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Acta Biomed ; 91(3): e2020005, 2020 09 07.
Article in English | MEDLINE | ID: covidwho-761237


ackground: During the pandemic of COVID-19, the overwhelm of infected patients created an exponential surge for ICU and ward beds. As a result, a major proportion of elective surgeries was postponed. However, various emergency and urgent procedures were allowed. Due to the mortality complications of hepatopancreatobiliary issues, we decided to afford urgent procedures under intensive protective arrangements. Method and results: In our ward (liver transplant), 4 ICU beds and 16 ward beds were allocated to non-COVID-19 patients. A total of 36 hepatopancreatobiliary procedures were managed for one month. All the surgeries were afforded under personal protective equipment and other intensive protective arrangements for personnel and patients. During 6 weeks following the surgery, all patients were followed up through telemedicine and no new case of COVID-19 was detected. Conclusion: In general, it appears that intensive protections could significantly reduce the number of COVID-19 incidence among patients with co-morbidities who undergo invasive procedures.

Biliary Tract Diseases/surgery , Coronavirus Infections/complications , Digestive System Surgical Procedures/methods , Emergency Service, Hospital/standards , Liver Diseases/surgery , Pancreatic Diseases/surgery , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/complications , Betacoronavirus , Biliary Tract Diseases/complications , COVID-19 , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Female , Humans , Liver Diseases/complications , Male , Middle Aged , Pancreatic Diseases/complications , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2
Updates Surg ; 72(2): 241-247, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-418919


The safety of minimally invasive procedures during COVID pandemic remains hotly debated, especially in a country, like Italy, where minimally invasive techniques have progressively and pervasively entered clinical practice, in both the hepatobiliary and pancreatic community. A nationwide snapshot of the management of HPB minimally invasive surgery activity during COVID-19 pandemic is provided: a survey was developed and conducted within AICEP (Italian Association of HepatoBilioPancreatic Surgeons) with the final aim of conveying the experience, knowledge, and opinions into a unitary report enabling more efficient crisis management. Results from the survey (81 respondents) show that, in Italian hospitals, minimally invasive surgery maintains its role despite the COVID-19 pandemic, with the registered reduction of cases being proportional to the overall reduction of the HPB surgical activity. Respondents agree that the switch from minimally invasive to open technique can be considered as a valid option for cases with a high technical complexity. Several issues merit specific attention: screening for virus positivity should be universally performed; only expert surgical teams should operate on positive patients and specific technical measures to lower the biological risk of contamination during surgery must be followed. Future studies specifically designed to establish the true risks in minimally invasive surgery are suggested. Furthermore, a standard and univocal process of prioritization of patients from Regional Healthcare Systems is advisable.

Biliary Tract Diseases/surgery , Coronavirus Infections , Liver Diseases/surgery , Minimally Invasive Surgical Procedures , Pancreatic Diseases/surgery , Pandemics , Pneumonia, Viral , COVID-19 , Health Care Surveys , Humans , Italy
Am J Transplant ; 20(11): 2983-2988, 2020 11.
Article in English | MEDLINE | ID: covidwho-245429


For those who work in the field of islet transplantation, the microvascular coronavirus disease 2019 (COVID-19) lung vessels obstructive thrombo-inflammatory syndrome (recently referred to as MicroCLOTS) is familiar, as one cannot fail to recognize the presence of similarities with the instant blood mediated inflammatory reaction (IBMIR) occurring in the liver hours and days after islet infusion. Evidence in both MicroCLOTS and IBMIR suggests the involvement of the coagulation cascade and complement system activation and proinflammatory chemokines/cytokines release. Identification and targeting of pathway(s) playing a role as "master regulator(s)" in the post-islet transplant detrimental inflammatory events could be potentially useful to suggest innovative COVID-19 treatments and vice versa. Scientific organizations across the world are fighting the COVID-19 pandemic. Islet transplantation, and more generally the transplantation scientific community, could contribute by suggesting strategies for innovative approaches. At the same time, in the near future, clinical trials in COVID-19 patients will produce an enormous quantity of clinical and translational data on the control of inflammation and complement/microthrombosis activation. These data will represent a legacy to be transformed into innovation in the transplant field. It will be our contribution to change a dramatic event into advancement for the transplant field and ultimately for our patients.

Blood Coagulation , COVID-19/epidemiology , Cytokines/blood , Islets of Langerhans Transplantation/methods , Pancreatic Diseases/surgery , Pandemics , SARS-CoV-2 , Biomarkers/metabolism , COVID-19/blood , Comorbidity , Complement Activation , Humans , Pancreatic Diseases/epidemiology , Transplantation, Heterologous