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2020 ; 79
(ä): 180-188
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International guidelines and recommendations for surgery during Covid-19
pandemic: A Systematic Review
#MMPMID32454253
Moletta L
; Pierobon ES
; Capovilla G
; Costantini M
; Salvador R
; Merigliano S
; Valmasoni M
Int J Surg
2020[Jul]; 79
(ä): 180-188
PMID32454253
show ga
BACKGROUND: During the COVID-19 pandemic, surgical departments were forced to
re-schedule their activity giving priority to urgent procedures and
non-deferrable oncological cases. There is a lack of evidence-based literature
providing clinical and organizational guidelines for the management of a general
surgery department. Aim of our study was to review the available recommendations
published by general Surgery Societies and Health Institutions and evaluate the
underlying Literature. MATERIALS AND METHODS: A review of the English Literature
was conducted according to the AMSTAR and to the 2009 Preferred Reporting Items
for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS: After
eligibility assessment, a total of 22 papers and statements were analyzed.
Surgical societies have established criteria for triage and prioritization in
order to identify procedures that can be postponed after the pandemic and those
that should not. Prioritization among oncologic cases represents a difficult
task: clinicians have to balance a possible delay in cancer diagnosis or
treatment against the risk for a potential COVID-19 exposure. There is broad
agreement among guidelines that indication to proceed with surgery should be
discussed in virtual Tumor Boards taking into consideration alternative
therapeutic approaches. Several guidelines deal with the role of laparoscopic
surgery during the pandemic: a tailored approach is currently suggested, with a
case-by-case evaluation provided that appropriate personal protective equipment
is available in order to minimize the potential risk of transmission. Finally,
there is a considerable agreement in the published Literature concerning the
management of the personnel during the peri- and intraoperative phase and on the
technical advices regarding the induction, operative and recover maneuvers in
COVID-19 cases. CONCLUSIONS: During COVID-19 pandemic, it is of paramount
importance to face the emergency in the most effective and efficient manner,
retrieving resources from non-essential settings and, at the same time, providing
care to high priority non-COVID-19 related diseases.