In the last several weeks we have been witnessing the exponentially progressing pandemic SARS-CoV-2 coronavirus. As the number of people infected with SARS-CoV2 escalates, the problem of surgical management of patients requiring urgent surgery is increasing. Patients infected with SARS-CoV2 virus but with negative test results will appear in general hospitals and may pose a risk to other patients and hospital staff. Health care workers constitutes nearly 17% of infected population in Poland, therefore early identification of infected people becomes a priority to protect human resources and to ensure continuity of the access to a surgical care. Both surgical operations, and endoscopic procedures are considered as interventions with an increased risk of infection. Therefore, determining the algorithm becomes crucial for qualifying patients for surgical treatment, but also to stratify the risk of personnel being infected during surgery and to adequately protect staff. Each hospital should be logistically prepared for the need to perform urgent surgery on a patient with suspected or confirmed infection, including personal protective equipment. Limited availability of the equipment, working under pressure and staff shortages in addition to a highly contagious pathogen necessitate a pragmatic management of human resources in health care. Instant synchronized action is needed, and clear uniform guidelines are essential for the healthcare system to provide citizens with the necessary surgical care while protecting both patients, and staff. This document presents current recommendations regarding surgery during the COVID-19 pandemic in Poland.
Introduction: Esophageal atresia is a congenital anomaly well known in the community of pediatric surgeons. Nonetheless some aspects of management remain vague and societies of gastroenterologists as well as surgeons have been gathering to determine pertinent ways to handle this condition. To make ground for unification, the guidelines of some most important societies were compared and gathered in one review. Materials and Methods: Literature review of online databases of the PubMed and the Cochrane Library with “(o)esophageal atresia”, “guidelines” and “follow-up” used as keywords. Results: Over the course of the last few years there was a lot of effort invested in making clear and accurate guidelines for management of EA, largely with good results. In the majority of important matters, opinions of specialists were consistent or complementary to each other. Because some of them described different phases of management, gathering them together led to obtaining the wider picture, which can help pediatric surgeons in making decisions while treating the patients with EA. Conclusion: There is a necessity for careful following guidelines which have been changing quite fast along with new significant publications about EA. Some concerns remained debatable and their accentuation in this review was made to bring awareness to vague issues, such as postoperative antibiotic prophylaxis or duration of administering PPI. Additionally structured follow-up programs for the first 18 years and after reaching maturity should be made.
The protective barriers used so far in surgery do not provide adequate protection against SARS-CoV-2 virus, and reinforced protective equipment is needed. The rapid increase in the number of patients and the worldwide panic associated with the increasingly low availability of protective equipment has resulted in a shortage of protective equipment in many hospitals. Appropriatepersonal protective equipment must be provided so that the surgical team proceeding to surgery is not excluded from the further struggle for patients' health, especially in MIS. Reckless and excessive use of maximum protective equipment may result in a severe shortage of these products when the number of infected persons requiring surgery increases. The use of a structured infection risk scheme for medical staff, depending on the results of reverse transcription polymerase chain reaction assays and COVID-19 symptoms, combined with the division of protection equipment into three groups, allows easy selection of an appropriate clothing scheme for the clinical setting.
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