Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March-April 2019 vs March-April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 202

A model of pilot study to assess the risk of exposure to surgical smokes for operating room personnel

During the last decades the exposure to surgical smokes has been a long-standing concern both in open and laparoscopic surgery. The aim of this project is to assess the health risks for medical operating room (OR) personnel associated with surgical plumes derived from laparoscopic procedures. The purpose of this model is to check the correlation between the concentration of toxic elements derived from electrosurgical procedures in the operating setting air and the concentration of the same substances in urine and plasma of patients and operating staff. Moreover, it will be considered also the correlation between toxic concentration and time of exposure. The results of the study could be relevant to indicate if individual protection devices are efficacious to make the surgical procedure safe for patients and staff or if any adequacy has to be considered. Some unexpected difficulties delayed the expected results

Glutaraldehyde-tanned mandril-grown grafts as venous substitutes

The present study was performed to evaluate the potential of glutaraldehyde-tanned mandril-grown grafts as caval substitutes. Short-term experiments consisted of 30 tubular grafts (35 x 8 mm), either of tanned collagen or polytetrafluoroethylene, that were sutured in the infrarenal inferior vena cava of pigs and removed 1 hour after implantation. There was no significant difference between the extent of the thrombus-lined graft surface in the biologic group and that in the polytetrafluoroethylene group. The amount of inner thrombus on tanned collagen grafts was significantly correlated to platelet activity. Long-term experiments involved 30 similar segments of both materials, which were sutured in the inferior vena cava and harvested 7, 14, 28, 56, and 112 days after operation. The 112-day patency rate of collagen grafts was 67%. The 56-day patency rate of polytetrafluoroethylene grafts was 16%. The difference was statistically significant (p < 0.01). Collagen grafts were lined by a thin neointima (200 \ub5m) in all but two cases. The neointima was completely endothelialized within 4 weeks from implantation. In conclusion, tanned collagen grafts may represent a suitable material for venous replacement