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

Sunjay S Kumar^#¹, Elisa C Calabrese^#^{2

3

4}, Bethany J Slater⁵, Chelsea Lin⁶, Julie Hong⁷, Jonathan Dort⁸, Robert Lim⁹, Shawn Tsuda¹⁰, Ziad Awad¹¹, Wendy Babidge^{12

13}, Guy Maddern^{12

13}, Pramod Nepal¹⁴, R Wesley Vosburg¹⁵, Romeo Ignacio¹⁶, Devi Bavishi¹⁷, Ali Kchaou¹⁸, Subhashini Ayloo¹⁹, Nader M Hanna^{20

21}, Geoffrey P Kohn⁶

Affiliations

¹ Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
² Department of Surgery, University of California-East Bay, 1411 E 31st St, Oakland, CA, 94602, USA. eclbrs@gmail.com.
³ Department of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia. eclbrs@gmail.com.
⁴ Research, Audit & Academic Surgery, Royal Australasian College of Surgeons, Adelaide, SA, Australia. eclbrs@gmail.com.
⁵ Department of Surgery, University of Chicago, Chicago, IL, USA.
⁶ Monash University, Clayton, VIC, Australia.
⁷ Department of Surgery, New York Presbyterian-Queens, Flushing, NY, USA.
⁸ Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA.
⁹ Wake Forest University School of Medicine Charlotte, Charlotte, NC, USA.
¹⁰ The Valley Health System GME Consortium, Las Vegas, NV, USA.
¹¹ Department of Surgery, University of Florida College of Medicine, Jacksonville, FL, USA.
¹² Department of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia.
¹³ Research, Audit & Academic Surgery, Royal Australasian College of Surgeons, Adelaide, SA, Australia.
¹⁴ Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
¹⁵ Department of Surgery, Grand Strand Medical Center, Myrtle Beach, SC, USA.
¹⁶ Department of Surgery, Division of Pediatric Surgery, University of California San Diego School of Medicine, La Jolla, CA, USA.
¹⁷ Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA.
¹⁸ Department of Surgery, Sfax Medical School, University of Sfax, Sfax, Tunisia.
¹⁹ Department of Surgery, Saginaw Veterans Healthcare System, Saginaw, MI, USA.
²⁰ Department of Surgery, Queen's University, Kingston, ON, Canada.
²¹ Department of Surgery, McMaster University, Hamilton, ON, Canada.

^# Contributed equally.

PMID: 39930124
DOI: 10.1007/s00464-025-11526-6

Practice Guideline

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

Sunjay S Kumar et al. Surg Endosc. 2025 Mar.

. 2025 Mar;39(3):1409-1418.

doi: 10.1007/s00464-025-11526-6. Epub 2025 Feb 10.

Authors

Affiliations

¹ Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
² Department of Surgery, University of California-East Bay, 1411 E 31st St, Oakland, CA, 94602, USA. eclbrs@gmail.com.
³ Department of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia. eclbrs@gmail.com.
⁴ Research, Audit & Academic Surgery, Royal Australasian College of Surgeons, Adelaide, SA, Australia. eclbrs@gmail.com.
⁵ Department of Surgery, University of Chicago, Chicago, IL, USA.
⁶ Monash University, Clayton, VIC, Australia.
⁷ Department of Surgery, New York Presbyterian-Queens, Flushing, NY, USA.
⁸ Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA.
⁹ Wake Forest University School of Medicine Charlotte, Charlotte, NC, USA.
¹⁰ The Valley Health System GME Consortium, Las Vegas, NV, USA.
¹¹ Department of Surgery, University of Florida College of Medicine, Jacksonville, FL, USA.
¹² Department of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia.
¹³ Research, Audit & Academic Surgery, Royal Australasian College of Surgeons, Adelaide, SA, Australia.
¹⁴ Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
¹⁵ Department of Surgery, Grand Strand Medical Center, Myrtle Beach, SC, USA.
¹⁶ Department of Surgery, Division of Pediatric Surgery, University of California San Diego School of Medicine, La Jolla, CA, USA.
¹⁷ Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA.
¹⁸ Department of Surgery, Sfax Medical School, University of Sfax, Sfax, Tunisia.
¹⁹ Department of Surgery, Saginaw Veterans Healthcare System, Saginaw, MI, USA.
²⁰ Department of Surgery, Queen's University, Kingston, ON, Canada.
²¹ Department of Surgery, McMaster University, Hamilton, ON, Canada.

^# Contributed equally.

PMID: 39930124
DOI: 10.1007/s00464-025-11526-6

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.

PubMed Disclaimer

Conflict of interest statement

Declarations. Disclosures: Bethany J. Slater is a Hologic consultant, SAGES guideline chair and SAGES board member. Elisa C. Calabrese is a SAGES ASERNIPS Evidence Guidance Research Scholarship recipient. Geoffrey Kohn gives expert opinion for Avant Law. Julie Hong has T32 funding for Columbia center for transplant immunology. Robert Lim has received payment from Up to Date, Inc, travel and lodging for a presentation from ASGBI and is the SAGES treasurer. Shawn Tsuda is a member of the SAGES Board of Governors member and the Surgical Data Science Committee, he also holds stock in Doximity. Ziad Awad, Ali Kchaou, Chelsea Lin, Devi Bavishi, Jonathan Dort, Nader Hanna, Pramod Nepal, Guy Maddern, Romeo Ignacio, Subhashini Ayloo, Sunjay Kumar, Wendy Babidge, and Wesley Vosburg had no conflict of interest or financial ties to disclose. Ethical approval: Not applicable. Patient consent: Not applicable.

References

1. Antia R, Halloran ME (2021) Transition to endemicity: understanding COVID-19. Immunity 54:2172–2176. https://doi.org/10.1016/j.immuni.2021.09.019 - DOI - PubMed - PMC
1. English W, Habib Bedwani N, Smith C, Doganay E, Marsden M, Muse S, Mak WK, Chana M, Eves J, Shatkar V (2021) Suspected appendicitis and COVID-19, a change in investigation and management-a multicentre cohort study. Langenbecks Arch Surg 406:357–365. https://doi.org/10.1007/s00423-020-02023-6 - DOI - PubMed
1. Guadalajara H, Muñoz de Nova JL, Yiasemidou M, Recarte Rico M, Juez LD, García Septiem J, Galindo Jara P, García Virosta M, Lobo Martínez E, Martín-Pérez E, Fernandez Gonzalez S, Lopez-Fernandez O, García-Olmo D (2021) The SARS-CoV-2 first wave impact in the acute inflammatory surgical pathologies. Sci Rep 11:19645. https://doi.org/10.1038/s41598-021-98878-w - DOI - PubMed - PMC
1. Javanmard-Emamghissi H, Boyd-Carson H, Hollyman M, Doleman B, Adiamah A, Lund JN, Clifford R, Dickerson L, Richards S, Pearce L, Cornish J, Hare S, Lockwood S, Moug SJ, Tierney GM (2021) The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study. Tech Coloproctol 25:401–411. https://doi.org/10.1007/s10151-020-02297-4 - DOI - PubMed
1. Martínez Caballero J, González González L, Rodríguez Cuéllar E, Ferrero Herrero E, Pérez Algar C, Vaello Jodra V, Pérez Díaz MD, Dziakova J, San Román Romanillos R, Di Martino M, de la Hoz RÁ, Galán Martín M, Sánchez López D, García Virosta M, de la Fuente BM, Pardo de Lama MM, Gutiérrez Samaniego M, Díaz Pérez D, Alias Jiménez D, de Nicolás NL, Pérez Alegre JJ, García-Quijada García J, Guevara-Martínez J, Villadoniga A, Martínez Fernández R (2021) Multicentre cohort study of acute cholecystitis management during the COVID-19 pandemic. Eur J Trauma Emerg Surg 47:683–692. https://doi.org/10.1007/s00068-021-01631-1 - DOI - PubMed - PMC

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical