Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

ObjectiveTo determine the efficiency of the interscrotal approach to inguinoscrotal pathologies.Patients and methodsWe report the use of the interscrotal approach in 21 boys, from September 2012 to November 2013, operated using an interscrotal access through a vertical incision on the median raphe.ResultsThe approach was used for bilateral inguinal hernia (48%), bilateral ectopic testis (19%), torsion of the spermatic cord (19%), testicular biopsy (10%) and webbing of the penis (5%).ConclusionInter-scrotal access is an option for inguinoscrotal pathologies, with the advantages of a single incision, much less dissection and disruption of tissue, and greater comfort for the ‘day-case’ child.

Background The echinococcosis and tuberculosis of the lungs are both endemic in Algeria. The coexistence of echinococcosis and tuberculosis in the same lobe of the lung is exceptional. Case presentation A 10-year-old girl was admitted with a history of productive cough, fever, and chest pain. Chest examination revealed decreased air entry at left lower lobe. Chest X-ray demonstrated a round left lower lobe with an air fluid interface. Chest CT scan with intravenous contrast showed a lingual hydroaeric formation measuring 5×6 cm with a detached membrane image. A diagnosis of a complicated hydatid disease of the lung was made and the patient was subsequently started on oral albendazole before undergoing exploratory thoracotomy where partial cystectomy and the obliteration of the pericyst cavity. Histopathology was notable for echinococcosis membrane characteristics. After 2 months, the patient re-presented with complaints of cough, hemoptysis, and dyspnea. Radiographic images favored repermeabilization of bronchopleural fistulas. The management was the closing of the bronchial openings. Histological findings include image characteristic of the echinococcosis and tuberculosis. The patient continued on albendazole and an anti-tuberculosis regimen, with concurrent functional physiotherapy sessions. During the following 3-year follow-up, drastic clinical, radiographic, and functional improvement was noted. Conclusion Concurrent tuberculosis and echinococcosis infection should be taken into consideration when patients present with persistent bronchopleural fistula in endemic areas. A multidisciplinary approach of different medical teams facilitates diagnosis and rapid treatment.