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Gallo G, Trompetto M. Clinical evidence and rationale of topical nifedipine and lidocaine ointment in the treatment of anal fissure and hemorrhoidal disease. Minerva Surg 2025; 80:177-192. [PMID: 39945661 DOI: 10.23736/s2724-5691.25.10771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2025]
Abstract
INTRODUCTION Anorectal conditions such as hemorrhoidal disease and anal fissure are frequently painful and debilitating. Pain after hemorrhoidectomy is also common and distressing. These conditions are at least initially managed conservatively. An ointment formulation containing the calcium channel blocker nifedipine and the local anesthetic lidocaine has an established role in the treatment of rectal conditions, particularly conditions associated with anal sphincter hypertonia such as hemorrhoidal disease and anal fissure. This review aimed to compile the evidence for the use of nifedipine 0.3% and lidocaine 1.5% ointment in treating these common but bothersome anorectal diseases. EVIDENCE ACQUISITION A comprehensive literature search was conducted, updated to 07 August 2024, using PubMed and MEDLINE databases to identify studies of lidocaine and nifedipine, alone or in combination, for the topical treatment of anal fissure or hemorrhoidal disease. Articles identified in the literature search were supplemented by ad hoc searches and supplemented by relevant literature known to the authors. EVIDENCE SYNTHESIS Nifedipine 0.3% and lidocaine 1.5% ointment is effective in relieving pain and aiding the resolution of thrombosed hemorrhoids, reducing resting anal pressure and healing chronic anal fissures, and controlling pain after hemorrhoidectomy. The ointment was significantly better than controls consisting of topical lidocaine 1.5% alone or in combination with hydrocortisone acetate 1%. CONCLUSIONS Although the available literature on the topical application of nifedipine and lidocaine in anorectal diseases is limited, nifedipine 0.3% and lidocaine 1.5% ointment should be considered a valid treatment option for clinicians treating anorectal diseases. Further studies are warranted to confirm and extend the results reported.
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Affiliation(s)
- Gaetano Gallo
- Department of Surgery, Sapienza University, Rome, Italy -
| | - Mario Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
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Ihnát P, Martínek L, Tulinský L, Kala Z, Grolich T, Gurlich R, Šturma J, Klos D, Špička P, Neoral Č, Černý V. Resilience in Rectal Cancer Treatment: Lessons from the COVID-19 Era in Czech Republic. Ther Clin Risk Manag 2024; 20:373-379. [PMID: 38912517 PMCID: PMC11192038 DOI: 10.2147/tcrm.s455332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/28/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction The management of patients with COVID-19 infection has placed great pressure on the healthcare systems around the world. The aim of this study was to investigate the impact of the COVID-19 pandemic on the treatment outcomes of patients with rectal cancer by comparing them to those of patients with the same diagnosis in the pre-pandemic period. Methods Retrospective data analysis of patients undergoing multimodal treatment for rectal cancer at the four university hospitals during the COVID-19 pandemic (2020-2021) and the 2-year pre-pandemic period (2018-2019). Results A total of 693 patients (319 in the pre-pandemic period and 374 in the pandemic period) with rectal cancer were included in the study. The demographic and clinical characteristics of patients in both study periods were comparable, as was the spectrum of surgical procedures. Palliative surgery was more common in the pandemic period (18% vs 13%, p=0.084). The proportion of patients undergoing minimally invasive surgery was higher during the COVID-19 pandemic (p=0.025). There were no statistically significant differences between the study periods in the incidence/severity of post-operative complications, 30-day mortality and length of hospital stay. The number of positive resection margins was similar (5% vs 5%). Based on these results, COVID-19 had no effect on the postoperative morbidity and mortality in patients undergoing surgery for rectal cancer. Neoadjuvant treatment was more common in the pre-pandemic period (50% vs 45%). Long-course RT was predominantly offered in the pre-pandemic period, short-course RT during the pandemic. Significantly shorter "diagnosis-surgery" intervals were observed during the pandemic (23 days vs 33 days, p=0.0002). The "surgery-adjuvant therapy" interval was similar in both analysed study periods (p=0.219). Conclusion Our study showed, that despite concerns about the COVID-19 pandemic, multimodal treatment of rectal cancer was associated with unchanged postoperative morbidity rates, increased frequency of short-course neoadjuvant RT administration and shorter "diagnosis-surgery" intervals.
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Affiliation(s)
- Peter Ihnát
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lubomír Martínek
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lubomír Tulinský
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Zdeněk Kala
- Department of Surgery, University Hospital Brno, Brno, Czech Republic
| | - Tomáš Grolich
- Department of Surgery, University Hospital Brno, Brno, Czech Republic
| | - Robert Gurlich
- Department of Surgery, University Hospital Královské Vinohrady, Praha, Czech Republic
| | - Jan Šturma
- Department of Surgery, University Hospital Královské Vinohrady, Praha, Czech Republic
| | - Dušan Klos
- 1st Department of Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Špička
- 1st Department of Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Čestmír Neoral
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- 1st Department of Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Vladimir Černý
- Department of Anaesthesia and Intensive Care Medicine, Charles University in Prague, 3rd Faculty of Medicine, Prague, Czech Republic
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Dorma MPF, Giuliani G, Guerra F, Santelli F, Esposito A, De Pastena M, Turri G, Pedrazzani C, Kauffmann EF, Boggi U, Solaini L, Ercolani G, Mastrangelo L, Jovine E, Di Franco G, Morelli L, Mazzola M, Ferrari G, Langella S, Ferrero A, La Mendola R, Abu Hilal M, Depalma N, D'Ugo S, Spampinato MG, Frisini M, Brolese A, Palaia R, Belli A, Cillara N, Deserra A, Cannavera A, Sagnotta A, Mancini S, Pinotti E, Montuori M, Coppola A, Di Benedetto F, Coratti A. The pan - COVID - AGICT study. The impact of COVID-19 pandemic on surgically treated pancreatic cancer patients. A multicentric Italian study. Surg Oncol 2024; 54:102081. [PMID: 38729088 DOI: 10.1016/j.suronc.2024.102081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/28/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND In this article we aimed to perform a subgroup analysis using data from the COVID-AGICT study, to investigate the perioperative outcomes of patients undergoing surgery for pancreatic cancers (PC) during the COVID-19 pandemic. METHODS The primary endpoint of the study was to find out any difference in the tumoral stage of surgically treated PC patients between 2019 and 2020. Surgical and oncological outcomes of the entire cohort of patients were also appraised dividing the entire peri-pandemic period into six three-month timeframes to balance out the comparison between 2019 and 2020. RESULTS Overall, a total of 1815 patients were surgically treated during 2019 and 2020 in 14 Italian surgical Units. In 2020, the rate of patients treated with an advanced pathological stage was not different compared to 2019 (p = 0.846). During the pandemic, neoadjuvant chemotherapy (NCT) has dropped significantly (6.2% vs 21.4%, p < 0.001) and, for patients who didn't undergo NCT, the latency between diagnosis and surgery was shortened (49.58 ± 37 days vs 77.40 ± 83 days, p < 0.001). During 2020 there was a significant increase in minimally invasive procedures (p < 0.001). The rate of postoperative complication was the same in the two years but during 2020 there was an increase of the medical ones (19% vs 16.1%, p = 0.001). CONCLUSIONS The post-pandemic dramatic modifications in healthcare provision, in Italy, did not significantly impair the clinical history of PC patients receiving surgical resection. The present study is one of the largest reports available on the argument and may provide the basis for long-term analyses.
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Affiliation(s)
- Maria Pia Federica Dorma
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est, School of Robotic Surgery, Grosseto, Italy; Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
| | - Giuseppe Giuliani
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est, School of Robotic Surgery, Grosseto, Italy
| | - Francesco Guerra
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est, School of Robotic Surgery, Grosseto, Italy
| | - Francesco Santelli
- Department of Economics, Business, Mathematics and Statistics (DEAMS), University of Trieste, Trieste, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Matteo De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Giulia Turri
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University and Hospital Trust of Verona, 37134, Verona, Italy
| | - Corrado Pedrazzani
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University and Hospital Trust of Verona, 37134, Verona, Italy
| | | | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Leonardo Solaini
- Department of Medical and Surgical Sciences, University of Bologna, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences, University of Bologna, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Laura Mastrangelo
- Division of General and Emergency Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elio Jovine
- Division of General and Emergency Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | - Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Roberta La Mendola
- Hepato-Bilio-Pancreatic Minimally Invasive Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Mohamnad Abu Hilal
- Hepato-Bilio-Pancreatic Minimally Invasive Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Norma Depalma
- Department of General Surgery, "Vito Fazzi" Hospital, Piazza Muratore 1-73100, Lecce, Italy
| | - Stefano D'Ugo
- Department of General Surgery, "Vito Fazzi" Hospital, Piazza Muratore 1-73100, Lecce, Italy
| | | | - Marco Frisini
- APSS, Department of General Surgery & HPB Unit, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Alberto Brolese
- APSS, Department of General Surgery & HPB Unit, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Raffaele Palaia
- Department of Abdominal Oncology, Division of Gastro-esophageal and Pancreatic Surgical Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, 80131, Italy
| | - Andrea Belli
- Department of Abdominal Oncology, Division of Gastro-esophageal and Pancreatic Surgical Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, 80131, Italy
| | - Nicola Cillara
- UOC Chirurgia Generale PO Santissima Trinità ASL Cagliari, Cagliari, Italy
| | - Antonello Deserra
- UOC Chirurgia Generale PO Santissima Trinità ASL Cagliari, Cagliari, Italy
| | | | - Andrea Sagnotta
- General and Oncology Surgery - San Filippo Neri Hospital - ASL Roma 1, Italy
| | - Stefano Mancini
- General and Oncology Surgery - San Filippo Neri Hospital - ASL Roma 1, Italy
| | - Enrico Pinotti
- Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy
| | - Mauro Montuori
- Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy
| | | | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Coratti
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est, School of Robotic Surgery, Grosseto, Italy
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Bangeas P, Konstantinidis N, Chrisopoulou T, Karatzia D, Giakoustidis A, Papadopoulos VN. Small Bowel Diverticulosis and COVID-19: Awareness Is the Key: A Case Series and Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:229. [PMID: 38399517 PMCID: PMC10890375 DOI: 10.3390/medicina60020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
Small bowel non-Meckelian diverticulosis is a rare condition with only a few published cases despite being described over 200 years ago. In the midst of the COVID-19 pandemic, studies suggested that many patients may experience gastrointestinal manifestations. Intestinal symptoms could worsen the inflammation and infection associated with small bowel diverticulitis. Here we present three cases: one with inflammation and rupture in a COVID-19 patient and another as an asymptomatic detection. The third case involved recurrence after the first laparoscopic lavage approach. Furthermore, we provide a mini-review of the literature to emphasize the importance of considering this entity in the differential diagnosis of an acute abdomen. In the majority of cases involving small bowel diverticula, conservative management is the preferred approach. However, when complications arise, surgical intervention, including enteroctomy and primary anastomosis, may be necessary to achieve optimal outcomes.
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Affiliation(s)
- Petros Bangeas
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
- Department of Radiology, Genesis General Clinic, 54301 Thessaloniki, Greece;
| | - Nikolaos Konstantinidis
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
| | - Tania Chrisopoulou
- Department of Radiology, Genesis General Clinic, 54301 Thessaloniki, Greece;
| | - Despoina Karatzia
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
| | - Alexandros Giakoustidis
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
| | - Vasileios N. Papadopoulos
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
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Gallo G, Goglia M. Grand challenges in colorectal and proctological surgery. Front Surg 2023; 10:1331877. [PMID: 38186385 PMCID: PMC10766734 DOI: 10.3389/fsurg.2023.1331877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Gaetano Gallo
- Department of Surgery, Sapienza University of Rome, Rome, Italy
- Colorectal and Proctological Surgery Section, Frontiers in Surgery
| | - Marta Goglia
- Colorectal and Proctological Surgery Section, Frontiers in Surgery
- Departmentof Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Gallo G, Dezi A, Grossi U, Picciariello A. Sclerotherapy with 3% polidocanol foam in the treatment of hemorrhoidal disease: unveiling the missing pieces for a comprehensive evaluation. Front Surg 2023; 10:1344724. [PMID: 38179315 PMCID: PMC10764418 DOI: 10.3389/fsurg.2023.1344724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Affiliation(s)
- Gaetano Gallo
- Department of Surgery, Sapienza University of Roma, Roma, Italy
| | - Agnese Dezi
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Aldo Moro of Bari, Bari, Italy
| | - Ugo Grossi
- Department of Surgery, Oncology and Gastroenterology – DISCOG, University of Padua, Padua, Italy
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Goglia M, Trompetto M, Realis Luc A, Clerico G, Gallo G. Editorial: Advances in proctology and colorectal surgery. Front Surg 2023; 10:1344739. [PMID: 38152343 PMCID: PMC10752601 DOI: 10.3389/fsurg.2023.1344739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 11/30/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Marta Goglia
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, School in Translational Medicine and Oncology, Sapienza University of Rome, Rome, Italy
| | - Mario Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | | | - Giuseppe Clerico
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - Gaetano Gallo
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
- Department of Surgery, Sapienza University of Rome, Rome, Italy
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Fujita M, Yamaguchi K, Nagashima K, Suzuki K, Kasai T, Hashimoto H, Onouchi Y, Sato D, Fujisawa T, Hata A. Changes in colorectal cancer treatment during the COVID-19 pandemic in Japan: Interrupted time-series analysis using the National Database of Japan. Cancer Epidemiol 2023; 85:102391. [PMID: 37207375 PMCID: PMC10191809 DOI: 10.1016/j.canep.2023.102391] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic forced us to accept changes in our usual diagnostic procedures and treatments for colorectal cancer. This study aimed to determine the impact of the pandemic on colorectal cancer treatment in Japan. METHODS The number of colorectal surgeries, stoma constructions, stent placements or long tube insertions, and neoadjuvant chemoradiotherapies were determined each month using sampling datasets from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. The observation periods before and during the pandemic were January 2015 to January 2020 and April 2020 to January 2021, respectively. An interrupted time-series analysis was used to estimate the changes in the number of procedures during the pandemic. RESULTS The number of endoscopic surgeries for colon cancer significantly decreased in April and July 2020 and for rectal cancer in April 2020. Additionally, the number of laparoscopic and open surgeries for colon cancer significantly decreased in July 2020 and October 2020, respectively. The number of stoma constructions and stent placements or long tube insertions did not increase during the observation period. Neoadjuvant chemoradiotherapy for rectal cancer significantly increased in April 2020 but levels returned shortly thereafter. These results suggest that the recommendations to overcome the pandemic proposed by expert committees, including the replacement of laparoscopic surgery with open surgery, stoma construction to avoid anastomotic leak, and replacement of surgery on the ileus with stent placement, were not widely implemented in Japan. However, as an exception, neoadjuvant chemoradiotherapy for rectal cancer was performed as an alternative treatment to delay surgery in small quantities. CONCLUSION A declining number of surgeries raises concerns about cancer stage progression; however, we found no evidence to suggest cancer progression from the trajectory of the number of stoma constructions and stent placements. In Japan, even during the pandemic, conventional treatments were performed.
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Affiliation(s)
- Misuzu Fujita
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan; Department of Public Health, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Kazuya Yamaguchi
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kiminori Suzuki
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Tokuzo Kasai
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Hideyuki Hashimoto
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Yoshihiro Onouchi
- Department of Public Health, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Daisuke Sato
- Center for Next Generation of Community Health, Chiba University Hospital, 1-8-15 Inohana, Chuo-ku, Chiba 260-0856, Japan
| | - Takehiko Fujisawa
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Akira Hata
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
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Gallo G, Guaitoli E, Barra F, Picciariello A, Pasculli A, Coppola A, Pertile D, Meniconi RL. Restructuring surgical training after COVID-19 pandemic: A nationwide survey on the Italian scenario on behalf of the Italian polyspecialistic young surgeons society (SPIGC). Front Surg 2023; 9:1115653. [PMID: 36713665 PMCID: PMC9875563 DOI: 10.3389/fsurg.2022.1115653] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/20/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has led to the disruption of surgical training. Lack of communication, guidelines for managing clinical activity as well as concerns for safety in the workplace appeared to be relevant issues. This study aims to investigate how surgical training has been reorganized in Italy, almost 2 years after the outbreak of COVID-19 pandemic. MATERIALS AND METHODS A 16-item-electronic anonymous questionnaire was designed through SurveyMonkey© web application. This survey was composed of different sections concerning demographic characteristics and impacts of the second COVID-19 pandemic wave on surgical and research/didactic activities. Changes applied in the training programme and activities carried out were also investigated. The survey was carried out in the period between June and October 2021. RESULTS Four hundred and thirty responses were collected, and 399 were considered eligible to be included in the study analysis. Three hundred and thirty-five respondents continued working in Surgical Units, with a significant reduction (less than one surgical session per week) of surgical sessions in 49.6% of them. With concern to didactic and research activities, 140 residents maintained their usual activity, while 116 reported a reduction. A sub-group analysis on resident moved to COVID-19 departments showed a reduction of research activities in 35% of them. During the period considered in this survey, the surgical training program was not substantially modified for most of participants (74.6%). CONCLUSION Our survey demonstrated that surgical residency programs haven't improved 2 years after the beginning of the pandemic. Further improvements are needed to guarantee completeness of surgical training, even in emergency conditions.
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Affiliation(s)
- Gaetano Gallo
- Department of Surgical Sciences, La Sapienza” University of Rome, Rome, Italy
| | | | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Alessandro Pasculli
- Department of Biomedical Sciences and Human Oncology - Unit of Endocrine, Digestive and Emergency Surgery, University “A. Moro” of Bari, Policlinic of Bari, Bari, Italy
| | | | - Davide Pertile
- Department of Surgery, Policlinico San Martino, Genova, Italy
| | - Roberto Luca Meniconi
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
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Nozawa H, Kawasaki A, Hayashi C, Kawai K, Sasaki K, Murono K, Emoto S, Ishihara S. Impact of COVID-19 Outbreak on Stoma Surgery and Stoma Clinic Service: A Retrospective Study at a Single Japanese Referral Hospital. Int J Clin Pract 2022; 2022:4789775. [PMID: 36016825 PMCID: PMC9371875 DOI: 10.1155/2022/4789775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/05/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Aim The impact of the COVID-19 pandemic on medical practice has been frequently reported from Western countries, but there have been few studies in other areas, especially regarding stoma surgery and stoma care. Methods We investigated the numbers of all operations and stoma-related surgeries at our hospital in 2019 and 2020. The cumulative numbers of consultations at our ostomy clinic and patient population stratified by the period of having a stoma were compared between these calendar years. The frequency of ostomy clinic visit by individual patients within the first year after stoma creation and stoma-related complications per consultation were also analyzed. Results The number of elective surgeries decreased by approximately 10% from 2019 to 2020, but the numbers of stoma creation and closure procedures did not differ. The total numbers of consultations at our ostomy clinic were also similar between these years. However, the percentage of patients with a stoma for less than a year who visited our ostomy clinic increased from 49.7% in 2019 to 53.5% in 2020, whereas the visitation rate for other patients decreased. Moreover, patients with a stoma for less than a year visited the ostomy clinic more frequently in 2020 (0.42/month) than in 2019 (0.30/month, p=0.032). There were fewer grade 2 or more severe peristomal complications in 2020 (11% vs 17% in 2019, p < 0.001) at our ostomy clinic. Conclusion The COVID-19 outbreak led to a shift in the patient population at ostomy clinics of new stoma patients, which may have resulted in fewer peristomal complications.
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Affiliation(s)
- Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Akiko Kawasaki
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Chieko Hayashi
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
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11
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Robotic Abdominal Surgery and COVID-19: A Systematic Review of Published Literature and Peer-Reviewed Guidelines during the SARS-CoV-2 Pandemic. J Clin Med 2022; 11:jcm11112957. [PMID: 35683346 PMCID: PMC9181746 DOI: 10.3390/jcm11112957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/05/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Significant concern emerged at the beginning of the SARS-CoV-2 pandemic regarding the safety and practicality of robotic-assisted surgery (RAS). We aimed to review reported surgical practice and peer-reviewed published review recommendations and guidelines relating to RAS during the pandemic. Methods: A systematic review was performed in keeping with PRISMA guidelines. This study was registered on Open Science Framework. Databases were searched using the following search terms: ‘robotic surgery’, ‘robotics’, ‘COVID-19’, and ‘SARS-CoV-2’. Firstly, articles describing any outcome from or reference to robotic surgery during the COVID-19/SARS-CoV-2 pandemic were considered for inclusion. Guidelines or review articles that outlined recommendations were included if published in a peer-reviewed journal and incorporating direct reference to RAS practice during the pandemic. The ROBINS-I (Risk of Bias in Non-Randomised Studies of Intervention) tool was used to assess the quality of surgical practice articles and guidelines and recommendation publications were assessed using the AGREE-II reporting tool. Publication trends, median time from submission to acceptance were reported along with clinical outcomes and practice recommendations. Results: Twenty-nine articles were included: 15 reporting RAS practice and 14 comprising peer-reviewed guidelines or review recommendations related to RAS during the pandemic, with multiple specialities (i.e., urology, colorectal, digestive surgery, and general minimally invasive surgery) covered. Included articles were published April 2020—December 2021, and the median interval from first submission to acceptance was 92 days. All surgical practice studies scored ‘low’ or ‘moderate’ risk of bias on the ROBINS-I assessment. All guidelines and recommendations scored ‘moderately well’ on the AGREE-II assessment; however, all underperformed in the domain of public and patient involvement. Overall, there were no increases in perioperative complication rates or mortalities in patients who underwent RAS compared to that expected in non-COVID practice. RAS was deemed safe, with recommendations for mitigation of risk of viral transmission. Conclusions: Continuation of RAS was feasible and safe during the SARS-CoV-2 pandemic where resources permitted. Post-pandemic reflections upon published robotic data and publication patterns allows us to better prepare for future events and to enhance urgent guideline design processes.
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12
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Kumar A, Parihar A, Panda U, Parihar DS. Microfluidics-Based Point-of-Care Testing (POCT) Devices in Dealing with Waves of COVID-19 Pandemic: The Emerging Solution. ACS APPLIED BIO MATERIALS 2022; 5:2046-2068. [PMID: 35473316 PMCID: PMC9063993 DOI: 10.1021/acsabm.1c01320] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/11/2022] [Indexed: 02/08/2023]
Abstract
Recent advances in microfluidics-based point-of-care testing (POCT) technology such as paper, array, and beads have shown promising results for diagnosing various infectious diseases. The fast and timely detection of viral infection has proven to be a critical step for deciding the therapeutic outcome in the current COVID-19 pandemic, which in turn not only enhances the patient survival rate but also reduces the disease-associated comorbidities. In the present scenario, rapid, noninvasive detection of the virus using low cost and high throughput microfluidics-based POCT devices embraces the advantages over existing diagnostic technologies, for which a centralized lab facility, expensive instruments, sample pretreatment, and skilled personnel are required. Microfluidic-based multiplexed POCT devices can be a boon for clinical diagnosis in developing countries that lacks a centralized health care system and resources. The microfluidic devices can be used for disease diagnosis and exploited for the development and testing of drug efficacy for disease treatment in model systems. The havoc created by the second wave of COVID-19 led several countries' governments to the back front. The lack of diagnostic kits, medical devices, and human resources created a huge demand for a technology that can be remotely operated with single touch and data that can be analyzed on a phone. Recent advancements in information technology and the use of smartphones led to a paradigm shift in the development of diagnostic devices, which can be explored to deal with the current pandemic situation. This review sheds light on various approaches for the development of cost-effective microfluidics POCT devices. The successfully used microfluidic devices for COVID-19 detection under clinical settings along with their pros and cons have been discussed here. Further, the integration of microfluidic devices with smartphones and wireless network systems using the Internet-of-things will enable readers for manufacturing advanced POCT devices for remote disease management in low resource settings.
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Affiliation(s)
- Avinash Kumar
- Department of Mechanical Engineering, Indian Institute of Information Technology Design & Manufacturing Kancheepuram, Chennai 600127, India
| | - Arpana Parihar
- Industrial Waste Utilization, Nano and Biomaterials, CSIR-Advanced Materials and Processes Research Institute (AMPRI), Hoshangabad Road, Bhopal, Madhya Pradesh 462026, India
| | - Udwesh Panda
- Department of Mechanical Engineering, Indian Institute of Information Technology Design & Manufacturing Kancheepuram, Chennai 600127, India
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13
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Ortenzi M, Balla A, Botteri E, Lepiane P, Guerrieri M, Arezzo A, Sartori A. COVID-19 pandemic: is it time for shared surgical guidelines? A systematic review of the literature. Minerva Surg 2022; 77:171-179. [PMID: 35416005 DOI: 10.23736/s2724-5691.21.09166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The recent COrona Virus Disease 2019 (COVID-19) pandemic caused a massive disruption of surgical activity and after a year from its first outbreak surgeons still struggle to keep their regular activity coexisting with the virus exhausting requests of healthcare resources. The aim of this paper is to offer a comprehensive overview of the most important recommendations by the International Guidelines about general surgery, and possibly to invite building common shared guidelines to preserve the potential to provide surgical assistance despite the pandemic. EVIDENCE ACQUISITION This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. PubMed, Embase, Cochrane and Web of Science databases were searched. EVIDENCE SYNTHESIS The searches revealed a total of 18579 articles published up to the end of February 2021. Five articles published between March and May 2020, were included in the present study: Guidelines from The European Society of Trauma and Emergency Surgery (ESTES), The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and The European Association for Endoscopic Surgeons (EAES), The Endoscopic and Laparoscopic Surgeons of Asia (ELSA), The European Hernia Society (EHS) and The International Organization for the Study of Inflammatory Bowel Disease (IOS-IBD). CONCLUSIONS In the likely scenario that the SARS-CoV-2 pandemic will become an endemic chronic problem, we should not be forced to choose between COVID-19 or surgery in the future and find a way to make both coexisting.
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Affiliation(s)
- Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy -
| | - Andrea Balla
- General Surgery Unit, San Paolo Hospital, Civitavecchia, Rome, Italy
| | - Emanuele Botteri
- General Surgery Unit, ASST Spedali Civili, Montichiari Hospital, Montichiari, Brescia, Italy
| | - Pasquale Lepiane
- General Surgery Unit, San Paolo Hospital, Civitavecchia, Rome, Italy
| | - Mario Guerrieri
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alberto Sartori
- Department of General Surgery, Montebelluna Hospital, Montebelluna, Treviso, Italy
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14
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Kopel J, Ristic B, Brower GL, Goyal H. Global Impact of COVID-19 on Colorectal Cancer Screening: Current Insights and Future Directions. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010100. [PMID: 35056408 PMCID: PMC8778776 DOI: 10.3390/medicina58010100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 12/17/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has brought significant challenges to many aspects of healthcare delivery since the first reported case in early December 2019. Once in the body, SARS-CoV-2 can spread to other digestive organs, such as the liver, because of the presence of ACE2 receptors. Colorectal cancer (CRC) remains the second-leading cause of death in the United States (US). Therefore, individuals are routinely screened using either endoscopic methods (i.e., flexible sigmoidoscopy and colonoscopy) or stool-based tests, as per the published guidelines. At the beginning of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) recommended that all non-urgent surgical and medical procedures, including screening colonoscopies, be delayed until the pandemic stabilization. This article aims to review the impact of COVID-19 on CRC screening.
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Affiliation(s)
- Jonathan Kopel
- Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Correspondence:
| | - Bojana Ristic
- Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA;
| | - Gregory L. Brower
- Department of Medication Education, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA;
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, PA 18501, USA;
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15
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Lugli G, Ottaviani MM, Botta A, Ascione G, Bruschi A, Cagnazzo F, Zammarchi L, Romagnani P, Portaluri T. The Impact of the SARS-CoV-2 Pandemic on Healthcare Provision in Italy to non-COVID Patients: a Systematic Review. Mediterr J Hematol Infect Dis 2022; 14:e2022012. [PMID: 35070219 PMCID: PMC8746940 DOI: 10.4084/mjhid.2022.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Italy has been one of the countries most affected by the SARS-CoV-2 pandemic, and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. Therefore, we investigated the management of non-COVID-19 patients across all medical specialities in Italy. METHODS A PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from February 20 to June 25 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialities combined with our geographical focus (Italy) and COVID-19. RESULTS Of the 4643 potentially eligible studies identified by the search, 247 were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialities have been affected by the re-organization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine. CONCLUSIONS Our work highlights the changes in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyse future directions for the healthcare system in the case of new pandemic scenarios.
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Affiliation(s)
- Gianmarco Lugli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Matteo Maria Ottaviani
- Department of Neurosurgery, University Politecnica delle Marche, Ancona, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Alessandro Bruschi
- Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Infectious and Tropical Disease, University Hospital Careggi, Florence, Italy
| | - Paola Romagnani
- Nephrology and Dialysis Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Tommaso Portaluri
- IN Srl, Udine, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
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16
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Cirocchi R, Nascimbeni R, Burini G, Boselli C, Barberini F, Davies J, Di Saverio S, Cassini D, Amato B, Binda GA, Bassotti G. The Management of Acute Colonic Diverticulitis in the COVID-19 Era: A Scoping Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1127. [PMID: 34684164 PMCID: PMC8538273 DOI: 10.3390/medicina57101127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023]
Abstract
Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign pathologies such as acute diverticulitis, for which we have identified a reduction in emergency room presentation with mild forms and an increase with more severe forms. The aim of our review was to discover new data on emergency presentation for patients with acute diverticulitis during the Covid-19 pandemic and their current management, and to define a better methodology for surgical decision-making. Method: We conducted a scoping review on 25 trials, analyzing five points: reduced hospital access for patients with diverticulitis, the preferred treatment for non-complicated diverticulitis, the role of CT scanning in primary evaluation and percutaneous drainage as a treatment, and changes in surgical decision-making and preferred treatment strategies for complicated diverticulitis. Results: We found a decrease in emergency access for patients with diverticular disease, with an increased incidence of complicated diverticulitis. The preferred treatment was conservative for non-complicated forms and in patients with COVID-related pneumonia, percutaneous drainage for abscess, or with surgery delayed or reserved for diffuse peritonitis or sepsis. Conclusion: During the COVID-19 pandemic we observed an increased number of complicated forms of diverticulitis, while the total number decreased, possibly due to delay in hospital or ambulatory presentation because of the fear of contracting COVID-19. We observed a greater tendency to treat these more severe forms by conservative means or drainage. When surgery was necessary, there was a preference for an open approach or a delayed operation.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy;
| | - Gloria Burini
- General & Emergency Surgical Clinic, University of Ancona, Hospital “Ospedali Riuniti di Ancona”, 60126 Ancona, Italy
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Francesco Barberini
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Justin Davies
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (J.D.); (S.D.S.)
| | - Salomone Di Saverio
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (J.D.); (S.D.S.)
| | - Diletta Cassini
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, 20099 Milano, Italy;
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy;
| | | | - Gabrio Bassotti
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
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Romanzi A, Gallo G, De Rango S, Vignati B, Vannelli A. Pain Distraction During Awake Major Colorectal Surgery: Supporting Patients Beyond the COVID-19 Era. Preliminary Findings. Front Surg 2021; 8:754059. [PMID: 34604299 PMCID: PMC8484703 DOI: 10.3389/fsurg.2021.754059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, hospitals rapidly ran out of intensive care beds. Because minimally invasive surgery and general anaesthesia are both aerosol-generating procedures, their use has become controversial. We report a case series of awake undelayable colorectal surgeries which, innovatively, took advantage of intraoperative pain distraction. Moreover, we describe our frugal solution to social distancing in psychological support of inpatients. Methods: Between October 2020 and February 2021, five patients underwent acute-care colorectal surgery under locoregional anaesthesia in our department. A 3D mobile theatre (3DMT) was used during the operation to distract the patients from pain. Vital signs, pain intensity, ergonomic comfort/discomfort, sense of presence and distress were intraoperatively monitored. A postoperative "cuddle delivery" service was instituted: video messages from relatives and close friends were delivered daily to the patient through the 3DMT. Emotional effects were investigated through clinical interviews conducted by a psychologist at our hospital. Results: Both intraoperative and postoperative pain were always well controlled. Conversion to general anaesthesia and postoperative intensive support/monitoring were never necessary. The "cuddle delivery" initiative helped patients fill the emotional gap created by the strict containment measures implemented inside the hospital, distracting them from emotional anxiety and physical pain. Conclusions: During the next phase of the COVID-19 pandemic and even after the COVID-19 era, awake laparotomy under locoregional anaesthesia may be a crucial option for delivering acute-care surgery to selected patients when intensive care beds are unavailable and postponing surgery is unacceptable. We also introduce a new modality for the provision of emotional support during postoperative inpatient care as a countermeasure to the restrictions imposed by social distancing measures.
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Affiliation(s)
- Andrea Romanzi
- Department of General Surgery, Valduce Hospital, Como, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Sabrina De Rango
- Department of Anesthesiology and Critical Care, Valduce Hospital, Como, Italy
| | - Barbara Vignati
- Department of Clinical and Biomedical Sciences “Luigi Sacco”, University of Milan, Milano, Italy
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18
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Gallo G, Ortenzi M, Grossi U, Di Tanna GL, Pata F, Guerrieri M, Sammarco G, Di Saverio S. What paradigm shifts occurred in the management of acute diverticulitis during the COVID-19 pandemic? A scoping review. World J Clin Cases 2021; 9:6759-6767. [PMID: 34447822 PMCID: PMC8362525 DOI: 10.12998/wjcc.v9.i23.6759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/15/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute colonic diverticulitis (ACD) is common in Western countries, with its prevalence increasing throughout the world. As a result of the coronavirus disease 2019 (COVID-19), elective surgery and in-patients' visits have been cancelled or postponed worldwide. AIM To systematically explore the impact of the pandemic in the management of ACD. METHODS MEDLINE, Embase, Scopus, MedxRiv, and the Cochrane Library databases were searched to 22 December 2020. Studies which reported on the management of patients with ACD during the COVID-19 pandemic were eligible. For cross sectional studies, outcomes of interest included the number of hospital admission for ACD, as well as key features of disease severity (complicated or not) across two time periods (pre- and during lockdown). RESULTS A total of 69 papers were inspected, and 21 were eligible for inclusion. Ten papers were cross sectional studies from seven world countries; six were case reports; three were qualitative studies, and two review articles. A 56% overall decrease in admissions for ACD was observed during lockdown, peaking 67% in the largest series. A 4%-8% decrease in the rate of uncomplicated diverticulitis was also noted during the lockdown phase. An initial non-operative management was recommended for complicated diverticulitis, and encouraged to an out-of-hospital regimen. Despite initial concerns on the use of laparoscopy for Hinchey 3 and 4 patients to avoid aerosolized contamination, societal bodies have progressively mitigated their initial recommendations as actual risks are yet to be ascertained. CONCLUSION During the COVID-19 pandemic, fewer patients presented and were diagnosed with ACD. Such decline may have likely affected the spectrum of uncomplicated disease. Established outpatient management and follow up for selected cases may unburden healthcare resources in time of crisis.
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Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro 88011, Italy
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona 60121, Italy
| | - Ugo Grossi
- 2nd Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Treviso 31100, Italy
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Sydney 2050, NSW, Australia
| | - Francesco Pata
- Department of General Surgery, Ospedale Nicola Giannettasio, Corigliano-Rossano 87064, Italy
- La Sapienza University, Roma 00185, Italy
| | - Mario Guerrieri
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona 60121, Italy
| | - Giuseppe Sammarco
- Department of Health Sciences, University "Magna Graecia" Medical School, University of Catanzaro, Catanzaro 88100, Italy
| | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, University Hospital of Varese, Varese 21100, Italy
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19
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Gallo G, Grossi U, Sturiale A, Di Tanna GL, Picciariello A, Pillon S, Mascagni D, Altomare DF, Naldini G, Perinotti R. E-consensus on telemedicine in proctology: A RAND/UCLA-modified study. Surgery 2021; 170:405-411. [PMID: 33766426 DOI: 10.1016/j.surg.2021.01.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/17/2021] [Accepted: 01/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronavirus disease 2019 is revolutionizing healthcare delivery. The aim of this study was to reach a consensus among experts as to the possible applications of telemedicine in the proctologic field. METHODS A group of 55 clinical practice recommendations was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Proctology Italian Working Group included 47 Italian Society of Colorectal Surgery nominated experts evaluating the appropriateness of each clinical practice recommendations based on published RAND/UCLA methodology in 2 rounds. RESULTS Stakeholder median age was 53 years (interquartile range limits 40-60), and 38 (81%) were men. Nine (19%) panelists reported no experience with telemedicine before the pandemic. Agreement was obtained on a minimum of 3 to 5 years of practice in the proctologic field before starting teleconsultations, which should be regularly paid, with advice and prescriptions incorporated into a formal report sent to the patient by e-mail along with a receipt. Of the panelists, 35 of 47 (74%) agreed that teleconsultation carries the risk of misdiagnosis of cancer, thus recommending an in-person assessment before scheduling any surgery. Fifteen additional clinical practice recommendations were re-elaborated in the second round and assessed by 44 of 47 (93.6%) panelists. The application of telemedicine for the diagnosis of common proctologic conditions (eg, hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappropriate. Teleconsultation was instead deemed appropriate for the diagnosis and management of pilonidal disease. CONCLUSION This e-consensus revealed the boundaries of telemedicine in Italy. Standardization of infrastructures, logistics, and legality remain to be better elucidated.
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Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
| | - Ugo Grossi
- IV Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Alessandro Sturiale
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Arcangelo Picciariello
- Surgical Unit 'M. Rubino', Department of Emergency and Organ Transplantation, Bari, Italy; Apulian Breath Analysis Centre (CeRBA), Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II, Bari, Italy
| | | | - Domenico Mascagni
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Roma, Roma, Italy
| | - Donato Francesco Altomare
- Surgical Unit 'M. Rubino', Department of Emergency and Organ Transplantation, Bari, Italy; Apulian Breath Analysis Centre (CeRBA), Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Gabriele Naldini
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - Roberto Perinotti
- Colorectal Surgical Unit, Department of Surgery, Infermi Hospital, Biella, Italy
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20
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Gallo G, Picciariello A, Di Tanna GL, Santoro GA, Perinotti R, Grossi U. E-consensus on telemedicine in colorectal surgery: a RAND/UCLA-modified study. Updates Surg 2021; 74:163-170. [PMID: 34312817 PMCID: PMC8312353 DOI: 10.1007/s13304-021-01139-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/06/2021] [Indexed: 12/12/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is revolutionizing healthcare delivery. The aim of the study was to reach consensus among experts on the possible applications of telemedicine in colorectal surgery. A group of 48 clinical practice recommendations (CPRs) was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Colorectal Surgery Italian Working Group included 54 colorectal surgeons affiliated to the Italian Society of Colo-Rectal Surgery (SICCR) who were involved in the evaluation of the appropriateness of each CPR, based on published RAND/UCLA methodology, in two rounds. Stakeholders’ median age was 44.5 (IQR 36–60) years, and 44 (81%) were males. Agreement was obtained on the applicability of telemonitoring and telemedicine for multidisciplinary pre-operative evaluation. The panel voted against the use of telemedicine for a first consultation. 15/48 statements deemed uncertain on round 1 and were re-elaborated and assessed by 51/54 (94%) panelists on round 2. Consensus was achieved in all but one statement concerning the cost of a teleconsultation. There was strong agreement on the usefulness of teleconsultation during follow-up of patients with diverticular disease after an in-person visit. This e-consensus provides the boundaries of telemedicine in colorectal surgery in Italy. Standardization of infrastructures and costs remains to be better elucidated.
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Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
| | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation, University Aldo Moro, Bari, Italy.,Apulian Breath Analysis Centre (CeRBA), IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Gian Luca Di Tanna
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | | | - Roberto Perinotti
- Department of Surgery, Colorectal Surgical Unit, Infermi Hospital, Biella, Italy
| | | | - Ugo Grossi
- IV Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Padua, Italy
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21
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Giani I, Gallo G, Grossi U, Tanda C, Linari C, Elbetti C. The Impact of COVID-19 pandemic on a tertiary referral proctology center: no one should be left behind. Minerva Surg 2021; 77:30-34. [PMID: 34160175 DOI: 10.23736/s2724-5691.21.08897-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has disrupted healthcare delivery. We aimed to describe a novel strategy to mitigate the impact of COVID-19 pandemic on a tertiary referral proctology center during the first wave of infection in Italy. METHODS All patients booked appointments at the Proctology Unit between March 9th and May 4th 2020 were identified. Patients booked for a first visit underwent a structured remote consultation. Patients with perianal or sacrococcygeal abscesses, major anorectal bleeding, incoercible anal pain and red flags for malignancy were labelled as 'non-deferrable'. A flowchart was designed to comply with adequate assistance of proctologic patients. Demographics, clinical data and outcomes of in-office procedures were collected. RESULTS On a total of 548 booked visits, 198 (36.1%) were cancelled before remote consultation. Of the remaining 350, 112 (32.0%) attended a follow-up visit. Among 238 (68.0%) patients undergoing remote consultation, 88 (25.1%) were deemed 'deferrable' and 148 (42.3%) 'nondeferrable'. 2 (0.6%) were hospitalized for COVID-19 while waiting for an outpatient visit. 25/88 (28.4%) deferrable patients cancelled their appointment as felt no longer necessary. A total of 45/148 (30.4%) non deferrable patients (mean age, 46 years; 31% females) underwent in-office procedures, most often related to anal abscess and/or fistula (48.9%). Final diagnosis of malignancy occurred in 4 cases. A 55% increase in the number of in-office procedures was noted compared to the previous year. None of the attending patients nor staff members resulted COVID-19 positive during the study period. CONCLUSIONS Despite the uncertainties accompanying the use of remote consultations in proctology, the results of this study may inform the development of strategies for restructuring activities in response to future emergencies of this magnitude.
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Affiliation(s)
- Iacopo Giani
- SOSD Proctologia USL Toscana Centro, Florence, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Ugo Grossi
- IV Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Padua, Italy -
| | - Cinzia Tanda
- SOSD Proctologia USL Toscana Centro, Florence, Italy
| | - Chiara Linari
- SOSD Proctologia USL Toscana Centro, Florence, Italy
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22
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Yoo HM, Kim IH, Kim S. Nucleic Acid Testing of SARS-CoV-2. Int J Mol Sci 2021; 22:6150. [PMID: 34200331 PMCID: PMC8201071 DOI: 10.3390/ijms22116150] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 12/13/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) has caused a large global outbreak. It is accordingly important to develop accurate and rapid diagnostic methods. The polymerase chain reaction (PCR)-based method including reverse transcription-polymerase chain reaction (RT-PCR) is the most widely used assay for the detection of SARS-CoV-2 RNA. Along with the RT-PCR method, digital PCR has emerged as a powerful tool to quantify nucleic acid of the virus with high accuracy and sensitivity. Non-PCR based techniques such as reverse transcription loop-mediated isothermal amplification (RT-LAMP) and reverse transcription recombinase polymerase amplification (RT-RPA) are considered to be rapid and simple nucleic acid detection methods and were reviewed in this paper. Non-conventional molecular diagnostic methods including next-generation sequencing (NGS), CRISPR-based assays and nanotechnology are improving the accuracy and sensitivity of COVID-19 diagnosis. In this review, we also focus on standardization of SARS-CoV-2 nucleic acid testing and the activity of the National Metrology Institutes (NMIs) and highlight resources such as reference materials (RM) that provide the values of specified properties. Finally, we summarize the useful resources for convenient COVID-19 molecular diagnostics.
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Affiliation(s)
- Hee Min Yoo
- Microbiological Analysis Team, Biometrology Group, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Korea; (H.M.Y.); (I.-H.K.)
- Department of Bio-Analytical Science, University of Science & Technology (UST), Daejeon 34113, Korea
| | - Il-Hwan Kim
- Microbiological Analysis Team, Biometrology Group, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Korea; (H.M.Y.); (I.-H.K.)
| | - Seil Kim
- Microbiological Analysis Team, Biometrology Group, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Korea; (H.M.Y.); (I.-H.K.)
- Department of Bio-Analytical Science, University of Science & Technology (UST), Daejeon 34113, Korea
- Convergent Research Center for Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon 34114, Korea
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23
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Jacob S, Hameed A, Lam V, Pang TC. Consistency of global recommendations regarding open versus laparoscopic surgery during the COVID-19 pandemic: a systematic review. ANZ J Surg 2021; 91:1358-1363. [PMID: 33792122 PMCID: PMC8250243 DOI: 10.1111/ans.16761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Abstract
Background Throughout the COVID‐19 pandemic, there has been worldwide debate regarding whether open surgery should be performed in preference to laparoscopic surgery due to the theoretical higher risk of viral aerosolization by the release of pneumoperitoneum. We aimed to assess the consistency of national and international surgical society recommendations regarding the choice of surgical approach; assess the quality of evidence of viral emission in surgical aerosol; and assess the quality of evidence comparing aerosol generation by different surgical energy devices. Methods A systematic review of PubMed, Medline, Embase and Cochrane databases was performed. Three search strategies were employed. Twenty‐eight studies were included in the final analysis and quality appraised. Confidence in review findings was assessed using the GRADE‐CERQual (Confidence in Evidence from Reviews of Qualitative research) tool. Results Worldwide recommendations regarding open versus laparoscopic surgery are consistent, with a majority recommending that surgical approach is decided on a case‐by‐case, risk minimization approach. There is limited, low‐quality evidence that viral particles can be emitted in surgical aerosol. There is a paucity of literature on the quantity of aerosol produced by different surgical energy devices, and no evidence to support the use of certain surgical instruments to minimize aerosol production. Conclusions There is considerable consistency among worldwide recommendations regarding the choice of surgical approach, although the evidence base is lacking. To inform clinical recommendations, further research examining viral emission, transmission, infectivity and amount of surgical aerosol produced is required.
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Affiliation(s)
- Susan Jacob
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ahmer Hameed
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Vincent Lam
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Tony Cy Pang
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
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24
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Santoro GA, Grossi U, Murad-Regadas S, Nunoo-Mensah JW, Mellgren A, Di Tanna GL, Gallo G, Tsang C, Wexner SD. DElayed COloRectal cancer care during COVID-19 Pandemic (DECOR-19): Global perspective from an international survey. Surgery 2021; 169:796-807. [PMID: 33353731 PMCID: PMC7670903 DOI: 10.1016/j.surg.2020.11.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer care during the pandemic. METHODS The impact of coronavirus disease 2019 on preoperative assessment, elective surgery, and postoperative management of colorectal cancer patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in colorectal cancer care. Respondents were divided into 2 comparator groups: (1) "delay" group: colorectal cancer care affected by the pandemic and (2) "no delay" group: unaltered colorectal cancer practice. RESULTS A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the delay (745, 70.9%) and no delay (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to coronavirus disease 2019 units, units fully dedicated to coronavirus disease 2019 care, and personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology, and prolonged chemoradiation therapy-to-surgery intervals. In the delay group, 48.9% of respondents reported a change in the initial surgical plan, and 26.3% reported a shift from elective to urgent operations. Recovery of colorectal cancer care was associated with the status of the outbreak. Practicing in coronavirus disease-free units, no change in operative slots and staff members not relocated to coronavirus disease 2019 units were statistically associated with unaltered colorectal cancer care in the no delay group, while the geographic distribution was not. CONCLUSION Global changes in diagnostic and therapeutic colorectal cancer practices were evident. Changes were associated with differences in health care delivery systems, hospital's preparedness, resource availability, and local coronavirus disease 2019 prevalence rather than geographic factors. Strategic planning is required to optimize colorectal cancer care.
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Affiliation(s)
- Giulio A Santoro
- Tertiary Referral Colorectal and Pelvic Floor Center, 4th Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy.
| | - Ugo Grossi
- Tertiary Referral Colorectal and Pelvic Floor Center, 4th Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | | | - Joseph W Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital Foundation NHS Trust, Department of Colorectal Surgery, Cleveland Clinic London, United Kingdom
| | - Anders Mellgren
- Division of Colon and Rectal Surgery, University of Illinois, Chicago, IL
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Italy
| | - Charles Tsang
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Steven D Wexner
- Digestive Disease Institute, Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, FL
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25
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Eftekhari A, Alipour M, Chodari L, Maleki Dizaj S, Ardalan M, Samiei M, Sharifi S, Zununi Vahed S, Huseynova I, Khalilov R, Ahmadian E, Cucchiarini M. A Comprehensive Review of Detection Methods for SARS-CoV-2. Microorganisms 2021; 9:232. [PMID: 33499379 PMCID: PMC7911200 DOI: 10.3390/microorganisms9020232] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 12/14/2022] Open
Abstract
Recently, the outbreak of the coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, in China and its subsequent spread across the world has caused numerous infections and deaths and disrupted normal social activity. Presently, various techniques are used for the diagnosis of SARS-CoV-2 infection, with various advantages and weaknesses to each. In this paper, we summarize promising methods, such as reverse transcription-polymerase chain reaction (RT-PCR), serological testing, point-of-care testing, smartphone surveillance of infectious diseases, nanotechnology-based approaches, biosensors, amplicon-based metagenomic sequencing, smartphone, and wastewater-based epidemiology (WBE) that can also be utilized for the detection of SARS-CoV-2. In addition, we discuss principles, advantages, and disadvantages of these detection methods, and highlight the potential methods for the development of additional techniques and products for early and fast detection of SARS-CoV-2.
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Affiliation(s)
- Aziz Eftekhari
- Pharmacology and Toxicology Department, Maragheh University of Medical Sciences, Maragheh 5515878151, Iran;
| | - Mahdieh Alipour
- Dental and Periodontal Research Center, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz 5166615731, Iran; (M.A.); (S.M.D.); (S.S.)
| | - Leila Chodari
- Physiology Department, Faculty of Medicine, Urmia University of Medical Sciences, Urmia 571478334, Iran;
| | - Solmaz Maleki Dizaj
- Dental and Periodontal Research Center, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz 5166615731, Iran; (M.A.); (S.M.D.); (S.S.)
| | - Mohammadreza Ardalan
- Kidney Research Center, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz 5166615731, Iran; (M.A.); (S.Z.V.)
| | - Mohammad Samiei
- Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz 5166615731, Iran;
| | - Simin Sharifi
- Dental and Periodontal Research Center, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz 5166615731, Iran; (M.A.); (S.M.D.); (S.S.)
| | - Sepideh Zununi Vahed
- Kidney Research Center, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz 5166615731, Iran; (M.A.); (S.Z.V.)
| | - Irada Huseynova
- Institute of Molecular Biology & Biotechnologies, Azerbaijan National Academy of Sciences, 11 Izzat Nabiyev, Baku AZ 1073, Azerbaijan;
| | - Rovshan Khalilov
- Department of Biophysics and Biochemistry, Baku State University, Baku AZ 1148, Azerbaijan;
- Joint Ukraine-Azerbaijan International Research and Education Center of Nanobiotechnology and Functional Nanosystems, 82100 Drohobych, Ukraine
| | - Elham Ahmadian
- Kidney Research Center, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz 5166615731, Iran; (M.A.); (S.Z.V.)
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, D-66421 Homburg/Saar, Germany
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26
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Gallo G, Sturiale A, De Simone V, Di Tanna GL, Giani I, Grossi U. A worldwide survey on proctological practice during COVID-19 lockdown (ProctoLock 2020): a cross-sectional analysis. Colorectal Dis 2021; 23:246-264. [PMID: 33025724 PMCID: PMC7675501 DOI: 10.1111/codi.15394] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 12/13/2022]
Abstract
AIM Proctology is one of the surgical specialties that has suffered the most during COVID-19 pandemic. Using a cross-sectional non-incentivised World Wide Web survey, we aimed to snapshot the current status of proctological practice in six world regions. METHOD Surgeons affiliated to renowned scientific societies with an interest in coloproctology were invited to join the survey. Members of the ProctoLock Working Group enhanced recruitment by direct invitation. The predictive power of respondents' and hospitals' demographics on the change of status of surgical and outpatient activities was calculated. RESULTS Respondents (n = 1050) were mostly men (79%), with a mean age of 46.9 years, at consultant level (79%), practising in academic hospitals (53%) offering a dedicated proctology service (68%). A total of 119 (11%) tested positive for SARS-CoV-2. The majority (54%) came from Europe. Participants from Asia reported a higher proportion of unaltered practice (17%), while those from Europe had the highest proportion of fully stopped practice (20%). The likelihood of ongoing surgical practice was higher in men (OR 1.54, 95% CI 1.13-2.09; P = 0.006), in those reporting readily availability of personal protective equipment (PPE) (OR 1.40, 1.08-1.42; P = 0.012) and in centres that were partially or not at all involved in COVID-19 care (OR 2.95, 2.14-4.09; P < 0.001). This chance decreased by 2% per year of respondent's age (P = 0.001). CONCLUSION Several factors including different screening policies and resource capacity affected the current status of proctological practice. This information may help health authorities to formulate effective preventive strategies to limit curtailment of care of these patients during the pandemic.
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Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical SciencesUniversity of CatanzaroCatanzaroItaly
| | - Alessandro Sturiale
- Proctology and Pelvic Floor Clinical CentreCisanello University HospitalPisaItaly
| | - Veronica De Simone
- Proctology UnitFondazione Policlinico Universitario ‘A. Gemelli’ IRCCSRomaItaly
| | - Gian Luca Di Tanna
- The George Institute for Global HealthFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | | | - Ugo Grossi
- IV Surgery UnitTreviso Regional HospitalUniversity of PaduaPaduaItaly
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27
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Rausei S, Ferrara F, Zurleni T, Frattini F, Chiara O, Pietrabissa A, Sarro G. Dramatic decrease of surgical emergencies during COVID-19 outbreak. J Trauma Acute Care Surg 2020; 89:1085-1091. [PMID: 32890343 PMCID: PMC7687876 DOI: 10.1097/ta.0000000000002923] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) outbreak, a general decrease in surgical activity was observed. There is perception that this phenomenon has involved also surgical emergency, but no extensive data have been presented to date. The aim of this study was to analyze the real number of admissions and procedures for emergency surgical disease during COVID-19 pandemic. METHODS This is a multicenter study including 18 general surgery units performing emergency surgery in hospitals of the "Red Zone" in Lombardy. Data about admissions from emergency department and surgical emergency procedures performed during March 2019 and March 2020 were collected in an online database. Additional data were collected according to the different indications for surgical treatment. The primary outcomes were the overall rate of admissions for emergent surgical disease and the overall rate of emergency surgical procedures in the study periods. The secondary outcome was the overall surgical rates (among all the diagnosed surgical diseases). RESULTS Emergency surgical admissions and surgical operations significantly decreased with a fall in value of 45% (p < 0.001) and 41% (p = 0.001), respectively. This reduction was confirmed by the analysis according to different surgical indications, with the exceptions of admissions and operations for gastrointestinal bleeding and operations for abdominal trauma. The overall ratio between surgical procedures and diseases was not significantly different (54% vs. 63%; p = 0.619). This ratio was significantly different only for bowel obstruction and for gastrointestinal perforation. CONCLUSIONS It seems correct to consider "true" the dramatic decrease of surgical problems during COVID-19 outbreak, despite any therapeutic strategies and logistic difficulties. LEVEL OF EVIDENCE Epidemiological, level III.
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28
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Gallo G, Sturiale A, De Simone V, Mancini S, Di Tanna GL, Milito G, Bianco F, Perinotti R, Giani I, Grossi U, Aiello D, Bianco F, Bondurri A, Gallo G, La Torre M, Milito G, Perinotti R, Pietroletti R, Serventi A, Fiorino M, De Simone V, Grossi U, Manigrasso M, Sturiale A, Zaffaroni G, Boffi F, Bellato V, Cantarella F, Deidda S, Marino F, Martellucci J, Milone M, Picciariello A, Bravo AM, Vigorita V, Cunha MF, Leventoglu S, Garmanova T, Tsarkov P, El-Hussuna A, Frontali A, Ioannidis A, Bislenghi G, Shalaby M, Porzio FC, Wu J, Zimmerman D, Elbetti C, Mayol J, Naldini G, Trompetto M, Sammarco G, Santoro GA. Deadlock of proctologic practice in Italy during COVID-19 pandemic: a national report from ProctoLock2020. Updates Surg 2020; 72:1255-1261. [PMID: 32770466 PMCID: PMC7414270 DOI: 10.1007/s13304-020-00860-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/25/2020] [Indexed: 01/19/2023]
Abstract
Proctology is one of the surgical specialties that suffered the most during COVID-19 pandemic. Using data from a cross-sectional worldwide web survey, we aimed to snapshot the current status of proctologic practice in Italy with differences between three macro areas (North, Centre, South). Specialists affiliated to renowned scientific societies with an interest in coloproctology were invited to join a 27-item survey. Predictive power of respondents' and hospitals' demographics on the change of status of surgical activities was calculated. The study was registered at ClinicalTrials.gov (NCT04392245). Of 299 respondents from Italy, 94 (40%) practiced in the North, 60 (25%) in the Centrer and 82 (35%) in the South and Islands. The majority were men (79%), at consultant level (70%), with a mean age of 46.5 years, practicing in academic hospitals (39%), where a dedicated proctologist was readily available (68%). Southern respondents were more at risk of infection compared to those from the Center (OR, 3.30; 95%CI 1.46; 7.47, P = 0.004), as were males (OR, 2.64; 95%CI 1.09; 6.37, P = 0.031) and those who routinely tested patients prior to surgery (OR, 3.02; 95%CI 1.39; 6.53, P = 0.005). The likelihood of ongoing surgical practice was higher in the South (OR 1.36, 95%CI 0.75; 2.46, P = 0.304) and in centers that were not fully dedicated to COVID-19 care (OR 4.00, 95%CI 1.88; 8.50, P < 0.001). The results of this survey highlight important factors contributing to the deadlock of proctologic practice in Italy and may inform the development of future management strategies.
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Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, Catanzaro, Italy.
| | - Alessandro Sturiale
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - Veronica De Simone
- Proctology Unit, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - Stefano Mancini
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Giovanni Milito
- General Surgery Unit, Department of General Surgery, Tor Vergata University, Rome, Italy
| | | | - Roberto Perinotti
- Colorectal Surgical Unit, Department of Surgery, Infermi Hospital, Biella, Italy
| | - Iacopo Giani
- SOSD Proctologia USL Toscana Centro, Prato, Italy
| | - Ugo Grossi
- IV Surgery Unit, Treviso Regional Hospital, University of Padua, Padua, Italy
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Elsabeeny WY, Abd El Dayem OY, Rabea A, Ibrahim RSM, Mahmoud HGM, Kamal E, Osman RA, Ghoneim A. Insights of COVID-19 pandemic impact on anesthetic management for patients undergoing cancer surgery in the National Cancer Institute, Egypt. AIN-SHAMS JOURNAL OF ANESTHESIOLOGY 2020. [PMCID: PMC7656221 DOI: 10.1186/s42077-020-00110-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract New corona virus disease COVID-19 is a pandemic outbreak viral infection that is highly contagious. The disease can affect any age groups. Majority of patients show mild or no symptoms. Immunocompromised patients and patients with co-morbidities are more vulnerable to have more aggressive affection with higher rate of complications. Thus, cancer patients carry a higher risk of infection. Diseased patient can transmit infection throughout the disease course starting from the incubation period to clinical recovery. All healthcare workers contacting COVID-19-positive patients are at great risk of infection, especially the anesthesiologists who can be exposed to high viral load during airway manipulation. In the National Cancer Institute of Egypt, we apply a protocol to prioritize cases where elective cancer surgeries that would not affect patient prognosis and outcome are postponed during the early phase and peak of the pandemic till reaching a plateau. However, emergency and urgent surgeries that can compromise cancer patient’s life and prognosis take place after the proper assessment of the patient’s condition. Aim This review aims to spot the management of cancer patients undergoing surgery during the COVID-19 pandemic in the National Cancer Institute, Egypt.
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Gallo G, Tiesi V, Fulginiti S, De Paola G, Vescio G, Sammarco G. Mesenchymal Stromal Cell Therapy in the Management of Perianal Fistulas in Crohn's Disease: An Up-To-Date Review. ACTA ACUST UNITED AC 2020; 56:medicina56110563. [PMID: 33121049 PMCID: PMC7692376 DOI: 10.3390/medicina56110563] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022]
Abstract
Crohn’s Disease (CD) is a chronic inflammatory disorder that potentially involves the entire gastrointestinal tract. Perianal fistulizing CD (pCD) is a serious and frequent complication associated with significant morbidities and a heavy negative impact on quality of life. The aim of CD treatment is to induce and maintain disease remission and to promote mucosal repair. Unfortunately, even the best therapeutic regimens in pCD do not have long-term efficacy and cause a significant number of side effects. Therefore, it is mandatory to study new therapeutical options such as the use of mesenchymal stromal cells (MSCs). These cells promote tissue repair via the induction of immunomodulation. The present review aims to analyze the existing updated scientific literature on MSCs adoption in the treatment of pCD to evaluate its efficacy and safety and to compare the use of bone marrow and adipose tissue derived MSCs, type of administration, and dose required for recovery.
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Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (V.T.); (S.F.); (G.D.P.); (G.V.)
- Correspondence: ; Tel.: +39-3284385222
| | - Vincenzo Tiesi
- Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (V.T.); (S.F.); (G.D.P.); (G.V.)
| | - Serena Fulginiti
- Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (V.T.); (S.F.); (G.D.P.); (G.V.)
| | - Gilda De Paola
- Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (V.T.); (S.F.); (G.D.P.); (G.V.)
| | - Giuseppina Vescio
- Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (V.T.); (S.F.); (G.D.P.); (G.V.)
| | - Giuseppe Sammarco
- Department of Health Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy;
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31
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Emile SH, Hamid HKS. A critical review of the safety of minimally invasive surgery in the era of COVID-19. MINIM INVASIV THER 2020; 31:370-376. [PMID: 33107358 DOI: 10.1080/13645706.2020.1838549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Corona virus disease 2019 (COVID-19) pandemic has affected surgical practice around the world. While several abdominal emergencies can be managed effectively and safely using minimally invasive surgery (MIS), the safety of using MIS amid the COVID-19 pandemic has been debated. MIS, including laparoscopy and robotic surgery, is considered an aerosol-generating procedure and some recent research demonstrated possible spread of the virus through aerosol. This review assessed the available evidence on the safety of MIS in the COVID-19 era, explored the possible precautions to be taken when using MIS to prevent exposure of the operating team to infection, and highlighted the recommendations of several surgical societies in this regard. MATERIAL AND METHODS Electronic databases, Google Scholar, and pre-print archives were searched for evidence on airborne transmission of COVID-19 and the safety of MIS amid the COVID-19 pandemic. Recommendations of recognized surgical societies were also searched. The available evidence was summarized in a narrative manner. RESULTS Limited data on the possibility of airborne transmission of COVID-19 were found. The studies that reported on the presence of the SARS-COV-2 in the air samples of patients with COVID-19 had conflicting results. Several precautions to minimize the presumed risk of exposure of the operation room staff to COVID-19 were devised. CONCLUSION According to the available evidence and recommendations of different surgical societies, MIS may be used in the treatment of acute abdominal emergency. However, considerable caution should be taken to avoid the presumed risk of aerosolization of the virus particles during the procedure, which may expose the operating staff to the risk of COVID-19.
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Affiliation(s)
- Sameh Hany Emile
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Hytham K S Hamid
- Department of surgery, Soba University Hospital, Khartoum, Sudan
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Pellino G, Vaizey CJ, Maeda Y. The COVID-19 pandemic: considerations for resuming normal colorectal services. Colorectal Dis 2020; 22:1006-1014. [PMID: 32790095 PMCID: PMC7436303 DOI: 10.1111/codi.15313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022]
Abstract
This European Society of Coloproctology guidance focuses on a proposed conceptual framework to resume standard service in colorectal surgery. The proposed conceptual framework is a schematic and stepwise approach including: in-depth assessment of damage to non-COVID-19-related colorectal service; the return of service (integration with the COVID-19-specific service and the existing operational continuity planning); safety arrangements in parallel with minimizing downtime; the required support for staff and patients; the aftermath of the pandemic and continued strategic planning. This will be dynamic guidance with ongoing updates using critical appraisal of emerging evidence. We will welcome input from all stakeholders (statutory organizations, healthcare professionals, public and patients). Any new questions, new data and discussion are welcome via https://www.escp.eu.com/guidelines.
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Affiliation(s)
- G. Pellino
- Department of Advanced Medical and Surgical SciencesUniversità degli Studi della Campania ‘Luigi Vanvitelli’NaplesItaly,Colorectal SurgeryVall d’Hebron University HospitalBarcelonaSpain
| | - C. J. Vaizey
- Department of Colorectal SurgerySt Mark’s HospitalLondonUK
| | - Y. Maeda
- Department of Colorectal SurgeryWestern General HospitalEdinburghUK,University of EdinburghEdinburghUK
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33
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Pata F, Bondurri A, Ferrara F, Parini D, Rizzo G. Enteral stoma care during the COVID-19 pandemic: practical advice. Colorectal Dis 2020; 22:985-992. [PMID: 32691949 PMCID: PMC7405158 DOI: 10.1111/codi.15279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/29/2020] [Accepted: 07/14/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Francesco Pata
- General Surgery UnitNicola Giannettasio HospitalCorigliano‐RossanoRossanoItaly
- La Sapienza UniversityRomeItaly
| | - Andrea Bondurri
- Department of General SurgeryLuigi Sacco University HospitalASST FBF‐SaccoMilanItaly
| | - Francesco Ferrara
- Department of SurgerySan Carlo Borromeo HospitalASST Santi Paolo e CarloMilanItaly
| | - Dario Parini
- General Surgery UnitSanta Maria della Misericordia HospitalRovigoItaly
| | - Gianluca Rizzo
- Department of SurgeryFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
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34
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Campos FG, Fillmann HS. General recommendations to the colorectal surgeon during the COVID-19 pandemic. JOURNAL OF COLOPROCTOLOGY 2020. [PMCID: PMC7303650 DOI: 10.1016/j.jcol.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The COVID-19 pandemic has shown our country in an unfavorable light, as Brazil has reported the second highest number of deaths to date. When the social isolation phase is finished, professional activities (including the medical ones) will resume their routines and the specialist must be updated in order to provide effective and safe care. Although many published recommendations are based on low levels of evidence, disclosing them has become necessary, since the coronavirus infection may affect operative outcomes. Overall, it is suggested that physicians adopt preventive measures, starting with the medical appointment, and extending them to the surgical procedure. Furthermore, it is also necessary to provisionally change criteria for operative indications and conducts. Currently, postponing elective surgeries seems to be a universally agreed decision. Moreover, we need to establish the early diagnosis of the viral infection, before or after the surgery. Several safety measures related to minimally-invasive procedures have been reported, disclosing the risks of aerosol dissemination by the pneumoperitoneum and smoke from energy-powered devices. The present article aimed to bring to the colorectal surgeon the current recommendations and general safety measures in order to prevent infection dissemination, to improve surgical planning in terms of timing and specific technical aspects.
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Affiliation(s)
- Fábio Guilherme Campos
- Universidade de São Paulo, Hospital das Clínicas, Divisão de Cirurgia Colorretal, Departamento de Gastroenterologia, São Paulo, SP, Brazil
| | - Henrique Sarubbi Fillmann
- Universidade PUCRS, Faculdade de Medicina, Departamento de Cirurgia, Divisão de Cirurgia Colorretal, Porto Alegre, RS, Brazil
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35
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Huddy JR, Rasheed S, Tilney HS. Continuation of minimally invasive surgery in the COVID-19 pandemic. Tech Coloproctol 2020; 24:1105-1106. [PMID: 32845405 PMCID: PMC7447698 DOI: 10.1007/s10151-020-02333-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- J R Huddy
- Department of Colorectal Surgery, Frimley Park Hospital, Portsmouth Road, Surrey, Camberley, GU16 7UJ, UK
| | - S Rasheed
- Department of Surgery, The Royal Marsden Hospital, London, UK
- Inspiral Health, St Luke's House, London, UK
| | - H S Tilney
- Department of Colorectal Surgery, Frimley Park Hospital, Portsmouth Road, Surrey, Camberley, GU16 7UJ, UK.
- Inspiral Health, St Luke's House, London, UK.
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36
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Gallo G, Sturiale A, De Simone V, Di Tanna GL, Bianco F, Perinotti R, Giani I, Grossi U. The impact of COVID-19 on proctologic practice in Italy. Tech Coloproctol 2020; 24:1103-1104. [PMID: 32778974 PMCID: PMC7416796 DOI: 10.1007/s10151-020-02319-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Affiliation(s)
- G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, Catanzaro, Italy.
| | - A Sturiale
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - V De Simone
- Proctology Unit, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - G L Di Tanna
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - F Bianco
- S. Leonardo Hospital, Castellammare Di Stabia, Naples, Italy
| | - R Perinotti
- Colorectal Surgical Unit, Department of Surgery, Infermi Hospital, Biella, Italy
| | - I Giani
- SOSD Proctologia USL Toscana Centro, Prato, Italy
| | - U Grossi
- IV Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Padua, Italy
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37
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Mori M, Ikeda N, Taketomi A, Asahi Y, Takesue Y, Orimo T, Ono M, Kuwayama T, Nakamura S, Yamada Y, Kuroda T, Yuzawa K, Hibi T, Nagano H, Unno M, Kitagawa Y. COVID-19: clinical issues from the Japan Surgical Society. Surg Today 2020; 50:794-808. [PMID: 32651686 PMCID: PMC7351651 DOI: 10.1007/s00595-020-02047-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 02/07/2023]
Abstract
In this unprecedented COVID-19 pandemic, several key issues must be addressed to ensure safe treatment and prevent rapid spread of the virus and a consequential medical crisis. Careful evaluation of a patient's condition is crucial for deciding the triage plan, based on the status of the disease and comorbidities. As functionality of the medical care system is greatly affected by the environmental situation, the treatment may differ according to the medical and infectious disease circumstances of the institution. Importantly, all medical staff must prevent nosocomial COVID-19 by minimizing the effects of aerosol spread and developing diagnostic and surgical procedures. Polymerase chain reaction (PCR) screening for COVID-19 infection, particularly in asymptomatic patients, should be encouraged as these patients are prone to postoperative respiratory failure. In this article, the Japan Surgical Society addresses the general principles of surgical treatment in relation to COVID-19 infection and advocates preventive measures against viral transmission during this unimaginable COVID-19 pandemic.
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Affiliation(s)
- Masaki Mori
- The Japanese Surgical Society, Tokyo, Japan.
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan.
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Norihiko Ikeda
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Akinobu Taketomi
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Yo Asahi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Minoru Ono
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan
- Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takashi Kuwayama
- Department of Breast Surgical Oncology, Showa University School of Medicine, 1-5-8, Hatanodai, Shibagawa-ku, Tokyo, 142-8666, Japan
| | - Seigo Nakamura
- Department of Breast Surgical Oncology, Showa University School of Medicine, 1-5-8, Hatanodai, Shibagawa-ku, Tokyo, 142-8666, Japan
| | - Yohei Yamada
- Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kenji Yuzawa
- Department of Transplantation Surgery, National Hospital Organization Mito Medical Center, Ibaraki-machi, Higashiibaraki-gun, Ibaraki, 311-3193, Japan
| | - Taizo Hibi
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan
| | - Hiroaki Nagano
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yuko Kitagawa
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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38
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Marino F, Trompetto M, Gallo G. COVID-19 pandemic: a large boulder on the head of stoma patients. Br J Surg 2020; 107:e303. [PMID: 32542654 PMCID: PMC7323345 DOI: 10.1002/bjs.11754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 11/07/2022]
Affiliation(s)
- F Marino
- Surgery Unit, National Institute of Gastroenterology 'S. de Bellis', Research Hospital Castellana Grotte, Bari, Italy
| | - M Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
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39
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40
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Preventing transmission among operating room staff during COVID-19 pandemic: the role of the Aerosol Box and other personal protective equipment. Updates Surg 2020; 72:907-910. [PMID: 32449034 PMCID: PMC7245989 DOI: 10.1007/s13304-020-00818-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/20/2020] [Indexed: 01/25/2023]
Abstract
The COVID-19 pandemic is highly challenging for the operating room staff and healthcare workers in emergency departments. SARS-CoV-2 is a positive-sense single-stranded RNA beta-coronavirus that primarily targets the human respiratory system, with fever, cough, myalgia, and pneumonia as the most common manifestations. However, since SARS-CoV-2 RNA was detected in stool specimens much more attention has been paid to gastrointestinal symptoms such as loss of appetite, nausea, and diarrhea. Furthermore, the expression of ACE-2 receptors in absorptive enterocytes from ileum and colon suggests that these organs should also be considered as a potential high risk for SARS-CoV-2 infection. During aerosol-generating medical procedures (AGMP; e.g. intubating and extubating patients or any surgical procedures), the production of both airborne particles and droplets may increase the risk of infection. In this situation, the surgical staff is strongly recommended to wear personal protective equipment (PPE). A transparent plastic cube, the so-called "Aerosol Box" (AB), has been recently designed to lend further protection against droplets and aerosol exposure during the AGMP.
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41
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Giani I, Elbetti C, Trompetto M, Gallo G. Proctology in the COVID-19 era: handle with care. Br J Surg 2020; 107:e243. [PMID: 32410223 PMCID: PMC7273076 DOI: 10.1002/bjs.11676] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 01/12/2023]
Affiliation(s)
- I Giani
- SOSD Proctologia USL Toscana Centro, Prato, Italy
| | - C Elbetti
- SOSD Proctologia USL Toscana Centro, Prato, Italy
| | - M Trompetto
- Department of Colorectal Surgery, St. Rita Clinic, Vercelli, Italy
| | - G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
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