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COVID-19: impact on colorectal surgery.
Wexner, S D; Cortés-Guiral, D; Gilshtein, H; Kent, I; Reymond, M A.
  • Wexner SD; Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
  • Cortés-Guiral D; Department of Colorectal Surgery, King Khalid Hospital, Nejran, Saudi Arabia.
  • Gilshtein H; Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
  • Kent I; Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
  • Reymond MA; Department of General and Transplant Surgery, National Center for Pleura and Peritoneum (NCPP), Tübingen, Germany.
Colorectal Dis ; 22(6): 635-640, 2020 06.
Article in English | MEDLINE | ID: covidwho-156358
ABSTRACT

AIM:

The rapid spread of the COVID-19 pandemic has created unprecedented challenges for the medical and surgical healthcare systems. With the ongoing need for urgent and emergency colorectal surgery, including surgery for colorectal cancer, several questions pertaining to operating room (OR) utilization and techniques needed to be rapidly addressed.

METHOD:

This manuscript discusses knowledge related to the critical considerations of patient and caregiver safety relating to personal protective equipment (PPE) and the operating room environment.

RESULTS:

During the COVID-19 pandemic, additional personal protective equipment (PPE) may be required contingent upon local availability of COVID-19 testing and the incidence of known COVID-19 infection in the respective community. In addition to standard COVID-19 PPE precautions, a negative-pressure environment, including an OR, has been recommended, especially for the performance of aerosol-generating procedures (AGPs). Hospital spaces ranging from patient wards to ORs to endoscopy rooms have been successfully converted from standard positive-pressure to negative-pressure spaces. Another important consideration is the method of surgical access; specifically, minimally invasive surgery with pneumoperitoneum is an AGP and thus must be carefully considered. Current debate centres around whether it should be avoided in patients known to be infected with SARS-CoV-2 or whether it can be performed under precautions with safety measures in place to minimize exposure to aerosolized virus particles. Several important lessons learned from pressurized intraperitoneal aerosolized chemotherapy procedures are demonstrated to help improve our understanding and management.

CONCLUSION:

This paper evaluates the issues surrounding these challenges including the OR environment and AGPs which are germane to surgical practices around the world. Although there is no single universally agreed upon set of answers, we have presented what we think is a balanced cogent description of logical safe approaches to colorectal surgery during the COVID-19 pandemic.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Operating Rooms / Pneumonia, Viral / Pneumoperitoneum, Artificial / Infection Control / Laparoscopy / Infectious Disease Transmission, Patient-to-Professional / Coronavirus Infections / Pandemics / Personal Protective Equipment Type of study: Experimental Studies / Observational study Limits: Humans Language: English Journal: Colorectal Dis Journal subject: Gastroenterology Year: 2020 Document Type: Article Affiliation country: Codi.15112

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Operating Rooms / Pneumonia, Viral / Pneumoperitoneum, Artificial / Infection Control / Laparoscopy / Infectious Disease Transmission, Patient-to-Professional / Coronavirus Infections / Pandemics / Personal Protective Equipment Type of study: Experimental Studies / Observational study Limits: Humans Language: English Journal: Colorectal Dis Journal subject: Gastroenterology Year: 2020 Document Type: Article Affiliation country: Codi.15112