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Feier CVI, Ratiu S, Muntean C, Olariu S. The Consequences of the COVID-19 Pandemic on Emergency Surgery for Colorectal Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2093. [PMID: 36767459 PMCID: PMC9915383 DOI: 10.3390/ijerph20032093] [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: 01/04/2023] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study is to analyze the impact of the COVID-19 pandemic on the emergency treatment of patients with colorectal cancer in a university surgery clinic. Data from patients undergoing emergency surgery during the pandemic period (2020-2021) was taken into consideration and the results were analyzed and compared with the periods 2016-2017 and 2018-2019. A significant decrease in the number of patients undergoing emergency surgery was reported (p = 0.028). The proportion of patients who presented more severe symptoms at the hospital was significantly higher (p = 0.007). There was an increase in the average duration of surgical interventions compared to pre-pandemic periods (p = 0.021). An increase in the percentage of stomas performed during the pandemic was reported. The average duration of postoperative hospitalization was shorter during the pandemic. A postoperative mortality of 25.7% was highlighted. Conclusions: The pandemic generated by COVID-19 had significant consequences on the emergency treatment of patients with colon cancer. A smaller number of patients showed up at the hospital, and with more severe symptoms. In order to reduce the risk of infection with SARS-CoV-2 virus, the postoperative hospitalization period was shortened and a higher number of protective stomas were performed.
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Affiliation(s)
- Catalin Vladut Ionut Feier
- First Discipline of Surgery, Department X-Surgery, “Victor Babes” University of Medicine and Pharmacy, 2 E. Murgu Sq., 300041 Timisoara, Romania
- First Surgery Clinic, “Pius Brinzeu” Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Sonia Ratiu
- Plastic Surgery Clinic, “Casa Austria, Pius Brinzeu” Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Calin Muntean
- Department of Informatics and Medical Biostatistics, “Victor Babes” University and Pharmacy, 300173 Timisoara, Romania
| | - Sorin Olariu
- First Discipline of Surgery, Department X-Surgery, “Victor Babes” University of Medicine and Pharmacy, 2 E. Murgu Sq., 300041 Timisoara, Romania
- First Surgery Clinic, “Pius Brinzeu” Clinical Emergency Hospital, 300723 Timisoara, Romania
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Lisi G, Gentileschi P, Spoletini D, Passaro U, Orlandi S, Campanelli M. Sclerotherapy for III- and IV-degree hemorrhoids: Results of a prospective study. Front Surg 2022; 9:978574. [PMID: 36117836 PMCID: PMC9474687 DOI: 10.3389/fsurg.2022.978574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/08/2022] [Indexed: 01/11/2023] Open
Abstract
BackgroundIn the last 2 years, anorectal surgery has been strongly affected and even surgery for urgent cases cannot be scheduled; also, patients with III- and IV-degree bleeding hemorrhoids should be treated conservatively. The aim was to evaluate the effectiveness of sclerotherapy in patients who had to postpone surgery.MethodsWe included all patients with III- and IV-degree bleeding hemorrhoids who underwent outpatient sclerotherapy. The visual analog scale and the hemorrhoid severity score were used at the baseline and at 4 weeks after the procedure with a telephone interview, and all patients were outpatient-evaluated 1 week, 1 month, and 1 year after the treatment. All pre- and postoperative data were recorded.ResultsFrom October 2020 to November 2021, 19 patients with III- (12 patients; 63%) and IV-degree (7 patients; 37%) bleeding hemorrhoids were enrolled. The mean operative time was 4.5 min, and no intraoperative complications occurred. One case of tenesmus and three failures were detected. Six months after the procedure, the overall success rate was 84%, although all of the patients enrolled reported persistent bleeding at the end of the study period. Of these, 5 patients (26%) were scheduled for surgery and 11 patients (58%) refused surgery and asked to undergo a re-do sclerotherapy.ConclusionSclerotherapy with 3% polidocanol foam is a safe and effective procedure also in III- and IV-degree bleeding hemorrhoids. The long-term data on the length of the foam remain to be evaluated in additional studies.
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Affiliation(s)
- Giorgio Lisi
- Department of Surgery, Sant’Eugenio Hospital, Rome, Italy
- Correspondence: Giorgio Lisi
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, University of Tor Vergata, San Carlo of Nancy Hospital, Rome, Italy
| | | | | | - Simone Orlandi
- Department of Gastroenterology and Digestive Endoscopy, IRCSS Sacro Cuore don Calabria, Negrar di Valpolicella, Italy
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Lisi G, Campanelli M, Mastrangeli MR, Spoletini D, Menditto R, Grande S, Boccuzzi M, Grande M. The treatment of acute appendicitis in two age-based groups during COVID-19 pandemic: a retrospective experience in a COVID-19 referral hospital. Int J Colorectal Dis 2022; 37:323-328. [PMID: 34738164 PMCID: PMC8567973 DOI: 10.1007/s00384-021-04060-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE During the past months, the Italian Government has reduced the restrictions and access to hospitals as well as outpatient. Since then, up to 40% of non-traumatic abdominal emergencies have had unusual delayed treatment. Given the rapidly evolving situation and the absence of evidence to support recommendations during the COVID-19 pandemic, it is useful to assess how the current situation is influencing the management of elderly patients with acute appendicitis. METHODS Between February 2020 and December 2020, all patients 18 years or older undergone appendectomy were included. Patients were divided in two age-based groups (young groups, YG; elderly group, EG). Surgical approach, hospital stay, post-operative complications, radiology reports, and histologic examination were included in the retrospective analysis. RESULTS One hundred eight patients underwent appendectomy, 81 patients into the YG, and 27 in the EG. Laparoscopy was performed in 87.7% of the YG and in 51.8% of the elderly (p < 0.000), while conversion to laparotomy was necessary in 3.7% in the YG vs 22.3% of the other group (p < 0.009). Open procedures were more frequent in the EG, 25.9% vs 8.6% (p value < 0.05). No mortality rate was reported in both groups; moreover, the mean hospital stay was greater in the EG than the YG (p < 0.000). CONCLUSION Our data highlighted a partial delay in diagnosis in the elderly group, and an increase in complicated appendicitis also demonstrated by the need for conversion to laparotomy despite no significant relationship between these findings and the histologic examination was reported.
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Affiliation(s)
- Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy.
| | - Michela Campanelli
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
| | | | - Domenico Spoletini
- Department of Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - Rosa Menditto
- Department of Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - Simona Grande
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
| | - Massimiliano Boccuzzi
- Department of Surgery, San Sebastiano Hospital, via Tuscolana 1, 00046, Frascati, Rome, Italy
| | - Michele Grande
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
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Lisi G, Campanelli M, Mastrangeli MR, Grande S, Viarengo MA, Garbarino GM, Vanni G, Grande M. Acute appendicitis in elderly during Covid-19 pandemic. Int J Colorectal Dis 2021; 36:2287-2290. [PMID: 34046696 PMCID: PMC8159028 DOI: 10.1007/s00384-021-03959-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE During the past months, the Italian Government has reduced the restrictions and access to hospitals. Since then, up to 40% of non-traumatic abdominal emergencies have had unusual delayed treatment. Given the rapidly evolving situation and the absence of evidence to support recommendations during the pandemic, it is useful to assess how the current situation is influencing the management of elderly with acute appendicitis. METHODS Between February 2020 and December 2020, all patients older than 68 years old undergone appendectomy were included. Surgical approach, hospital stay, post-operative complications, radiology reports, and histologic examination were included in the retrospective analysis and compared with a same sample of the same period before the pandemic. RESULTS Twenty-seven patients underwent appendectomy for acute appendicitis during the pandemic and 34 patients in the pre-outbreak period. Laparoscopic approach was completed in 51.8% of the cases, while conversion to laparotomy in 22.3% of patients and open procedure in the 25.9%, before the pandemic 73.6%, 14.7%, and 11.7%, respectively. During the pandemic, complicated appendicitis occurred in 59.3% of the cases (26.5% before the outbreak). One patient was treated for a pelvic abscess, while no minor complications were detected. No mortality rate was reported, with a mean hospital stay of 5.64 days during the outbreak and 4.21 days before the pandemic. CONCLUSION Our data highlighted a partial delay in diagnosis in the elderly group, and an increase in complicated appendicitis also demonstrated by the need for conversion to laparotomy.
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Affiliation(s)
- G Lisi
- Department of Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy.
| | - M Campanelli
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
| | - M R Mastrangeli
- Department of Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - S Grande
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
| | - M A Viarengo
- Day-Case Surgery Unit, Israelitic Hospital, 00144, Rome, Italy
| | - G M Garbarino
- Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea University, Via di Grottarossa, 1035-39, 00189, Rome, Italy
| | - G Vanni
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
| | - M Grande
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
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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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Lisi G, Campanelli M, Grande S, Milito G, Grande M. Sclerotherapy with 3% polidocanol foam for third- and fourth-degree hemorrhoids as "bridge treatment" during the COVID-19 pandemic in Italy. Int J Colorectal Dis 2021; 36:1321-1322. [PMID: 33452908 PMCID: PMC7811334 DOI: 10.1007/s00384-021-03848-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE In Italy, colorectal surgery has been strongly affected with the vast majority (90%) of operations treating benign diseases, with an estimated overall 12-week cancellation rate of 72%. Little is known on how to best manage patients with benign diseases and the consequences this interruption of care will have in post-pandemic times. Proctologic diseases have social, psychological, and healthcare repercussions for their high incidence and great impact on the quality of life. METHODS We decided to treated 10 urgent cases affected from III- and IV-degree hemorrhoids with 3% polidocanol foam in attempt to reduce hemorrhoidal symptoms while waiting for surgery so called "bridge treatment". RESULTS During the follow-up no complications were occurred, and all patients had resolution of bleeding and pruritus with a mean VAS of 1 (range, 0-1). CONCLUSIONS This treatment could reduce the bleeding that is the main symptom from which patients suffer and for which they underwent proctological evaluation and surgery. According to our preliminary experience in the impossibility of accessing the surgery during the COVID-19 pandemic, ST could be considered as the treatment of choice in those patients who are suffering from grade III- and IV-degree hemorrhoids while waiting for surgery.
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Affiliation(s)
- Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Viale dell'Umanesimo 10, 00144, Rome, Italy.
| | - M Campanelli
- Emergency Surgery Unit, University Hospital of Tor Vergara, viale Oxford 81, 00133, Rome, Italy
| | - S Grande
- Emergency Surgery Unit, University Hospital of Tor Vergara, viale Oxford 81, 00133, Rome, Italy
| | - G Milito
- Emergency Surgery Unit, University Hospital of Tor Vergara, viale Oxford 81, 00133, Rome, Italy
| | - M Grande
- Emergency Surgery Unit, University Hospital of Tor Vergara, viale Oxford 81, 00133, Rome, Italy
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