Acute cholecystitis during COVID-19 pandemic: a multisocietary position statement

Campanile, Fabio Cesare; Podda, Mauro; Arezzo, Alberto; Botteri, Emanuele; Sartori, Alberto; Guerrieri, Mario; Cassinotti, Elisa; Muttillo, Irnerio Angelo; Pisano, M; Contul, Riccardo Brachet; D’Ambrosio, Giancarlo; Cuccurullo, Diego; Bergamini, Carlo; Allaix, Marco Ettore; Caracino, Valerio; Petz, Wanda; Milone, Marco; Silecchia, Gianfranço; Anania, Gabriele; Agrusa, Antonino; Saverio, Salomone Di; Casarano, Salvatore; Cicala, Caterina; Narilli, P; Federici, Sara; Carlini, Massimo; Paganini, Alessandro M.; Bianchi, Paolo Pietro; Salaj, Adelona; Mazzari, Andrea; Meniconi, Roberto Luca; Puzziello, Alessandro; Terrosu, Giovanni; Simone, Belinda De; Coccolini, Federico; Catena, Fausto; Agresta, Ferdinando

doi:10.1186/s13017-020-00317-0

Cited by 66 publications

(98 citation statements)

References 15 publications

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“…Gangrenous cholecystitis is caused by ischemia arising from vascular insu ciency and it evolves into necrosis and perforation of the gallbladder wall with bile leakage 8 . Surgical societies released their recommendations to manage surgical disease during the COVID-19 pandemic 9 . The recommendations on emergency surgery have fueled a debate among surgeons on an international level 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Surgical societies released their recommendations to manage surgical disease during the COVID-19 pandemic 9 . The recommendations on emergency surgery have fueled a debate among surgeons on an international level 9 . Reports from China showed that asymptomatic COVID-19-positive patients underwent surgery presented poor clinical outcomes, with an increasing of mortality and pulmonary complication rate 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Multidisciplinary team decide to perform surgery after cholecystostomy due to worsening clinical condition of the patient, presenting fever and right upper quadrant abdominal pain. Laparoscopic cholecystectomy was preferred to open cholecystectomy because of the lack of evidence about an increased risk of SARS-CoV-2 infection during laparoscopy 9 . Finally, SARS-CoV-2 RNA was detected from a variety respiratory sources such as throat, nasal nasopharyngeal, sputum and bronchoalveolar lavage uid, but it was also detected in feces 13 , placental and fetal membrane 14 .…”

Section: Discussionmentioning

confidence: 99%

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Acute acalculous cholecystitis on a COVID-19 patient: a case report

Mattone

Sofia

Schembari

et al. 2020

Preprint

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Background coronavirus disease-19 (COVID-19) has spread to several countries around the world and has become an unprecedented pandemic. We report an extremely rare case of acute acalculous cholecystitis on a COVID-19 patient. In our knowledge, this is the first report of laparoscopic cholecystectomy performed on a COVID-19 patient. Case presentation: a COVID-19 patient was diagnosed with acute acalculous cholecystitis and a multidisciplinary team decided to perform a percutaneous transhepatic biliary drainage (PTBD) as the first treatment. SARS-CoV-2 RNA was not found in the bile fluid. Because of deterioration of the patient’s clinical conditions, laparoscopic cholecystectomy had to be performed and since the gallbladder was gangrenous, the severe inflammation made surgery difficult to perform. Conclusions acalculous cholecystitis was related with mechanical ventilation and prolonged total parenteral nutrition, in this case the gangrenous histopathology pattern and the gallbladder wall ischemia was probably caused by vascular insufficiency secondary to severe acute respiratory distress syndrome of COVID-19 pneumonia. The percutaneous transhepatic gallbladder drainage (PTBD) was performed according to Tokyo Guidelines because of high surgical risk. Laparoscopic cholecystectomy was next performed due to no clinical improvement. The absence of viral RNA in the bile highlights that SARS-CoV-2 is not eliminated with the bile while it probably infects small intestinal enterocytes which is responsible of gastrointestinal symptoms such as anorexia, nausea, vomiting, and diarrhea. Although the lack of evidence and guidelines about the management of patient with acute cholecystitis during COVID-19 pandemic, laparoscopic cholecystectomy, at most preceded by PTGBD on high surgical risk patients, remains the gold standard for the treatment of acute cholecystitis on COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Acute acalculous cholecystitis on a COVID-19 patient: a case report

Mattone

Sofia

Schembari

et al. 2020

Preprint

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“…It is still matter of debate whether HEDs represent an advantage or a risk for thermal injuries [15,16]. Also, the production of smoke is highly debated [17,18] especially in time of COVID-19 pandemic [19][20][21]. Ultimately, the issue of high costs is still slackening the implementation of HED in surgical activity.…”

Section: Discussionmentioning

confidence: 99%

Current status on the adoption of high energy devices in Italy: An Italian Society for Endoscopic Surgery and New Technologies (SICE) national survey

et al. 2020

Self Cite

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Background In the past three decades, different High Energy Devices (HED) have been introduced in surgical practice to improve the efficiency of surgical procedures. HED allow vessel sealing, coagulation and transection as well as an efficient tissue dissection. This survey was designed to verify the current status on the adoption of HED in Italy. Methods A survey was conducted across Italian general surgery units. The questionnaire was composed of three sections (general information, elective surgery, emergency surgery) including 44 questions. Only one member per each surgery unit was allowed to complete the questionnaire. For elective procedures, the survey included questions on thyroid surgery, lower and upper GI surgery, proctologic surgery, adrenal gland surgery, pancreatic and hepatobiliary surgery, cholecystectomy, abdominal wall surgery and breast surgery. Appendectomy, cholecystectomy for acute cholecystitis and bowel obstruction due to adhesions were considered for emergency surgery. The list of alternatives for every single question included a percentage category as follows: " < 25%, 25-50%, 51-75% or > 75%", both for open and minimally-invasive surgery. Results A total of 113 surgical units completed the questionnaire. The reported use of HED was high both in open and minimally-invasive upper and lower GI surgery. Similarly, HED were widely used in minimally-invasive pancreatic and adrenal surgery. The use of HED was wider in minimally-invasive hepatic and biliary tree surgery compared to open surgery, whereas the majority of the respondents reported the use of any type of HED in less than 25% of elective cholecystectomies. HED were only rarely employed also in the majority of emergency open and laparoscopic procedures, including cholecystectomy, appendectomy, and adhesiolysis. Similarly, very few respondents declared to use HED in abdominal wall surgery and proctology. The distribution of the most used type of HED varied among the different surgical interventions. US HED were mostly used in thyroid, upper GI, and adrenal surgery. A relevant use of H-US/RF devices was reported in lower GI, pancreatic, hepatobiliary and breast surgery. RF HED were the preferred choice in proctology. Conclusion HED are extensively used in minimally-invasive elective surgery involving the upper and lower GI tract, liver, pancreas and adrenal gland. Nowadays, reasons for choosing a specific HED in clinical practice rely on several aspects, including surgeon's preference, economic features, and specific drawbacks of the energy employed.

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“…Percutaneous cholecystostomy can be used as an alternative treatment method in cases where laparoscopic and open surgery cannot be performed [21]. Campanile et al reported that laparoscopic cholecystectomy could be safely performed for uncomplicated cases even during the COVID-19 pandemic; they also added that percutaneous cholecystostomy might be considered for patients who are unfit for surgery [22]. Although it was mentioned that laparoscopic cholecystectomy could be performed safely, medical treatment was applied to patients diagnosed with uncomplicated acute cholecystitis since there were no filtering devices in our center.…”

Section: Discussionmentioning

confidence: 99%

Performing General Surgery Emergencies Safely during COVID-19 Outbreak

2020

Signa Vitae

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Background: After the first case was diagnosed in Turkey on 11 March 2020 the decision was made by the science committee formed by the Ministry of Health to establish pandemic hospitals across the country. Herein, we aimed to evaluate management of the patients who required urgent intervention and/or surgery at the general surgery ward during the COVID-19 pandemic. Methods: A cross-sectional study conducted in a pandemic hospital. The medical records of patients requiring urgent surgical intervention and of trauma patients admitted to the general surgery outpatient clinic between 11 March 2020 and 11 May 2020 were retrospectively reviewed. Descriptive statistics were calculated, including means, standard deviations, medians, minimums, maximums, frequencies and ratios. Results: A total of 48 patients were included in the study. Thirty (62.5%) patients were male and 18 (37.5%) were female. Their mean age was 50.3 ± 19 (range 13 - 93) years, with 13 (27%) patients being 65 years old or older. In the preoperative period, only one patient (2%) was suspected of COVID-19. On the other hand, four (8%) patients had a suspicion in the postoperative period. All of them discharged uneventfully. Mortality occurred in 5 patients (10%) who had undergone due to trauma (2), perforation (2) and ischemia (1). None of the deceased patients had suspected COVID-19. No suspected case of COVID-19 was observed during the 14-day follow-up period after discharge. Conclusion: Patients who needs emergency surgery should be intervened without delay during the pandemic. Possible COVID-19 should be considered for each patient and preoperative preparations should be carried out with a multidisciplinary approach that involves infectious diseases and anesthesia teams.

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Acute cholecystitis during COVID-19 pandemic: a multisocietary position statement

Cited by 66 publications

References 15 publications

Acute acalculous cholecystitis on a COVID-19 patient: a case report

Acute acalculous cholecystitis on a COVID-19 patient: a case report

Current status on the adoption of high energy devices in Italy: An Italian Society for Endoscopic Surgery and New Technologies (SICE) national survey

Performing General Surgery Emergencies Safely during COVID-19 Outbreak

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