Document Type : Original Article
Author
Abstract
The coronavirus disease 2019 (COVID‑19) is a serious global pandemic that has extremely affected
health‑care systems. This article aimed to review the perspectives of general surgical practice during
the COVID‑19 pandemic. A systematic review of the literature addressing modification to general
surgical practice during the COVID‑19 pandemic indexed in PubMed, Scopus, Google, and Google
scholar was carried out on June 19–20, 2020. The literature review yielded 577 articles. The exclusion
of duplication, articles not in English, and specialized ones in various surgical disciplines precluded
398 articles. Finally, following checking for relevance and publication status, 114 papers were included.
Recommendations for surgical practice during the COVID‑19 pandemic revolved around mitigation
of the risk of virus transmission to patients and health‑care workers. The emerging themes of safety
precautions were related to patient prioritization and testing, mindful consideration of the operative
strategy, optimum use of personal protective equipment, operative room setup, and departmental
organization. However, those recommendations were often diverging and bore on a dearth of
evidence and personal opinions. Multidisciplinary work and cooperation among surgical specialties
are required to establish and validate the protocols for safe surgical practice during the pandemic
and perhaps similar crises in future. The COVID‑19 pandemic has brought several challenges to
the field of medicine, including the surgical specialty. The centrality of safety precautions emerging
in this crisis requires surgeons to adopt the new roles and work standards and translate them into
practice during the pandemic and perhaps longer.
Keywords
- Lombardi C, Gordini L, D’Amore A, Marzi F, Tedesco S, Grani G,
et al. Endocrine surgery during COVID‑19 pandemic: Do we need
an update of indications in Italy? Endocrine 2020;4:1‑4.
2. World Health Organization; Accessed on 22, September 2020
from: https://covid19.who.int/.
3. Deo SV, Kumar S, Kumar N, Saikia J, Bhoriwal S, Bhatnagar S,
et al. Guiding Principles for Cancer Surgery during the COVID‑19
Pandemic. Indian J Surg Oncol 2020;11 Suppl 1:3‑10.
4. Correia M, Ramos R, Bahten L. The surgeons and the COVID‑19
pandemic. Rev Col Bras Cir 202;47:e536.
5. Gok AF, Eryılmaz M, Ozmen MM, Alimoglu O, Ertekin C,
Kurtoglu MH. Recommendations for trauma and emergency
general surgery practice during COVID‑19 pandemic. Ulus
Travma Acil Cerrahi Derg 2020;26:335‑42.
6. De Simone B, Chouillard E, Di Saverio S, Pagani L, Sartelli M,
Biffl WL, et al. Emergency surgery during the COVID‑19
pandemic: What you need to know for practice. Ann R Coll Surg
Engl 2020;102:323‑32.
7. Patriti A, Baiocchi GL, Catena F, Marini P, Catarci M; FACS on
behalf of the Associazione Chirurghi Ospedalieri Italiani (ACOI).
Emergency general surgery in Italy during the COVID‑19 outbreak:
First survey from the real life. World J Emerg Surg 2020;15:36.
8. Mitura K, Myśliwiec P, Rogula W, Solecki M, Furcal J,
Kazanowski M, et al. Guidelines for the management of surgical
departments in non‑uniform hospitals during the COVID‑19
pandemic. Guidelines 2020;92:42‑53.
9. Stahel PF. How to risk‑stratify elective surgery during the
COVID‑19 pandemic? Patient Saf Surg 2020;14:8.
10. Balasubramanian A, Paleri V, Bennett R, Paleri V. Impact of
COVID‑19 on the mental health of surgeons and coping strategies.
Head Neck 2020;42:1‑7.
11. Diaz A, Sarac B, Schoenbrunner A, Jians J, Pawlik T. Elective
surgery in the time of COVID‑19. Am J Surg 2020;219:900‑2.
12. The Equator Network. Enhancing the Quality and Transparency of
Health Research. Available from: https://www.equator‑network
.org. [Last accessed on 2021 Feb 03].
13. Campanile FC, Podda M, Arezzo A, Botteri E, Sartori A,
Guerrieri M, et al. Acute cholecystitis during COVID‑19 pandemic:
A multisocietary position statement. World J Emerg Surg
2020;15:38.
14. Al‑Jabir A, Kerwan A, Nicola M, Alsafi Z, Khan M, Sohrabi C,
et al. Impact of the Coronavirus (COVID‑19) pandemic on surgical
practice – Part 2 (surgical prioritisation). Int J Surg 2020;79:233‑48.
15. Flemming S, Hankir M, Ernestus RI, Seyfried F, Germer CT,
MeybohmP, etal. Surgery in times of COVID‑19–Recommendations
for hospital and patient management. Langenbecks Arch Surg
2020;405:359‑64.
16. Al‑Omar K, Bakkar S, Khasawneh L, Donatini G, Miccoli P.
Resuming elective surgery in the time of COVID‑19: A safe and
comprehensive strategy. Updates Surg 2020;3:1‑5.
17. Guerci C, Maffioli A, Bondurri AA, Ferrario L, Lazzarin F,
Danelli P. COVID‑19: How can a department of general surgery
survive in a pandemic? Surgery 2020;167:909‑11.
18. Olson MT, Triantafyllou T, Singhal S. Resumption of elective
surgery during the COVID‑19 pandemic: What lessons can we
apply? Eur Surg 2020;5:1‑3.
19. Tan WJ, Foo FJ, Sivarajah SS, Li LH, Koh FH, Chew MH. Safe
colorectal surgery in the COVID‑19 Era – A Singapore experience.
Ann Coloproctol 2020;36:65‑9.
20. Moletta L, Pierobon ES, Capovilla G, Costantini M, Salvador R,
Merigliano S, et al. International guidelines and recommendations
for surgery during Covid‑19 pandemic: A Systematic Review. Int
J Surg 2020;79:180‑8.
21. Mouton C, Hirschmann MT, Ollivier M, Seil R, Menetrey J.
COVID‑19‑ESSKA guidelines and recommendations for resuming
elective surgery. J Exp Orthop 2020;7:28.
22. Sharma D, Agrawal V, Agarwal P. Roadmap for restarting
elective surgery during/after COVID‑19 pandemic. Indian J Surg
2020;11:1‑5.
23. Peloso A, Moeckli B, Oldani G, Triponez F, Toso C. Response of
a European surgical department to the COVID‑19 crisis. Swiss
Med Wkly 2020;150:w20241.
24. Finley C, Prashad A, Camuso N, Daly C, Aprikian A, Ball CG,
et al. Guidance for management of cancer surgery during the
COVID‑19 pandemic. Can J Surg 2020;63:S2‑4.
25. Vourtzoumis P, Alkhamesi N, Elnahas A, Hawel JE, Schlachta C.
Operating during COVID‑19: Is there a risk of viral transmission
from surgical smoke during surgery? Can J Surg 2020;63:E299‑301.
26. Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, et al. Clinical
characteristics and outcomes of patients undergoing surgeries
during the incubation period of COVID‑19 infection.
EClinicalMedicine 20205;21:100331.
27. Sorrentino L, Guaglio M, Cosimelli M. Elective colorectal cancer
surgery at the oncologic hub of Lombardy inside a pandemic
COVID-19 area. J Surg Oncol 2020;122:1‑3.
28. Kumar J, Raina R. Recommendations for surgery during the
COVID‑19 pandemic. Indian J Surg 2020;11:1‑2.
29. Wong D, Tang E, Njo A, Chu C, Chau S, Chow TL, et al. Risk
stratification protocol to reduce consumption of personal
protective equipment for emergency surgeries during COVID‑19
pandemic. Hong Kong Med J 2020;26:252‑4.
30. Al‑Muharraqi M A . T e s t i n g r e c o m m e n d a t i o n f o r
COVID‑19 (SARS‑CoV‑2) in patients planned for
surgery – Continuing the service and ‘suppressing’ the pandemic.
Br J Oral Maxillofac Surg 2020;58:503‑5.
31. Alimoglu O, Erol C, Kilic F, Baysal H. Cancer surgery during the
Covid‑19 pandemic in Turkey. Int J Surg 202;79:54‑5.
32. Tomulescu V, Surlin V, Scripcariu V, Bintintan V, Duta C,
Calu V, et al. Colorectal surgery in romania during the COVID‑19
pandemic. Chirurgia 2020;115:129‑37.
33. Liu Z, Zhang Y, Wang X, Zhang D, Dias D, Chandramohan K,
et al. Recommendations for surgery during the novel
coronavirus (COVID‑19) epidemic. Indian J Surg 2020;11:1‑5.
34. Zarrintan S. Surgical operations during the COVID‑19 outbreak:
Should elective surgeries be suspended? Int J Surg 2020;78:5‑6.
35. Welsh Surgical Research Initiative (WSRI) Collaborative.
Recommended operating room practice during the COVID‑19
pandemic: Systematic review. BJS Open 2020;4:748‑56.
36. Al‑BalasM, Al‑Balas HI, Al‑Balas H. Surgery during the COVID‑19
pandemic: A comprehensive overview and perioperative care. Am
J Surg 2020;219:903‑6.
37. Orthopoulos G, Fernandez GL, Dahle JL, Casey E, Jabbour N.
Perioperative considerations during emergency general surgery
in the Era of COVID‑19: A U.S. experience. J Laparoendosc Adv
Surg Tech A 2020;30:481‑4.
38. Mi B, Chen L, Panayi C, Xiong Y, Liu G. Surgery in the
COVID‑19 pandemic: Clinical characteristics and outcomes. BJS
2020;107:e297. - 39. Dexter F, Elhakim M, Loftus RW, Seering MS, Epstein RH.
Strategies for daily operating room management of ambulatory
surgery centers following resolution of the acute phase of the
COVID‑19 pandemic. J Clin Anesth 2020;64:109854.
40. Coccolini F, Perrone G, Chiarugi M, Di Marzo F, Ansaloni L,
Scandroglio I, et al. Surgery in COVID‑19 patients: Operational
directives. World J Emerg Surg 2020;15:25.
41. Yib H, Chiu P, Hassan C, Antonelli G, Sharma P. ISDE guidance
statement: Management of upper gastrointestinal endoscopy and
surgery in COVID‑19 outbreak. Dis Esophagus 2020;33:1‑4.
42. Macleod J, Mezher S, Hasan R. Surgery during COVID‑19 crisis
conditions: Can we protect our ethical integrity against the odds?
J Med Ethics 2020;46:1‑3.
43. Myles P, Maswime S. Mitigating the risks of surgery during the
COVID‑19 pandemic. Lancet 2020;396: 2‑3.
44. Besnier E, Tuech JJ, Schwarz L. We asked the experts: COVID‑19
outbreak: Is there still a place for scheduled surgery? “Reflection
from pathophysiological data”. World J Surg 2020;44:1695‑8.
45. Joseph J, Joseph A, Oomman S, Jayanthi N. Laparoscopic versus
open surgery: Aerosols and their implications for surgery during
the COVID‑19 pandemic. Eur Surg 2020;10:1‑2.
46. Scaravonati R, Diaz E, Roche S, Bertone S, Brandi C. Strategies
for follow up after hernia surgery during COVID 19 Pandemia.
Int J Surg 2020;79:103‑4.
47. Krishnamurthy A, Gopinath KS. The need for prioritizing cancer
surgeries amidst the COVID‑19 pandemic. Indian J Surg Oncol
2020;11:169‑70.
48. Hojaij FC, Chinelatto LA, Boog GH, Kasmirski JA, Lopes JV,
Sacramento FM. Surgical practice in the current COVID‑19
pandemic: A rapid systematic review. Clinics (Sao Paulo)
2020;75:e1923.
49. Wexner SD, Cortés‑Guiral D, Gilshtein H, Kent I, Reymond MA.
COVID‑19: Impact on colorectal surgery. Colorectal Dis
2020;22:635‑40.
50. Vigneswaran Y, Prachand VN, Posner MC, Matthews JB,
Hussain M. What is the appropriate use of laparoscopy over open
procedures in the current COVID‑19 Climate? J Gastrointest Surg
2020;24:1686‑91.
51. Mowbray NG, Ansell J, Horwood J, Cornish J, Rizkallah P,
Parker A, et al. Safe management of surgical smoke in the age of
COVID‑19. Br J Surg 2020;107:1406‑13.
52. Heffernan DS, Evans HL, Huston JM, Claridge JA, Blake DP,
May AK, et al. Surgical infection society guidance for operative
and peri‑operative care of adult patients infected by the severe
acute respiratory syndrome coronavirus‑2 (SARS‑CoV‑2). Surg
Infect (Larchmt) 2020;21:301‑8.
53. Williams M, Blake S, Matthews H. Mitigating the risk of aerosol
generation from power tools during the COVID‑19 pandemic.
Ann R Coll Surg Engl 2020;102:393‑4.
54. Al‑Niaimi F, Ali F. COVID‑19 and dermatologic surgery: Hazards
of surgical plume. Dermatol Ther 2020;33:e13593.
55. Harkin DW. Ethics for surgeons during the COVID‑19 pandemic,
review article. Ann Med Surg (Lond) 2020;55:316‑9.
56. Rana RE, Ather MH, Enam SA. Change in surgical practice amidst
COVID 19; example from a tertiary care centre in Pakistan. Ann
Med Surg (Lond) 2020;54:79‑81.
57. Karim J, Hachach‑Haram N, Dasgupta P. Bolstering the surgical
response to COVID‑19: How virtual technology will save lives
and safeguard surgical practice. BJU Int 2020;125:E18‑9.
58. Hamza M, Khan HS, Sattar ZA, Hanif M. Doctor‑patient
c o m m u n i c a t i o n i n s u r g i c a l p r a c t i c e d u r i n g t h e
coronavirus (COVID‑19) pandemic. Br J Surg 2020;107:e193.
59. La Torre M, Pata F, Gallo G. Delayed benign surgery during
the COVID‑19 pandemic: The other side of the coin. Br J Surg
2020;107:e258.
60. Brethauer SA, Poulose BK, Needleman BJ, Sims C, Arnold M,
Washburn K, et al. Redesigning a department of surgery during
the COVID‑19 pandemic. J Gastrointest Surg 2020;24:1852‑9.
61. COVIDSurg Collaborative. Elective surgery cancellations due to
the COVID‑19 pandemic: Global predictive modelling to inform
surgical recovery plans. Br J Surg 2020;107:1440‑9.
62. Berardi G, Levi Sandri GB, Colasanti M, Ettorre GM. Readaptation
of surgical practice during COVID‑19 outbreak: What has been
done, what is missing and what to expect. Br J Surg 2020;107:e251.
63. Cook T, Harrop‑Griffiths W. Kicking on while it’s still kicking
off – Getting surgery and anaesthesia restarted after COVID‑19.
Anaesthesia 2020;75:1273‑7.
)