 and 0.9 patients per day and hospital (p < 0.001), representing a 58.9% decrease in Acute Care Surgery activity. Time from symptoms onset to patient arrival at the Emergency Department was longer during the pandemic (44.6 vs. 71.0 h, p < 0.001). Surgeries due to acute cholecystitis and complications from previous elective procedures decreased (26.7% vs. 9.4%) during the pandemic, while bowel obstructions and abdominal wall hernia surgeries increased (12.3% vs. 22.2%) (p = 0.001). Morbidity was higher during pandemic period (34.7% vs. 47.1%, p = 0.022), although this difference was not statistically significant in the multivariate analysis. Reoperation rate (17.9% vs. 12.8%, p = 0.212) and mortality (6.7% vs. 4.3%, p = 0.358) were similar in both groups. CONCLUSION: during the COVID-19 pandemic, a significant reduction in the performance of Acute Care Surgery procedures was observed. Moreso, a longer time from symptoms onset to patient arrival at the Emergency Department was noted. Higher morbidity was observed in patients undergoing Acute Care Surgery during the pandemic period, although there was not any difference in mortality or reoperation rate.


Subject(s)
Abscess/surgery , Appendicitis/surgery , Cholecystitis, Acute/surgery , Coronavirus Infections/epidemiology , Intestinal Obstruction/surgery , Mortality , Pneumonia, Viral/epidemiology , Postoperative Complications/epidemiology , Rectal Diseases/surgery , Abdominal Wall , Abscess/epidemiology , Acute Disease , Appendectomy/statistics & numerical data , Appendicitis/epidemiology , Betacoronavirus , COVID-19 , Cholecystitis, Acute/epidemiology , Cohort Studies , Comorbidity , Diabetes Mellitus/epidemiology , Dyslipidemias/epidemiology , Emergencies , Female , Hernia, Abdominal/epidemiology , Hernia, Abdominal/surgery , Herniorrhaphy/statistics & numerical data , Humans , Hypertension/epidemiology , Intestinal Obstruction/epidemiology , Laparoscopy/statistics & numerical data , Logistic Models , Male , Middle Aged , Myocardial Ischemia/epidemiology , Pandemics , Rectal Diseases/epidemiology , Reoperation/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Spain/epidemiology , Time-to-Treatment/statistics & numerical data
17.
BMC Infect Dis ; 20(1): 437, 2020 Jun 22.
Article in English | MEDLINE | ID: covidwho-610519

ABSTRACT

BACKGROUND: The 2019 novel coronavirus (COVID-19) presents a major threat to public health and has rapidly spread worldwide since the outbreak in Wuhan, Hubei Province, China in 2019. To date, there have been few reports of the varying degrees of illness caused by the COVID-19. CASE PRESENTATION: A case of 68-year-old female with COVID-19 pneumonia who had constant pain in the right upper quadrant of her abdomen during her hospitalization that was finally diagnosed as acute cholecystitis. Ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) was performed, and the real-time fluorescence polymerase chain reaction (RT-PCR) COVID-19 nucleic acid assay of the bile was found to be negative. PTGD, antibacterial and anti-virus combined with interferon inhalation treatment were successful. CONCLUSION: The time course of chest CT findings is typical for COVID-19 pneumonia. PTGD is useful for acute cholecystitis in COVID-19 patients. Acute cholecystitis is likely to be caused by COVID-19 .


Subject(s)
Cholecystitis, Acute/complications , Coronavirus Infections/complications , Pneumonia, Viral/complications , Aged , Antiviral Agents , Betacoronavirus/physiology , COVID-19 , China , Cholecystitis, Acute/diagnosis , Cholecystitis, Acute/surgery , Coronavirus Infections/drug therapy , Disease Outbreaks , Drainage/methods , Female , Hospitalization , Humans , Pandemics , Pneumonia, Viral/drug therapy , SARS-CoV-2 , Tomography, X-Ray Computed , Ultrasonography, Interventional
18.
World J Emerg Surg ; 15(1): 38, 2020 06 08.
Article in English | MEDLINE | ID: covidwho-574739

ABSTRACT

Following the spread of the infection from the new SARS-CoV2 coronavirus in March 2020, several surgical societies have released their recommendations to manage the implications of the COVID-19 pandemic for the daily clinical practice. The recommendations on emergency surgery have fueled a debate among surgeons on an international level.We maintain that laparoscopic cholecystectomy remains the treatment of choice for acute cholecystitis, even in the COVID-19 era. Moreover, since laparoscopic cholecystectomy is not more likely to spread the COVID-19 infection than open cholecystectomy, it must be organized in such a way as to be carried out safely even in the present situation, to guarantee the patient with the best outcomes that minimally invasive surgery has shown to have.


Subject(s)
Cholecystectomy/standards , Cholecystitis, Acute/surgery , Coronavirus Infections/complications , Infection Control/standards , Pneumonia, Viral/complications , Practice Guidelines as Topic , Betacoronavirus , COVID-19 , Cholecystectomy/methods , Cholecystitis, Acute/virology , Coronavirus Infections/virology , Humans , Pandemics , Pneumonia, Viral/virology , SARS-CoV-2 , Societies, Medical
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