Purpose To analyse acute cholecystitis (AC) management during the first pandemic outbreak after the recommendations given by the surgical societies estimating: morbidity, length of hospital stay, mortality and hospital-acquired SARS-CoV-2 infection rate. Methods Multicentre-combined (retrospective-prospective) cohort study with AC patients in the Community of Madrid between 1st March and 30th May 2020. 257 AC patients were involved in 16 public hospital. Multivariant binomial logistic regression (MBLR) was applied to mortality. Results Of COVID-19 patients, 30 were diagnosed at admission and 12 patients were diagnosed during de admission or 30 days after discharge. In non-COVID-19 patients, antibiotic therapy was received in 61.3% of grade I AC and 40.6% of grade II AC. 52.4% of grade III AC were treated with percutaneous drainage (PD). Median hospital stay was 5 [3-8] days, which was higher in the non-surgical treatment group with 7.51 days (p < 0.001) and a 3.25% of mortality rate (p < 0.21). 93.3% of patients with SARS-CoV-2 infection at admission were treated with non-surgical treatment (p = 0.03), median hospital stay was 11.0 [7.5-27.5] days (p < 0.001) with a 7.5% of mortality rate (p > 0.05). In patients with hospital-acquired SARS-CoV-2 infection, 91.7% of grade I-II AC were treated with non-surgical treatment (p = 0.037), with a median hospital stay of 16 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] days and a 18.2% mortality rate (p > 0.05). Hospital-acquired infection risk when hospital stay is > 7 days is OR 4.7, CI 95% (1.3-16.6), p = 0.009. COVID-19 mortality rate was 11.9%, AC severity adjusted OR 5.64 (CI 95% 1.417-22.64). In MBLR analysis, age (OR 1.15, CI 95% 1.02-1.31), SARS-CoV-2 infection (OR 14.49,, conservative treatment failure (OR 8.2,) and AC severity were associated with an increased odd of mortality. Conclusion In our population, during COVID-19 pandemic, there was an increase of non-surgical treatment which was accompanied by an increase of conservative treatment failure, morbidity and hospital stay length which may have led to an increased risk hospital-acquired SARS-CoV-2 infection. Age, SARS-CoV-2 infection, AC severity and conservative treatment failure were mortality risk factors.

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Aim Our principal aim is to determine the retraction distance (RD) of the transverse abdominis muscle after unilateral endoscopic transversus abdominis release (eTAR) for the treatment of midline and lateral hernias, and compare it with the same patient contralateral unreleased side. Material and Methods We performed a retrospective analysis of a prospective database collection. We defined the RD as the measure between the lateral edge of the rectus abdominis muscle and the medial edge of the transversus abdominis muscle at the level of L3-L4 and at the defect´s maximum diameter. RD was measured pre and postoperatively and compared in the eTAR side with the contralateral (non- eTAR) side. Results 94 midline and 63 lateral hernias underwent hernia repair via endoscopic totally extraperitoneal (eTEP). Thirtyfive patients required unilateral TAR, including 1 primary and 34 incisional hernias. Lateral (65,7%) and medial (34,3%) defects were both included. The mean hernia defect was 49mm transverse diameter and 52mm longitudinal. We compared the postoperative RD at L4, obtaining 45,8mm on the eTAR side and 42,2mm on the non-eTAR side (p=0,284). At the defect site a mean of 38,3mm on the eTAR side was compared with 35,5mm (p=0.363). In our series we didn't find any statistically significant differences in the transversus muscle retraction after unilateral eTAR when compared with the unreleased side. Conclusions eTAR is a safe technique especially during the treatment of lateral hernias, allowing a proper mesh placement without significant transverse muscle retraction.