SAGES guidelines update to laparoscopy in the era of COVID-19

Abstract

Background: Patients requiring cholecystectomy or appendectomy may present with concomitant COVID infection in both the inpatient and outpatient scenarios. It is unclear whether these patients benefit more from operative or nonoperative management in the setting of active COVID infection. These guidelines seek to address urgent and elective clinical scenarios.

Methods: A systematic review was conducted to address these questions. These results were then presented to an interdisciplinary panel that formulated recommendations based on the best available evidence or utilized expert opinion when the evidence base was lacking.

Results: Conditional recommendations were made in favor of (1) either operative or nonoperative management of COVID-positive patients with appendicitis or cholecystitis and (2) delaying operations by more than six weeks in patients who test positive for COVID in the elective setting.

Conclusions: These recommendations should provide guidance regarding the management of surgical patients with concomitant COVID infection. This guideline also identifies important areas where future research should focus to strengthen the evidence base.

Keywords: Appendicitis; COVID; COVID-19; Cholecystitis; Guideline update; Guidelines; Surgery.