Emergency surgery during the COVID-19 pandemic: what you need to know for practice
B De Simone1, E Chouillard1, S Di Saverio2, L Pagani3, M Sartelli4, WL Biffl5, F Coccolini6,A Pieri3, M Khan7, G Borzellino8, FC Campanile9, L Ansaloni10, F Catena11
1 Centre Hospitalier Intercommunal Poissy/Saint-Germain-en-Laye, France
2University of Insubria, Varese, Italy
3Bolzano Central Hospital, Italy
4Macerata Hospital, Italy
5Scripps Memorial Hospital, La Jolla, CA, US
6University Hospital of Pisa, Italy
7Brighton and Sussex University Hospitals NHS Trust, UK
8San Giovanni Decollato-Andosilla Hospital, Civita Castellana, Italy
9University Hospital of Verona, Italy
10Bufalini Hospital, Cesena, Italy
11University Hospital of Parma, Italy
Introduction
Several articles have been published about the reorganisation of surgical activity during the COVID-19 pandemic but few, if any, have focused on the impact that this has had on emergency and trauma surgery. Our aim was to review the most current data on COVID-19 to provide essential suggestions on how to manage the acute abdomen during the
pandemic.
Methods
A systematic review was conducted of the most relevant English language articles on COVID-19 and surgery published between 15 December 2019 and 30 March 2020.
Findings
Access to the operating theatre is almost exclusively restricted to emergencies and oncological procedures. The use of laparoscopy in COVID-19 positive patients should be cautiously considered. The main risk lies in the presence of the virus in the pneumoperitoneum: the aerosol released in the operating theatre could contaminate both staff and the environment.
Conclusions
During the COVID-19 pandemic, all efforts should be deployed in order to evaluate the feasibility of postponing surgery until the patient is no longer considered potentially infectious or at risk of perioperative complications. If surgery is deemed necessary, the emergency surgeon must minimise the risk of exposure to the virus by involving a minimal number of healthcare staff and shortening the occupation of the operating theatre. In case of a lack of security measures to enable safe laparoscopy, open surgery should be considered.