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Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Sep 19, 2020; 9(2): 7-16
Published online Sep 19, 2020. doi: 10.5409/wjcp.v9.i2.7
Pediatric surgery during the COVID-19 pandemic
Aikaterini Dedeilia, Stepan M Esagian, Ioannis A Ziogas, Dimitrios Giannis, Ioannis Katsaros, Georgios Tsoulfas
Aikaterini Dedeilia, Stepan M Esagian, Ioannis A Ziogas, Dimitrios Giannis, Ioannis Katsaros, Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
Aikaterini Dedeilia, National and Kapodistrian University of Athens, Athens 15772, Greece
Ioannis A Ziogas, Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN 37232, United States
Dimitrios Giannis, Institute of Health Innovations and Outcomes Research, the Feinstein Institute for Μedical Research, Manhasset, NY 11030, United States
Ioannis Katsaros, Department of Surgery, Metaxa Cancer Hospital, Piraeus 18537, Greece
Georgios Tsoulfas, First Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54622, Greece
Author contributions: Ziogas IA conceived the original research idea; all authors contributed to the design of this study; Dedeilia A and Esagian SM drafted the original manuscript; Ziogas IA, Giannis D, Katsaros I and Tsoulfas G critically reviewed and edited the original manuscript; all authors have read and approved the submitted manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Georgios Tsoulfas, MD, PhD, Associate Professor, First Department of Surgery, Aristotle University of Thessaloniki, 66 Tsimiski Street, Thessaloniki 54622, Greece. tsoulfasg@gmail.com
Received: May 13, 2020
Peer-review started: May 13,2020
First decision: June 13, 2020
Revised: June 14, 2020
Accepted: August 1, 2020
Article in press: August 1, 2020
Published online: September 19, 2020
Processing time: 126 Days and 19.6 Hours
Abstract

The coronavirus disease 2019 (COVID-19) pandemic has had a major impact on pediatric surgery. The infection is often asymptomatic and atypical in children, while overlapping presentations with other infectious diseases generate additional diagnostic challenges. The high probability of missed pediatric cases and the invasive nature of surgery generate great concern for widespread transmission in this setting. Current guidelines suggest that triage of cases should be made on a case-by-case basis by a multidisciplinary team of experts. Decision-making can be assisted by classifying cases as elective, urgent, or an emergency according to the risks of delaying their surgical management. A workflow diagram should ideally guide the management of all cases from admission to discharge. When surgery is necessary, all staff should use appropriate personal protective equipment, and high-risk practices, such as aerosol-generating tools or procedures, should be avoided if possible. Furthermore, carefully designed organizational protocols should be established to minimize transmission while ensuring the uninterrupted operation of pediatric surgery units. For example, surgical teams can be divided into small weekly rotating groups, and healthcare workers should be continuously monitored for COVID-19 symptoms. Additionally, team protocols in the operating room can optimize communication and improve adherence to personal protective equipment use. Isolated operating rooms, pediatric intensive care units, and surgical wards should be specifically designed for suspected or confirmed COVID-19 cases. Finally, transportation of patients should be minimal and follow designated short routes. All these measures can help mitigate the effects of the COVID-19 pandemic on pediatric surgery units.

Keywords: Pediatric surgery; COVID-19; SARS-CoV-2; Coronavirus; Emergency surgery; Personal protective equipment

Core Tip: The coronavirus disease 2019 (COVID-19) pandemic has had a major impact on pediatric surgery. The diagnostic challenges in the pediatric population and the invasive nature of surgery generate concern for widespread transmission. Each case should be assessed individually, categorized by urgency and managed according to a predesigned workflow diagram. All staff should use appropriate personal protective equipment and high-risk practices should be avoided. Protocols for organization of the surgical team and hospital infrastructure should be established to maximize safety and efficiency, while minimizing transmission. All these measures can help mitigate the effects of the COVID-19 pandemic on pediatric surgery units.