Surgical trends in appendicectomy during Covid-19

Purpose: Acute appendicitis is the most common cause of an acute abdomen. The COVID-19 pandemic has affected the management of acute appendicitis. Initial guidelines advised the use of laparoscopy only if benefits substantially exceeded the risk of potential viral transmission. The main aim of this study was to evaluate the trends in surgical management of appendicitis in the first year of COVID-19 in a tertiary referral centre in Ireland. Methods: A retrospective review of all appendicectomies in a tertiary hospital from January to December 2020 was performed. Basic demographic data was collected along with information on operative approach, conversion to open, laboratory and radiological investigations and histopathology. Results: 452 appendicectomies were identified. More males were affected, at 52.5%. The mean age was 25 years (range: 3-85 years). Laparoscopic appendicectomy was performed in 97% of cases (n = 438). All appendicectomies in January and February were laparoscopic. 66.6% of all open appendicectomies performed were in March and April (n = 4). Regarding these 4 open appendicectomies, none were perforated and 3 were paediatric patients. Open appendicectomies outside of these months (n = 2) were for complicated appendicitis. A combination of laparoscopic and open technique was required in 9 cases. Conclusion: The first phase of Covid-19 in Ireland resulted in a significant increase in the number of open appendicectomies, when concerns surrounded the potential aerosolisation of the virus during laparoscopic procedures. It was not a result of case complexity. This was not mirrored in Phase 2 of the pandemic in September and October.