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COVID-19: impact on colorectal surgery.
Colorectal Dis. 2020 06; 22(6):635-640.CD

Abstract

AIM

The rapid spread of the COVID-19 pandemic has created unprecedented challenges for the medical and surgical healthcare systems. With the ongoing need for urgent and emergency colorectal surgery, including surgery for colorectal cancer, several questions pertaining to operating room (OR) utilization and techniques needed to be rapidly addressed.

METHOD

This manuscript discusses knowledge related to the critical considerations of patient and caregiver safety relating to personal protective equipment (PPE) and the operating room environment.

RESULTS

During the COVID-19 pandemic, additional personal protective equipment (PPE) may be required contingent upon local availability of COVID-19 testing and the incidence of known COVID-19 infection in the respective community. In addition to standard COVID-19 PPE precautions, a negative-pressure environment, including an OR, has been recommended, especially for the performance of aerosol-generating procedures (AGPs). Hospital spaces ranging from patient wards to ORs to endoscopy rooms have been successfully converted from standard positive-pressure to negative-pressure spaces. Another important consideration is the method of surgical access; specifically, minimally invasive surgery with pneumoperitoneum is an AGP and thus must be carefully considered. Current debate centres around whether it should be avoided in patients known to be infected with SARS-CoV-2 or whether it can be performed under precautions with safety measures in place to minimize exposure to aerosolized virus particles. Several important lessons learned from pressurized intraperitoneal aerosolized chemotherapy procedures are demonstrated to help improve our understanding and management.

CONCLUSION

This paper evaluates the issues surrounding these challenges including the OR environment and AGPs which are germane to surgical practices around the world. Although there is no single universally agreed upon set of answers, we have presented what we think is a balanced cogent description of logical safe approaches to colorectal surgery during the COVID-19 pandemic.

Authors+Show Affiliations

Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.Department of Colorectal Surgery, King Khalid Hospital, Nejran, Saudi Arabia.Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.Department of General and Transplant Surgery, National Center for Pleura and Peritoneum (NCPP), Tübingen, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32359223

Citation

Wexner, S D., et al. "COVID-19: Impact On Colorectal Surgery." Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, vol. 22, no. 6, 2020, pp. 635-640.
Wexner SD, Cortés-Guiral D, Gilshtein H, et al. COVID-19: impact on colorectal surgery. Colorectal Dis. 2020;22(6):635-640.
Wexner, S. D., Cortés-Guiral, D., Gilshtein, H., Kent, I., & Reymond, M. A. (2020). COVID-19: impact on colorectal surgery. Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, 22(6), 635-640. https://doi.org/10.1111/codi.15112
Wexner SD, et al. COVID-19: Impact On Colorectal Surgery. Colorectal Dis. 2020;22(6):635-640. PubMed PMID: 32359223.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19: impact on colorectal surgery. AU - Wexner,S D, AU - Cortés-Guiral,D, AU - Gilshtein,H, AU - Kent,I, AU - Reymond,M A, Y1 - 2020/05/22/ PY - 2020/04/17/received PY - 2020/04/26/revised PY - 2020/04/30/accepted PY - 2020/5/3/pubmed PY - 2020/7/1/medline PY - 2020/5/3/entrez KW - COVID-19 KW - Coronavirus KW - pandemic KW - transmission SP - 635 EP - 640 JF - Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland JO - Colorectal Dis VL - 22 IS - 6 N2 - AIM: The rapid spread of the COVID-19 pandemic has created unprecedented challenges for the medical and surgical healthcare systems. With the ongoing need for urgent and emergency colorectal surgery, including surgery for colorectal cancer, several questions pertaining to operating room (OR) utilization and techniques needed to be rapidly addressed. METHOD: This manuscript discusses knowledge related to the critical considerations of patient and caregiver safety relating to personal protective equipment (PPE) and the operating room environment. RESULTS: During the COVID-19 pandemic, additional personal protective equipment (PPE) may be required contingent upon local availability of COVID-19 testing and the incidence of known COVID-19 infection in the respective community. In addition to standard COVID-19 PPE precautions, a negative-pressure environment, including an OR, has been recommended, especially for the performance of aerosol-generating procedures (AGPs). Hospital spaces ranging from patient wards to ORs to endoscopy rooms have been successfully converted from standard positive-pressure to negative-pressure spaces. Another important consideration is the method of surgical access; specifically, minimally invasive surgery with pneumoperitoneum is an AGP and thus must be carefully considered. Current debate centres around whether it should be avoided in patients known to be infected with SARS-CoV-2 or whether it can be performed under precautions with safety measures in place to minimize exposure to aerosolized virus particles. Several important lessons learned from pressurized intraperitoneal aerosolized chemotherapy procedures are demonstrated to help improve our understanding and management. CONCLUSION: This paper evaluates the issues surrounding these challenges including the OR environment and AGPs which are germane to surgical practices around the world. Although there is no single universally agreed upon set of answers, we have presented what we think is a balanced cogent description of logical safe approaches to colorectal surgery during the COVID-19 pandemic. SN - 1463-1318 UR - https://www.unboundmedicine.com/medline/citation/32359223/COVID_19:_impact_on_colorectal_surgery_ L2 - https://doi.org/10.1111/codi.15112 DB - PRIME DP - Unbound Medicine ER -