• Acute cholecystitis
• Covid-19
• Exploratory laparoscopy
• Laparoscopic cholecystectomy
• Rokitansky-Aschoff sinus

• COVID-19
• Cholecystectomy outcomes
• Post-surgical outcomes
• Staff shortage

• Cholecystectomy
• Cholecystitis
• Perioperative period
• SARS-CoV‑2
• Surgery

• Humans
• COVID-19/epidemiology
• Female
• Male
• Retrospective Studies
• Middle Aged
• Elective Surgical Procedures
• Cholecystectomy
• Aged
• Pandemics
• Cholecystitis/surgery
• Cholecystitis/epidemiology
• Adult
• Treatment Outcome
• Cohort Studies
• Postoperative Complications/epidemiology
• Severity of Illness Index
• Aged, 80 and over
• Germany/epidemiology
• SARS-CoV-2
• Length of Stay
• Emergencies

• COVID‐19
• endoscopic surgery
• national clinical database

• COVID
• SARS-Cov
• cholecystectomy
• cholecystitis
• emergency surgery
• pandemic

• COVID-19
• comorbidities
• complications
• orthopedic surgery
• reschedule
• retrospective cohort

• Humans
• COVID-19/complications
• COVID-19/epidemiology
• Male
• Female
• Retrospective Studies
• Postoperative Complications/epidemiology
• Pilot Projects
• Middle Aged
• Aged
• Orthopedic Procedures/adverse effects
• Time Factors
• Elective Surgical Procedures
• SARS-CoV-2
• Adult

• biomedical engineering
• health services
• health care

• Aged
• Humans
• Cholecystectomy, Laparoscopic
• Hospitalization
• Length of Stay
• Algorithms
• Health Facilities

• acute cholelithiasis
• acutely inflamed gallbladder
• biliary diseases
• covid 19
• pancreatitis

• COVID‐19
• National Clinical Database
• endoscopic surgery
• gastric cancer
• rectal cancer

• COVID-19
• acute appendicitis
• appendicectomy
• conservative treatment

• Acute acalculous cholecystitis
• Biliary complications
• COVID-19
• Gangrenous gallbladder
• SARS-CoV-2
• Systematic review

• COVID-19
• Cholecystectomy
• Hospitalization time
• Pandemic
• Surgery

• Aged
• Female
• Humans
• Male
• Middle Aged
• Cholecystectomy/methods
• Communicable Disease Control
• COVID-19/epidemiology
• Hospitalization
• Pandemics
• Retrospective Studies
• Postoperative Period

The COVID-19 pandemic caused a global health crisis in 2020. This pandemic also had a negative impact on standard procedures in general surgery. Surgeons were challenged to find the best treatment plans for patients with acute cholecystitis. The aim of this study is to investigate the impact of the COVID-19 pandemic on the outcomes of laparoscopic cholecystectomies performed in a tertiary care hospital in Germany.

We examined perioperative outcomes of patients who underwent laparoscopic cholecystectomy during the pandemic from March 22, 2020 (first national lockdown in Germany) to December 31, 2020. We then compared these to perioperative outcomes from the same time frame of the previous year.

A total of 182 patients who underwent laparoscopic cholecystectomy during the above-mentioned periods were enrolled. The pandemic group consisted of 100 and the control group of 82 patients. Subgroup analysis of elderly patients (> 65 years old) revealed significantly higher rates of acute [5 (17.9%) vs. 20 (58.8%); p = 0.001] and gangrenous cholecystitis [0 (0.0%) vs. 7 (20.6%); p = 0.013] in the “pandemic subgroup”. Furthermore, significantly more early cholecystectomies were performed in this subgroup [5 (17.9%) vs. 20 (58.8%); p = 0.001]. There were no significant differences between the groups both in the overall and subgroup analysis regarding the operation time, intraoperative blood loss, length of hospitalization, morbidity and mortality.

Elderly patients showed particularly higher rates of acute and gangrenous cholecystitis during the pandemic. Laparoscopic cholecystectomy can be performed safely in the COVID-19 era without negative impact on perioperative results. Therefore, we would assume that laparoscopic cholecystectomy can be recommended for any patient with acute cholecystitis, including the elderly.

• COVID-19
• Cholecystectomy
• Cholecystitis
• Hepatobiliary surgery
• Laparoscopic surgery
• Pandemic

The resulting tissue hypoxia and increased inflammation secondary to severe coronavirus disease 2019 (COVID-19) combined with viral load, and other baseline risk factors contribute to an increased risk of severe sepsis or co-existed septic condition exaggeration.

To describe the clinical, radiological, and laboratory characteristics of a small cohort of patients infected by severe acute respiratory syndrome coronavirus 2 who underwent percutaneous drainage for septic complications and their post-procedural outcomes.

This retrospective study consisted of 11 patients who were confirmed to have COVID-19 by RT-PCR test and required drain placement for septic complications. The mean age ± SD of the patients was 48.5 ± 14 years (range 30-72 years). Three patients underwent cholecystostomy for acute acalculous cholecystitis. Percutaneous drainage was performed in seven patients; two peripancreatic collections; two infected leaks after hepatic resection; one recurrent hepatic abscess, one psoas abscess and one lumbar abscess. One patient underwent a percutaneous nephrostomy for acute pyelonephritis.

Technical success was achieved in 100% of patients, while clinical success was achieved in 4 out of 11 patients (36.3%). Six patients (54.5%) died despite proper percutaneous drainage and adequate antibiotic coverage. One patient (9%) needed operative intervention. Two patients (18.2%) had two drainage procedures to drain multiple fluid collections. Two patients (18.2%) had repeat drainage procedures due to recurrent fluid collections. The average volume of the drained fluid immediately after tube insertion was 85 mL. Follow-up scans show a reduction of the retained content and associated inflammatory changes after tube insertion in all patients. There was no significant statistical difference (P = 0.6 and 0.4) between the mean of WBCs and neutrophils count before drainage and seven days after drainage. The lymphocyte count shows significant increased seven days after drainage (P = 0.03).

In this study, patients having septic complications associated with COVID-19 showed relatively poor clinical outcomes despite technically successful percutaneous drainage.

• COVID-19
• SARS-CoV-2
• Coronavirus
• Sepsis
• Drainage
• Abscess

Since the beginning of the COVID-19 pandemic, many patients with clinically acute presentations have been approached differently. The fear of viral transmission along with the short period of study made patients delay their hospital visits and doctors reassess the approach of certain acute situations. This study aimed to assess the changes in the management of patients with acute cholecystitis before and during COVID-19.

A systematic review of the literature using PubMed (MEDLINE), Scopus, and ScienceDirect databases was performed until 01 September 2021. Totally, two kinds of studies were included, those assessing the management of acute cholecystitis during COVID-19 and those comparing the periods before and during the pandemic. The outcomes recorded include management approaches, complications, and mean length of stay.

A number of 15 eligible articles were included in the study. During the pandemic, six studies revealed a shift toward conservative management of acute cholecystitis and five of them reported that conservative management was opted in 73% of the patients. On the contrary, data from all studies revealed that the surgical approach was preferred in only 29.2% of patients. Furthermore, when comparing the periods before vs. during COVID-19, the conservative approach was reported in 36.3 and 43.2% before vs. during COVID-19, respectively, whereas surgical intervention was performed in 62.5% of patients before COVID-19 and 55.3% during the pandemic. The length of stay was delayed when a non-surgical approach was selected in most studies. Complications, mainly classified by the Clavien-Dindo scale, were higher in the pandemic period.

A tendency toward more conservative approaches was observed in most studies, reversing the previously used surgical approach in most cases of acute cholecystitis. In most of the examined cases during the COVID-19 pandemic, antibiotic treatment and percutaneous cholecystostomy were much more considered and even preferred.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide. Most of the infected patients present with respiratory symptoms and acute lung damage. Here, we present three cases of patients with COVID-19 disease whose main clinical manifestations are gastrointestinal symptoms. In our first case, we present a COVID-19 patient with histologic findings associated with ischemic necrosis of the small bowel. In the second and third cases, we demonstrate acute cholecystitis and histology showing microvascular thrombosis. These three cases highlight the ischemic and thrombotic changes seen in the setting of COVID-19 infection without classic respiratory symptoms, with resulting severe gastrointestinal and hepatobiliary disease requiring surgical management. Although the bile or stool viral load was not tested in these patients, the small intestine and gallbladder were infected with SARS-CoV-2, most likely via the epithelial angiotensin-converting enzyme 2 (ACE2) receptor.

Research concerning postoperative outcomes of confirmed coronavirus disease 2019 (COVID-19) patients revealed unfavorable postoperative results with increased morbidity, pulmonary complications and mortality. Case reports have suggested that COVID-19 is associated with more aggressive presentation of acute cholecystitis. The aim of the present study is to describe the perioperative assessment and postoperative outcomes of ten patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with concomitant acute cholecystitis who underwent cholecystectomy.

We report a total of 10 SARS-CoV-2 positive patients with concomitant acute cholecystitis that underwent cholecystectomy. Six patients were males, the mean age was 47.1 years. Nine patients had moderate acute cholecystitis, and one patient had severe acute cholecystitis. All patients were treated with urgent/early laparoscopic cholecystectomy. Regarding the Parkland grading scale, two patients received a Parkland grade of 3, two patients received a Parkland grade of 4, and six patients received a Parkland grade of 5. Eight patients required a bail-out procedure. Four patients developed biliary leakage and required endoscopic retrograde cholangiopancreatography with biliary sphincterotomy. After surgery, five patients developed acute respiratory distress syndrome (ARDS) and required intensive care unit (ICU) admission. One patient died after cholecystectomy due to ARDS complications. The mean total length of stay (LOS) was 18.2 d. The histopathology demonstrated transmural necrosis (n = 5), vessel obliteration with ischemia (n = 3), perforation (n = 3), and acute peritonitis (n = 10).

COVID-19 patients with acute cholecystitis had difficult cholecystectomies, high rates of ICU admission, and a prolonged LOS.

• COVID-19
• SARS-CoV-2
• Cholecystectomy in COVID-19
• Acute cholecysti- tis in COVID-19
• Case report

• Appendectomy
• Appendicitis
• COVID-19 Pandemic
• Machine learning

• Appendectomy
• Appendicitis/epidemiology
• Appendicitis/surgery
• COVID-19
• Cohort Studies
• Humans
• Italy/epidemiology
• Laparoscopy
• Length of Stay
• Pandemics
• Postoperative Complications/epidemiology
• Retrospective Studies
• SARS-CoV-2

• Università degli Studi di Torino

• COVID-19
• ChoCO-W
• Cholecystitis
• SARS-CoV-2
• WSES
• management

• Abdominal imaging
• COVID-19
• Multisystem inflammatory syndrome

• Abdomen
• Adult
• COVID-19/complications
• Child
• Humans
• SARS-CoV-2
• Systemic Inflammatory Response Syndrome

The spread of COVID-19 has restricted the delivery of standard medical care to surgical patients dramatically. Surgical triage is performed by considering the type of disease, its severity, the urgency for surgery, and the condition of the patient, in addition to the scale of infectious outbreaks in the region. The purpose of this study was to evaluate the impact of the COVID-19 pandemic on the number of surgical procedures performed and whether the effects were more prominent during certain periods of widespread infection and in the affected regions.

We selected 20 of the most common procedures from each surgical field and compared the weekly numbers of each operation performed in 2020 with the respective numbers in 2018 and 2019, as recorded in the National Clinical Database (NCD). The surgical status during the COVID-19 pandemic as well as the relationship between surgical volume and the degree of regional infection were analyzed extensively.

The rate of decline in surgery was at most 10–15%. Although the numbers of most oncological and cardiovascular procedures decreased in 2020, there was no significant change in the numbers of pancreaticoduodenectomy and aortic replacement procedures performed in the same period.

The numbers of most surgical procedures decreased in 2020 as a result of the COVID-19 pandemic; however, the precise impact of surgical triage on decrease in detection of disease warrants further investigation.

The online version contains supplementary material available at 10.1007/s00595-021-02406-2.

• COVID-19
• National clinical database
• Surgical triage

• Bipolar vessels sealing systems
• Electrosurgery
• Harmonic scalpel
• High energy devices
• Radiofrequency electrosurgery
• Survey

• Dissection
• Humans
• Italy
• Laparoscopy
• Minimally Invasive Surgical Procedures
• Pancreas

• acute pancreatitis complications
• covid-19 impact on general surgery
• digestive organs/ liver/ pancreas
• pancreatitis demographics
• pancreatitis outcomes

• COVID-19
• Emergency surgery
• first wave
• pandemic

While primarily a respiratory disease, COVID-19 can affect several organ systems and has been recently linked to cases of acalculous cholecystitis. We present a previously healthy elderly patient who presented to the emergency department with sepsis and was found to have COVID-19 after initially testing negative on PCR, along with suspected concomitant acalculous gangrenous cholecystitis. The patient passed away before any surgical intervention could be made. This case aims to discuss the potential relationship between acalculous cholecystitis and COVID-19.

• COVID-19
• SARS-CoV-2
• acalculous cholecystitis
• gangrenous cholecystitis

• COVID-19
• cancer
• hub and spoke
• pandemic
• surgery
• virus

• COVID-19
• Elective Surgical Procedures
• Humans
• Pandemics/prevention & control
• Perioperative Care
• SARS-CoV-2

• Acute cholecystitis
• Bedside
• COVID-19
• Drainage
• Percutaneous cholecystostomy
• SARS-CoV-2

• COVID-19/epidemiology
• COVID-19/surgery
• Cholecystitis, Acute/surgery
• Cholecystostomy
• Disease Outbreaks
• Hospitals
• Humans
• Italy/epidemiology
• Retrospective Studies
• Treatment Outcome

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.

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.

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 [4–21] 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, CI 95% 1.33–157.81), conservative treatment failure (OR 8.2, CI 95% 1.34–50.49) and AC severity were associated with an increased odd of mortality.

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.

• Acute cholecystitis
• COVID-19
• Cholecystectomy
• Hospital-acquired infection
• SARS-CoV-2

Acute cholecystitis is a common reason for emergency general surgery admission. The declaration of the COVID-19 pandemic may have resulted in treatment delays and corresponding increases in severity of disease. This study compared cholecystitis admissions and disease severity pre- and postdeclaration of pandemic.

Retrospective review of adult acute cholecystitis admissions (January 1,2020-May 31, 2020). Corresponding time periods in 2018 and 2019 comprised the historical control. Difference-in-differences analysis compared biweekly cholecystitis admissions pre- and postdeclaration in 2020 to the historical control. Odds of increased severity of disease presentation were assessed using multivariable logistic regression.

Cholecystitis admissions decreased 48.7% from 5.2 to 2.67 cases (RR 0.51 [0.28,0.96], P = 0.04) following pandemic declaration when comparing 2020 to historical control (P = 0.02). After stratifying by severity, only Tokyo I admissions declined significantly postdeclaration (RR 0.42 [0.18,0.97]), when compared to historical control (P = 0.02). There was no change in odds of presenting with severe disease after the pandemic declaration (aOR 1.00 [95% CI 0.30, 3.38] P < 0.99) despite significantly longer lengths of symptoms reported in mild cases.

Postpandemic declaration we experienced a significant decrease in cholecystitis admissions without corresponding increases in disease severity. The pandemic impacted healthcare-seeking behaviors, with fewer mild presentations. Given that the pandemic did not increase odds of presenting with increased severity of disease, our data suggests that not all mild cases of cholecystitis progress to worsening disease and some may resolve without medical or surgical intervention.

• Acute calculous cholecystitis
• Benign gallbladder disease
• COVID-19 pandemic
• Cholecystitis
• Tokyo guidelines

To assess how the COVID-19 outbreak has affected emergency general surgery (EGS) care during the pandemic, indications for surgery, types of procedures, perioperative course, and final outcomes.

This is a retrospective study of EGS patients during the pandemic period. The main outcome was 30-day morbidity and mortality according to severity and COVID-19 infection status. Secondary outcomes were changes in overall management. A logistic regression analysis was done to assess factors predictive of mortality.

One hundred and fifty-three patients were included. Half of the patients with an abdominal ultrasound and/or CT scan had signs of severity at diagnosis, four times higher than the previous year. Non-COVID patients underwent surgery more often than the COVID group. Over 1/3 of 100 operated patients had postoperative morbidity, versus only 15% the previous year. The most common complications were septic shock, pneumonia, and ARDS. ICU care was required in 17% of patients, and was most often required in the SARS-CoV-2-infected group, which also had a higher morbidity and mortality. The 30-day mortality in the surgical series was of 7%, with no differences with the previous year. The strongest independent predictors of overall mortality were age > 70 years, ASA III–IV, ESS > 9, and SARS-CoV-2 infection.

Non-operative management (NOM) was undertaken in a third of patients, and only 14% of operated patients had a perioperative confirmation of -CoV-2 infection. The severity and morbidity of COVID-19-infected patients was much higher. Late presentations for medical care may have added to the high morbidity of the series.

• COVID-19
• Emergency surgery
• General surgery

• COVID-19/epidemiology
• COVID-19/prevention & control
• Conservative Treatment/methods
• Conservative Treatment/statistics & numerical data
• Emergencies/epidemiology
• Emergency Service, Hospital/statistics & numerical data
• Female
• General Surgery/trends
• Hospitals, Teaching/statistics & numerical data
• Humans
• Incidence
• Infection Control/methods
• Infection Control/organization & administration
• Male
• Middle Aged
• Mortality
• Outcome and Process Assessment, Health Care
• Postoperative Complications/diagnosis
• Postoperative Complications/mortality
• SARS-CoV-2
• Spain/epidemiology
• Surgical Procedures, Operative/adverse effects
• Surgical Procedures, Operative/methods
• Surgical Procedures, Operative/statistics & numerical data

• COVID-19
• Delphi consensus
• EAES guidance
• Minimally invasive surgery
• Priority

• COVID-19/epidemiology
• COVID-19/prevention & control
• Delphi Technique
• Elective Surgical Procedures/methods
• Elective Surgical Procedures/standards
• Emergencies
• Global Health
• Health Care Rationing/standards
• Health Services Accessibility/standards
• Humans
• Infection Control/methods
• Infection Control/standards
• Minimally Invasive Surgical Procedures/methods
• Minimally Invasive Surgical Procedures/standards
• Pandemics
• SARS-CoV-2

• Università degli Studi di Torino

• Coronavirus disease 2019
• departmental organization
• general surgical practice
• operative room guidelines
• patient prioritization
• patient testing
• personal protective equipment

• Appendicitis
• COVID-19
• Cholecystitis
• Emergency surgery
• SARS-CoV-2
• WSES

• COVID-19
• Emergency Service, Hospital/statistics & numerical data
• Facilities and Services Utilization/statistics & numerical data
• General Surgery/statistics & numerical data
• Global Health/statistics & numerical data
• Health Care Surveys
• Humans
• SARS-CoV-2
• Surgical Procedures, Operative/statistics & numerical data

• Acute acalculous cholecystitis
• COVID-19 pandemic
• Case report
• Cholecystostomy
• Emergency surgery
• Laparoscopy