Management of oncological and emergency surgery cases during COVID-19 pandemic

Öz

Objective: IEmergency surgery cases have an important place in General Surgery. During the COVID-19 epidemic, patients’ fear of being affected by the epidemic and the complexity of their behavior make the diagnosis and treatment of these diseases difficult. Methods: The computerized database of patients who underwent surgery with the diagnosis of acute appendicitis, cholecystitis, and colorectal cancer in our tertiary center during the COVID pandemic was retrospectively reviewed as pre-pandemic and pre-pandemic. Results: During the study period, 1100 patients were operated for appendicitis, 500 patients for cholecystitis, and 120 patients for oncological diseases. The mean age was similar for both periods, with a mean age of 34.06 ± 16.7 years in the pre-pandemic period and 36.72 ± 15.31 years in the pandemic period. The duration of admission to hospital after symptom onset was similar in both periods (34.55 ± 31.51 vs. 34.35 ± 37.94 h, P = 0.968). There was no significant difference between laboratory tests. WBC values were 12.73 ± 4.3 × 103 in the pre-pandemic period and 13.62 ± 4.62 × 103 (P = 0.1308) in the post-pandemic period. All patients used at least 1 imaging method before and during the pandemic. Conclusion: IIn the initial phase of the COVID-19 pandemic, there was a significant increase in the rate of need for complicated emergency surgery. Patients should be strongly encouraged to seek emergency outpatient clinics at the onset of symptoms to avoid this.

Anahtar Kelimeler

• Appendicitis
• Cholecystitis
• Covid-19
• Oncologic
• Coronavirus Disease 2019

COVID-19 pandemisi döneminde onkolojik ve acil cerrahi vakalarının yönetimi

Öz

Amaç: Acil cerrahi vakalara Genel Cerrahide önemli bir yer tutmaktadır. COVID-19 salgını döneminde, hastaların salgından etkilenme korkusu ve davranış şekillerinin karmaşıklığı bu hastalıkların teşhis ve tedavisini zorlaştırmaktadır. Yöntem: Üçüncü basamak olan merkezimizde, COVID pandemisi sırasında akut apandisit, kolesistit ve kolorektal kanser tanısı ile cerrahi geçiren hastaların bilgisayarlı veri tabanı retrospektif olarak pandemi öncesi ve pandemi dönemi şeklinde gözden geçirildi. Bulgular: Çalışma süresi boyunca 1100 hasta apandisit, 500 hasta kolesistit, 120 hasta onkolojik hastalıklar nedeni ile ameliyat edildi. Ortalama yaş her iki dönem için benzerdi, pandemi öncesi dönemde 34.06 ± 16.7 pandemi döneminde 36,72 ± 15,31 yaş ortalaması mevcuttu. Semptom başlaması ile hastaların hastaneye başvuru süreleri her iki döneme benzerdir (34,55 ± 31,51 ile 34,35 ± 37,94 sa, P = 0,968). Laboratuvar testler arasında anlamlı bir farklılık göstermemiştir. WBC değerleri pandemi öncesi dönemde 12.73 ± 4.3 × 103 idi pandemi sonrası dönemde 13.62 ± 4.62×103 (P = 0.1308) idi. Pandemi öncesi ve pandemi döneminde tüm hastalar en az 1 görüntüleme yöntemi kullanılmıştır. Sonuç: COVID-19 pandemisinin ilk aşamasında, komplike acil cerrahi gereksinimi oranında önemli bir artış vardı. Hastalar bundan kaçınmaları için semptomların başlaması ile acil polikliniklere başvurmaları şiddetle teşvik edilmelidir.

Anahtar Kelimeler

• Onkoloji
• Apandisit
• Kolesistit
• Covid-19
• Koronavirüs Hastalığı 2019

Kaynakça

1. F Mehmet Mahir, Ç Hüseyin, F Ayşe Tuba et al. A comparison of patients who have appendectomy during the COVID-19 pandemic period with the period before the pandemicUlus Travma Acil Cerrahi Derg 2022;28 (2):170-174 DOI: 10.14744/tjtes.2021.57946
2. TC Sağlık Bakanlığı COVID-19 Bilgilendirme Platformu. https://covid19.saglik.gov.tr
3. H. JavanmardEmamghissi, H. BoydCarson, M. Hollyman et al. Techniques in Coloproctology (2021) 25:401–411 https://doi.org/10.1007/s10151-020-02297-4
4. T James, K Aner, B Ori et al. The Decreasing Incidence of Acute Appendicitis During COVID-19: A Retrospective Multi-centre Study. World J Surg https://doi.org/10.1007/s00268-020-05599-8
5. S Ming-Yang, U Saif, Y Hui-Yu, et al. Long-term effects of appendectomy in humans: is it the optimal management of appendicitis?, Expert Review of Gastroenterology & Hepatology, 15:6, 657-664, DOI: 10.1080/17474124.2021.1868298
6. Georgios, S Elizabeth, I Francesca, et al. Increasing incidence of complicated appendicitis during COVID-19 pandemic The American Journal of Surgery https://doi.org/10.1016/j.amjsurg.2020.09.0260002-9610/
7. A Roi, N Mariya, H Asaf et al. Laparoscopic Appendectomy in the Days of COVID-19 Surg Laparosc Endosc Percutan Tech 2021;31:599–602
8. B Matteo, P Gaetano, T Arianna et al.COVID19 outbreak and acute cholecystitis in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy Barabino et al. BMC Surg (2021) 21:180 https://doi.org/10.1186/s12893-021-01137-y

9. Gallego MA, Casas SG de las, Migueláñez IP et al. Impacto de la pandemia por SARS-CoV-2 sobre la actividad y profesionales de un Servicio de Cirugía General y del Aparato Digestivo en un hospital terciario. Cirugía Española. 2020; 98: 320–327. https://doi.org/10.1016/j.ciresp.2020.04.001
10. De Simone B, Chouillard E, Di Saverio S, et al. Emergency surgery during the COVID-19 pandemic: what you need to know for practice. Ann R Coll Surg Engl. 2020;102 (5):323–32.