Exploring the Trends of Acute Appendicitis Following Recovery or Vaccination From COVID-19.

INTRODUCTION: The relationship that vaccination against corona virus disease 19 (COVID-19) or recovery from the acute form of the illness may have with the incidence or severity of acute appendicitis (AA) has not been explored. The aim of this study was to evaluate this relationship. METHODS: A single centre retrospective study of all consecutive adult patients presenting with AA in the 6 mo after the initiation of a national vaccination program was performed. The presenting characteristics and pathological data of patients who had either been vaccinated against or recovered from COVID-19 were compared with those who had not. In addition, historical data from the equivalent period 12 and 24 mo beforehand was also extracted. The incidence of AA was compared between each of these time-frames. RESULTS: Of the 258 patients initially identified, 255 were included in the analysis of which 156 had either been vaccinated and/or recovered from COVID-19 (61.2%) whilst 99 (38.8%) patients had not. When comparing these two groups, there were no significant differences in the presenting characteristics, operative findings or postoperative courses. There was also no significant change in the incidence of AA when comparing the study dates with historical data (median weekly incidence of AA 8.0 versus 8.0 versus 8.0 respectively, P = 0.672). CONCLUSIONS: Based on the data presented here, we failed to find a relationship between a national vaccination program and both the nature and incidence of AA presenting to a busy urban hospital.

The Decreasing Incidence of Acute Appendicitis During COVID-19: A Retrospective Multi-centre Study.

BACKGROUND: As the novel coronavirus disease 19 (COVID-19) spreads, a decrease in the number of patients with acute appendicitis (AA) has been noted in our institutions. The aim of this study was to compare the incidence and severity of AA before and during the COVID-19 pandemic. METHODS: A retrospective cohort analysis was performed between December 2019 and April 2020 in the four high-volume centres that provide health care to the municipality of Jerusalem, Israel. Two groups were created. Group A consisted of patients who presented in the 7 weeks prior to COVID-19 first being diagnosed, whilst those in the 7 weeks after were allocated to Group B. A comparison was performed between the clinicopathological features of the patients in each group as was the changing incidence of AA. RESULTS: A total of 378 patients were identified, 237 in Group A and 141 in Group B (62.7% vs. 37.3%). Following the onset of COVID-19, the weekly incidence of AA decreased by 40.7% (p = 0.02). There was no significant difference between the groups in terms of the length of preoperative symptoms or surgery, need for postoperative peritoneal drainage or the distribution of complicated versus uncomplicated appendicitis. CONCLUSIONS: The significant decrease in the number of patients admitted with AA during the onset of COVID-19 possibly represents successful resolution of mild appendicitis treated symptomatically by patients at home. Further research is needed to corroborate this assumption and identify those patients who may benefit from this treatment pathway.

[Laparoscopic adrenalectomy of large adrenal lesions].

INTRODUCTION: In recent years, laparoscopic adrenalectomy has become the procedure of choice for small and benign adrenal lesions. With the experience gained in the laparoscopic approach, many surgeons have expanded the range of indications for laparoscopic adrenalectomy and nowadays, this approach is used for large adrenal lesions and in lesions suspicious for malignancy. However, great controversy still exists regarding the oncological safety of this approach and therefore, some surgeons still prefer using the open technique. PURPOSE: To assess the outcome and the oncological safety of Laparoscopic adrenalectomy of large adrenal lesions. METHODS: A retrospective analysis was conducted of prospectively collected data of all consecutive patients who underwent laparoscopic adrenatectomy in our department for adrenal lesions of 6 cm or larger during the years 1995-2014. RESULTS: A total of 50 patients, out of 230 who underwent laparoscopic adrenalectomy in our department, were included in the study. The main indications for surgery were pheochromocytoma, non-functional lesions and Cushing's syndrome. The surgical approach in all cases was the lateral transperitoneal approach. The final histopathological diagnoses in the majority of patients were adenoma and pheochromocytoma. Three patients were diagnosed with adrenocortical carcinoma. During a follow-up period of up to 5-years, no Local or distant recurrences were found. CONCLUSIONS: The laparoscopic approach for removal of adrenal lesions Larger than 6 cm is safe in respect of intra- and peri-operative morbidity as well as oncological safety. The true incidence of malignancy in large adrenal Lesions appears to be lower than that reputed in the Literature thus far. In high-volume centers the laparoscopic approach should be attempted for large adrenal lesions.