Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Barium Enema in the Diagnosis of Hirschsprung's Disease: A Comparison with Rectal Biopsy

Aim: The aim of the present study was to compare the diagnostic accuracy of a barium enema in Hirschsprung's disease with respect to a rectal biopsy. Materials And Methods: This study was conducted on 60 consecutive patients of clinically suspected cases of Hirschsprung's disease admitted to a tertiary care hospital in Kashmir over a period of three and a half years. All the patients were subjected to a barium enema and a full-thickness rectal biopsy. Results: The mean age was 3.5 + 0.5 years. A rectal biopsy revealed absence of ganglion cells in 36 (60%) patients, absence of ganglion cells with nerve hypertrophy in 4 (6.66%) patients and ruled out Hirschsprung's disease in 20 (33.33%) patients. A barium enema was compatible with Hirschsprung's disease in 20 (33.33%), suggestive in 14 (23.33%) and unremarkable in 26 (43.33%) patients. A barium enema had a diagnostic accuracy of 76.67% with a positive predictive value of 88.23%, a negative predictive value of 61.53%, specificity of 80% and a sensitivity of 75%, and a rectal biopsy had a diagnostic accuracy of 100% (P value < 0.0001). Conclusion: Barium enema is a valuable diagnostic tool for the diagnosis of patients with Hirschsprung's disease. We recommend a barium enema as a routine initial workup in the management of patients of suspected Hirschsprung's disease. [Arch Clin Exp Surg 2013; 2(4.000): 224-228

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study (vol 46, pg 2021, 2022)

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Inequalities in screening policies and perioperative protection for patients with acute appendicitis during the pandemic: Subanalysis of the ACIE Appy study

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