Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

Craniomaxillofacial reconstructive surgery is a challenging field. First it aims to restore primary functions and second to preserve craniofacial anatomical features like symmetry and harmony. Three-dimensional (3D) printed biomodels have been widely adopted in medical fields by providing tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. Craniomaxillofacial reconstructive surgery was one of the first areas to implement 3D printing technology in their practice. Biomodeling has been used in craniofacial reconstruction of traumatic injuries, congenital disorders, tumor removal, iatrogenic injuries (e.g., decompressive craniectomies), orthognathic surgery, and implantology. 3D printing has proven to improve and enable an optimization of preoperative planning, develop intraoperative guidance tools, reduce operative time, and significantly improve the biofunctional and the aesthetic outcome. This technology has also shown great potential in enriching the teaching of medical students and surgical residents. The aim of this review is to present the current status of 3D printing technology and its practical and innovative applications, specifically in craniomaxillofacial reconstructive surgery, illustrated with two clinical cases where the 3D printing technology was successfully used.

BACKGROUND: Meckel's diverticulum (MD) is the most prevalent congenital anomaly of the gastrointestinal tract with an estimated prevalence ranging from 2% to 4%. The diverticulum is a remnant of the vitelline duct, which leads to the formation of a true diverticulum containing all the layers of the small intestine. The condition is usually clinically silent; however, it can present with unusual symptoms and signs and therefore can result in a delayed diagnosis, particularly in adults. The aim of this study is to review the most updated literature reporting Littre hernias (LHs) in adults, the diagnostic approach, and its subsequent management. This is a literature review, complemented by an unusual clinical case of an adult who presented with a complicated umbilical LH which required emergency surgery. MATERIALS AND METHODS: Literature reviews using PubMed, Web of Science, and other reliable sources use the possible combinations of the following keywords: Meckel's diverticulum, Littre hernia, umbilical hernia, adults, complications, surgical treatment. RESULTS: The herniation of an MD through a potential opening in the abdominal wall is defined as an LH, representing a rare complication of the diverticula. Due to their rarity, they remain underdiagnosed, often leading to suboptimal treatment with substantial morbidity and mortality. CONCLUSION: An MD, despite being a rare clinical entity in adults, can theoretically be found in any hernia, with patients experiencing a wide range of potential complications.

Despite traumatic abdominal wall hernia (TAWH) being a rare entity, the incidence of associated intra-abdominal injuries is extremely common. With only few cases published, TAWH remains a diagnostic as well as a therapeutic challenge. We present an obese 47-year-old female, front seat passenger, that was transferred to our hospital from a neighbouring DGH with a diagnosis of TAWH after a 30mph road traffic collision. On arrival, she was haemodynamically stable, abdominal examination showed a large hernia, extensive bruising but the abdomen was otherwise unremarkable. The CT performed before transfer showed a large hernia but no obvious other injury, no free fluid or gas was identified. Hernia repair was planned for the following day. Overnight there was a transient period of hypotension responsive to transfusion of multiple RBC units. The surgical approach was over the hernia site. Within the sac a transected end of small bowel was found and so laparotomy was undertaken, which demonstrated a bucket handle mesenteric tear of terminal ileal mesentery with infarction of 20 cm of small bowel and a complete transverse tear of mid sigmoid colon and its mesentery. Remarkably there was no intraperitoneal contamination from either injury. Our clinical case highlights that although the CT scan is the gold standard for initial diagnosis of intra-abdominal injuries in TAWH, these can still be missed. To note that failure to make a timely diagnosis can result in delayed complications with significant morbidity and mortality. Therefore, a high clinical suspicion, despite of negative imaging, is crucial to provide appropriate management.