A commentary on "Changes in appendicitis treatment during the COVID-19 pandemic - A systematic review and meta-analysis" [Int. J. Surg. 95 (2021) 106148].

Dear Editor,

With special attention, we read the interesting article published by Köhler F et al. [1] entitled “Changes in appendicitis treatment during the COVID-19 pandemic - A systematic review and meta-analysis”, in which the impact of the emerging SARS-CoV-2 virus pandemic on the incidence, severity, length of hospital stay, treatment options and time of presentation of acute appendicitis in adults and children was reported. We thank the authors for providing such valuable evidence. In this Letter to the Editor, we reinforce what has been stated in the said manuscript regarding the need on surgical treatment as a priority, as definitive treatment of this pathology is to avoid complications, but without forgetting the use of primary antibiotic therapy when the benefits outweigh the risks [2].

The recent onset of the disease with global impact called COVID-19 is characterized by a set of acute systemic symptoms caused by a new coronavirus called SARS-CoV-2 [3]. Once declared a pandemic in March 2020, it was decided to prioritize the care of critically ill patients, cancellation of elective surgical procedures and creation of specific intrahospital routes for respiratory symptomatic patients to control the said population to avoid increase in these cases [4,5].

Acute appendicitis is a very common abdominal pathology characterized by inflammation of appendix. If not treated in a timely manner, can results in complications of abscesses, gangrene and/or rupture the treatment of choice for both complicated and uncomplicated appendicitis is appendectomy. However, primary antibiotic therapy without surgery is an optional approach for uncomplicated appendicitis for patients who are contraindicated to undergo surgery [6].

In the present systematic review, 46 studies were analyzed evaluating the impact of the COVID-19 pandemic on acute appendicitis. This Review found a notable change in the traditional surgical therapeutic strategy to the pharmacological approach using antibiotics, probably because of the need to avoid exposures to the virus using surgery. Although drug therapy without surgery can successfully treat appendicitis, this approach is closely related to a higher risk of recurrence when compared to surgery, thus resulting in an increase in complications [7].

Like what has been reported, in the present systematic review we found a significant increase in patients presenting with complicated appendicitis. We believe it is important to resume and prioritize surgery as the treatment of choice as soon as possible. When the available scientific evidence is taken into account, there is no specific data that indicates that exposure to surgical procedures poses a definite risk to uninfected patients and healthcare personnel [8].

We conclude that all variables of the patient must be balanced against the health status to decide when to intervene at the most appropriate time to avoid the deleterious effects on health due to uncomplicated conditions, on productivity and on unnecessary increase in Health-care costs.

Ethical approval

It is not necessary.

Sources of funding

None.

Author contribution

All authors equally contributed to the analysis and writing of the manuscript.

Research registration Unique Identifying number (UIN)

1. Name of the registry: Not applicable.

2. Unique Identifying number or registration ID: Not applicable.

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Guarantor

María Manuela Rodríguez-Gutiérrez, Future Surgeons Chapter, Colombian Surgery Association, Calle 100 #14–63 Of.502, Bogotá, Colombia. Email: maria.rodriguezg@uam.edu.co.

Provenance and peer review

Commentary, internally reviewed.

Declaration of competing interest

None.