Deeply reconsidering elective surgery: worldwide concerns regarding colorectal surgery in a COVID-19 pandemic and a Singapore perspective

Chew, MH; Tan, WJ; Ng, C.T.; Kh, Ng

doi:10.11622/smedj.2020070

Cited by 16 publications

(18 citation statements)

References 19 publications

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“…Isobaric minimally invasive technique and robotic-assisted surgery might reduce the risk of infection in the operating theatre staff. Chew, Tan, Ng, Ng (2020) 14 Singapore Medical Journal Commentary Reconsidering elective surgery In laparoscopic colorectal surgery: laparoscopy can lead to aerosolization of blood-borne viruses, although the applicability to SARS-CoV-2 remains unknown. In laparoscopic colorectal surgery, there may be risks of faecal spillage into the pneumoperitoneum due to bowel injury.…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic Surgery and the debate on its safety during COVID-19 pandemic: A systematic review of recommendations

Boghdady

Ewalds‐Kvist

2021

The Surgeon

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Introduction The transmission of COVID-19 virus since the outbreak of viral pneumonia due to SARS-CoV-2 gave rise to protective operative measures. Aerosol generating procedures such as laparoscopic surgery are known to be associated with increased risks of viral transmission to the healthcare workers. The safety of laparoscopy during the pandemic was then debated. We aimed to systematically review the literature regarding the safe use of laparoscopy during COVID-19. Methods We performed a systematic search using PubMed and ScienceDirect databases from inception to 1st May, 2020. The following search terms were used: ‘‘laparoscopic surgery and COVID-19’’; ‘‘minimally invasive surgery and COVID-19’’. Search items were considered from the nature of the articles, date of publication, aims and findings in relation to use of laparoscopic surgery during COVID-19. The study protocol was registered with PROSPERO register for systematic reviews (CRD42020183432). Results Altogether, 174 relevant citations were identified and reviewed for this study, of which 22 articles were included. The analysis of the findings in relation to laparoscopic surgery during the pandemic were presented in tabular form. We completed the common recommendations for performing laparoscopy during the COVID-19 pandemic in forms of pre-, intra- and postoperative phases. Conclusion There is no scientific evidence to date for the transmission of COVID-19 by laparoscopic surgery. Laparoscopy can be used with precautions because of its benefits compared to open surgery. If safe, conservative management is the primary alternative during the pandemic. We concluded that recommended precautions should be respected while performing laparoscopy during the pandemic.

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Section: Resultsmentioning

confidence: 99%

Laparoscopic Surgery and the debate on its safety during COVID-19 pandemic: A systematic review of recommendations

Boghdady

Ewalds‐Kvist

2021

The Surgeon

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“…Subsequently, numerous guidelines were published that advised postponing or cancelling elective surgical services. 2 , 3 , 4 , 5 , 6 , 7…”

Section: Introductionmentioning

confidence: 99%

Is a “COVID-19-free” hospital the answer to resuming elective surgery during the current pandemic? Results from the first available prospective study

Gammeri

Cillo

Sunthareswaran

et al. 2020

Surgery

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Background Resumption of elective surgery during the current coronavirus disease 2019 pandemic crisis has been debated widely and largely discouraged. The aim of this prospective cohort study was to assess the feasibility of resuming elective operations during the current and possible future peaks of this coronavirus disease 2019 pandemic. Methods We collected data during the peak of the current pandemic in the United Kingdom on adult patients who underwent elective surgery in a “COVID-19-free” hospital from April 8 to May 29, 2020. The study included patients from various surgical specialties. Nonelective and pediatric cases were excluded. The primary outcome was 30-day mortality postoperatively. Secondary outcomes were the rate of coronavirus disease 2019 infections, new onset of pulmonary symptoms after hospitalization, and requirement for admission to the intensive care unit. Results A total of 309 consecutive adult patients were included in this study. No patients died nor required intensive care unit admission. Operations graded “Intermediate” were the most performed procedure representing 91% of the total number. One patient was diagnosed with a coronavirus disease 2019 infection after being transferred to the nearest local emergency hospital for management of postoperative pain secondary to common bile duct stone and was successfully treated conservatively on the ward. No patient developed pulmonary complications. Three patients were admitted for greater than 23 hours. Twenty-seven patients (8.7%) developed complications. Complications graded as 2 and 3 according to the Clavien-Dindo classification occurred in 14 and 2 patients, respectively. Conclusion This prospective study shows that, despite the severity and high transmissibility of novel coronavirus 2 disease, COVID-19-free hospitals can represent a safe setting to resume many types of elective surgery during the peak of a pandemic.

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“…Finally, special care must be taken during patient intubation, peritoneal insufflation, excessive use of electrocautery, aerosolization, aspiration and transoperative endoscopy when necessary. 28,29 To date, the postoperative mortality in patients who tested positive for SARS-CoV-2 is much higher than that observed for other patients. A retrospective study of 34 IBD patients submitted to surgery showed a 20% mortality in elective surgeries.…”

Section: Surgical Procedures In Patients With Covid-19mentioning

confidence: 99%

Potential impact of COVID-19 on colorectal disease management

Campos

Fillmann

2020

Journal of Coloproctology

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The current recommendations for management of colorectal diseases are still evolving, due to the limited experience on this issue. As the new coronavirus can be transmitted through breath droplets, by contact and orofecally, there is no consensus of how this fact may affect the investigation and treatment of anorectal diseases. Thus, high-quality multicenter studies are urgently needed to provide better information to both patients and the multiprofessional team, in order to build an effective pandemic response plan in our specialty. As a greater operative risk for infected patients has already been demonstrated, the next step lies on the identification of new therapeutic strategies that could minimize this effect on an individual basis. There is a present understanding that the COVID-19 pandemic should change some traditional practices. Therefore, the surgical treatment of suspected or known COVID-19 case demands specific insights. This article analyses potential influences regarding the treatment of patients with Colorectal Cancer (CRC) and Inflammatory Bowel Diseases (IBD). At present, elective surgery must be avoided, and the colorectal surgeon must carefully evaluate the risks and benefits of such decision. Within this context, a change toward nonsurgical and less aggressive modalities of CRC treatment may help to postpone definitive treatment. We also discuss the concerns regarding the viral infection among the population, the influence on clinical symptoms and the proposed modifications on therapeutic schemes.

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Deeply reconsidering elective surgery: worldwide concerns regarding colorectal surgery in a COVID-19 pandemic and a Singapore perspective

Cited by 16 publications

References 19 publications

Laparoscopic Surgery and the debate on its safety during COVID-19 pandemic: A systematic review of recommendations

Laparoscopic Surgery and the debate on its safety during COVID-19 pandemic: A systematic review of recommendations

Is a “COVID-19-free” hospital the answer to resuming elective surgery during the current pandemic? Results from the first available prospective study

Potential impact of COVID-19 on colorectal disease management

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