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Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis - 29/07/20

Doi : 10.1016/j.jviscsurg.2020.04.014 
M. Collard a, Z. Lakkis b, J. Loriau c, D. Mege d, C. Sabbagh e, f, J.H. Lefevre a, L. Maggiori g,
a Digestive Surgery Department, Sorbonne University, Saint-Antoine Hospital, AP–HP, 75012 Paris, France 
b Department of Digestive Surgical Oncology, Liver Transplantation Unit, University Hospital of Besançon, 2, boulevard Alexander Fleming, 25000, Besançon, France 
c Department of Visceral Surgery, Groupe Hospitalier Paris Saint Joseph, 75014, Paris, France 
d Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France 
e Digestive surgery department, CHU Amiens-Picardie, 80000 Amiens, France 
f Research Unit SSPC (simplification des soins des patients chirurgicaux complexes), université de Picardie Jules Verne, 80025 Amiens, France 
g Department of Colorectal surgery, Beaujon Hospital, Paris University, AP-HP, 92110, Clichy, France 

Corresponding author.

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Summary

The massive inflow of patients with COVID-19 requiring urgent care has overloaded hospitals in France and impacts the management of other patients. Deferring hospitalization and non-urgent surgeries has become a priority for surgeons today in order to relieve the health care system. It is obviously not simple to reduce emergency surgery without altering the quality of care or leading to a loss of chance for the patient. Acute appendicitis is a very specific situation and the prevalence of this disease leads us to reconsider this particular disease in the context of the COVID-19 crisis. Indeed, while the currently recommended treatment for uncomplicated acute appendicitis is surgical appendectomy, the non-surgical alternative of medical management by antibiotic therapy alone has been widely evaluated by high-quality studies in the literature. Insofar as the main limitation of exclusively medical treatment of uncomplicated acute appendicitis is the risk of recurrent appendicitis, this treatment option represents an alternative of choice to reduce the intra-hospital overload in this context of health crisis. The aim of this work is therefore to provide physicians and surgeons with a practical guide based on a review of the literature on the medical treatment of uncomplicated acute appendicitis in adults, to offer this alternative treatment to the right patients and under good conditions, especially when access to the operating room is limited or impossible.

El texto completo de este artículo está disponible en PDF.

Keywords : Acute appendicitis, Appendectomy, Antibiotic therapy, COVID-19, Coronavirus


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© 2020  Publicado por Elsevier Masson SAS.
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Vol 157 - N° 3S1

P. S33-S42 - juin 2020 Regresar al número
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