Abstract
Acute appendicitis (AA) is a frequent cause of abdominal pain requiring surgical treatment. During the COVID-19 pandemic, surgical societies considered other therapeutic options due to uncertainties in the evolution of the disease. The purpose of this study is to assess the treatment of AA by members of two Brazilian surgical societies in this period. A common questionnaire was sent in 2020. There were 382 responses. Most surgeons had more than 15 years of profession (68.3%) and treated more than five cases per month (44.8%). About 72.5% would indicate chest CT to investigate COVID-19 in patients with AA. For those patients sustaining uncomplicated AA, without COVID-19, 60.2% would indicate laparoscopic appendectomy (VLA), followed by open appendectomy (OA) (31.7%) and non-operative management (NOM) (1.3%). For those with mild COVID-19, OA was suggested by 51.0%, followed by VLA (29.6%) and NOM (6.0%). For those with severe COVID-19, OA was proposed by 35.3%, followed by NOM (19.9%) and VLA (18.6%). For patients with periappendiceal abscesses, without COVID-19, VLA was suggested by 54.2%, followed by OA (33.2%) and NOM (4.4%). For those with mild COVID-19, OA was proposed in 49.5%, followed by VLA (29.3%) and NOM (8.9%). In those with severe COVID-19, OA was proposed in 36.6%, followed by NOM (25.1%) and VLA (17.3%). This information, based on two recognized Brazilian surgical societies, can help the surgeon to select the best approach individually.
Highlights
The World Health Organization (WHO) considered the evolution of COVID-19 as a pandemic on March 11, 20201
44.8% of the respondents reported treating more than 5 cases of acute appendicitis per month (Figure 2)
The most frequently proposed treatment was laparoscopic appendectomy, both for uncomplicated appendicitis (75.1%) and for cases complicated with local abscess (66.2%)
Summary
The World Health Organization (WHO) considered the evolution of COVID-19 as a pandemic on March 11, 20201. Non-traumatic surgical emergencies continue to be a frequent cause of acute abdominal pain in emergency services. Acute appendicitis is one of the most frequent causes of surgically treated abdominal pain[2,3,4]. Operative treatment is considered the standard for most patients with acute appendicitis[4]. During the pandemic, non-operative treatment has been considered by several societies, based on arguments such as the worst evolution in patients who developed COVID-19 in the postoperative course and the resource allocation priority for the treatment of patients with COVID-195,6. Studies demonstrated a higher incidence of respiratory complications, admission to intensive care, and deaths in patients undergoing elective surgeries who developed COVID-19 in the postoperative period[7,8]
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