key: cord-0072996-hmjlxksm authors: Rodríguez-Gutiérrez, María Manuela; Hurtado-Mayor, Jorge Andrés; Sánchez-Pinto, Laura Manuela; Díaz-Rivera, María Carolina title: A commentary on “Changes in appendicitis treatment during the COVID-19 pandemic - A systematic review and meta-analysis” (Int J Surg 2021;95:106148) date: 2022-01-06 journal: Int J Surg DOI: 10.1016/j.ijsu.2021.106201 sha: 01cac29d684841a935bbd51491487216a96a945e doc_id: 72996 cord_uid: hmjlxksm nan 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. Commentary, internally reviewed. The following additional information is required for submission. Please note that failure to respond to these questions/statements will mean your submission will be returned. If you have nothing to declare in any of these categories, then this should be stated. None. None. It is not necessary The World Medical Association's Declaration of Helsinki 2013 states in article 35: 'Every research study involving human subjects must be registered in a publicly accessible database before recruitment of the first subject'. Editors of IJS require that all types of research studies involving human participants should be registered prospectively and failing that retrospectively. There are many places to register your research, and you can choose which is the most suitable for your needs: •https://www.clinicaltrials.gov/ -for all human studies -free •http://www.chictr.org.cn/index.aspx -for all human studies -free •https://www.researchregistry.com/ -for all human studies -charge •https://www.isrctn.com/ -for all human studies -charge •Prospero -for systematic reviews -free •There are many national registries approved by the UN that can be found here Elsevier does not support or endorse any registry. Changes in appendicitis treatment during the COVID-19 pandemic -A systematic review and meta-analysis Current and future use of telemedicine in surgical clinics during and beyond COVID-19: A narrative review Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention Global guidance for surgical care during the COVID-19 pandemic A comment on "laparoscopic versus open appendicectomy for complicated appendicitis in children: A systematic review and meta-analysis Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines Name of the registry: Not applicable Unique Identifying number or registration ID: Not applicable Hyperlink to your specific registration (must be publicly accessible and will be checked): Not applicable Please specify the contribution of each author to the paper, e.g. study design, data collections, data analysis, writing. Others, who have contributed in other ways should be listed as contributors.All authors equally contributed to the analysis and writing of the manuscript. The Guarantor is the one or more people who accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. Please note that providing a guarantor is compulsory.