COVID-19 and the Global Impact on Colorectal Practice and Surgery

Background: The novel severe acute respiratory syndrome coronavirus 2 virus that emerged in December 2019 causing coronavirus disease 2019 (COVID-19) has led to the sudden national reorganization of health care systems and changes in the delivery of health care globally. The purpose of our study was to use a survey to assess the global effects of COVID-19 on colorectal practice and surgery. Materials and Methods: A panel of International Society of University Colon and Rectal Surgeons (ISUCRS) selected 22 questions, which were included in the questionnaire. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in the ISUCRS database and was advertised on social media sites. The questionnaire remained open from April 16 to 28, 2020. Results: A total of 287 surgeons completed the survey. Of the 287 respondents, 90% were colorectal specialists or general surgeons with an interest in colorectal disease. COVID-19 had affected the practice of 96% of the surgeons, and 52% were now using telemedicine. Also, 66% reported that elective colorectal cancer surgery could proceed but with perioperative precautions. Of the 287 respondents, 19.5% reported that the use of personal protective equipment was the most important perioperative precaution. However, personal protective equipment was only provided by 9.1% of hospitals. In addition, 64% of surgeons were offering minimally invasive surgery. However, 44% reported that enough information was not available regarding the safety of the loss of intra-abdominal carbon dioxide gas during the COVID-19 pandemic. Finally, 61% of the surgeons were prepared to defer elective colorectal cancer surgery, with 29% willing to defer for ≤ 8 weeks. Conclusion: The results from our survey have demonstrated that, globally, COVID-19 has affected the ability of colorectal surgeons to offer care to their patients. We have also discussed suggestions for various practical adaptation strategies for use during the recovery period. We have presented the results of a survey used to assess the global impact of coronavirus disease 2019 (COVID-19) on the delivery of colorectal surgery. Despite accessible guidance information, our results have demonstrated that COVID-19 has significantly affected the ability of colorectal surgeons to offer care to patients. We have also discussed practical adaptation strategies for use during the recovery phase

The Chevrel Technique in the Treatment of Midline Giant Incisional Hernia

Introduction: Giant incisional hernia (GIH) is a serious pathological entity which is characterized with a massive loss of muscle and fascial tissue and a total impairment of the anatomical and physiological function of the anterior abdominal wall, which also leads to severe respiratory and visceral malfunction. Reconstruction is accompanied with a high rate of relapses, complications and even mortality.Materials and Methods: During a 15-year period (2000-2015), 319 patients in total have been operated on for midline GIH. Using the Chevrel classification, it is classified as an M4-W4R type of incissional hernia. The patients have been electively operated on under general endotracheal anesthesia. Standard reconstruction by Chevrel`s techniqe was used with the creation of a new linea alba. The defect on the anterior rectus sheath was covered with polypropylene mesh. Female to male ratio was 209/110 with a median age of 48 (31-72). The median BMI was 32.1. Concomitant cholecystectomies were done in 11 patients and dermolypectomies were performed on 31 at the same time.Results: There were no cases of intraoperative complications and mortality. Postoperative mortality, as a result of a perforated peptic ulcer was seen in one patient. The operative time after the improvement of the technique varied between 60-70 min. The average time of hospitalization was 8.8 days (range 7-21). SSI were noted in 56 (17%) patients. Seroma was a leading complication in our series. Partial necrosis of the skin was seen in 12 patients (4%). Hernia recurrence was observed in 7 patients (2.1%) during the follow-up period (6-48 months) in the controlled 284 patients.Conclusion: The original Chevrel technique consists of tissue reconstruction on the linea alba and approximation of rectus muscle, strengthened with a mesh lining. It represents an acceptable method with very good results. The low recurrence and complication rate, as well as the functional results, influence the acceptance of this method by highly specialized institutions that deal with the treatment of GIH

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care