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Gallstone disease with advanced symptoms is one of the common abdominal emergencies during pregnancy and it is considered to be one of the most frequently reported non-obstetric surgical conditions in pregnant women. This study aimed to evaluate the outcomes of surgical cholecystectomy in pregnant women with symptoms of advanced gallstones. This is a retrospective analysis of 2814 pregnant women who attended various wards in government and private hospitals in the governorates of Diyala and Kirkuk in Iraq for more than 2 years, between February 2020 and June 2022. The hospital database was used to confirm the diagnosis of advanced gallstone symptoms in these pregnant women. The incidence of symptomatic gallstones in pregnant women, diagnosis and method of therapeutic management, cholecystectomy according to the pregnancy periods, and perinatal complications of patients according to therapeutic methods were determined. The results confirmed that out of 2814 pregnancies, only 126 (4%) had symptoms of gallstones. It was found that the majority of cases 67 (53%) were within the first trimester of pregnancy and the least 29 (23%) was observed in the second trimester. Acute cholecystitis was the generality 84 (67%) diagnosed in pregnant women with symptomatic gallbladder disease and only 9 (7%) of the patients had undergone prenatal cholecystectomy versus 117 (93%) who were managed conservatively. A total of 20 (16%) cases with undesirable complications were recorded, where 12 cases with low birth weight were noted, where 4 of them underwent surgery and 8 were treated conservatively. It was concluded that a large proportion of women suffer from symptoms of gallstones during pregnancy. Most cases can be managed conservatively, and intervention should be performed as often as needed.Copyright © 2023, Codon Publications. All rights reserved.
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Introduction: Increasing evidence demonstrates the effectiveness of universal masking precautions in reducing the transmission of COVID-19. Whether these precautions have an impact on surgical site infections (SSI), currently remains unknown. This study assesses whether implementation of universal masking precautions altered the rates of SSI. Method(s): We performed a single-institution, retrospective cohort study using the NSQIP database, evaluating all patients undergoing most performed general surgery procedures from June 2018 to December 2021. SSI rates were compared between patients who underwent operation before and after implementation of universal masking precautions at our institution in March 2020. Statistical analyses were performed using Fisher's exact test. Result(s): A total of 1,539 patients were included;721 patients were in the pre-masking cohort, while 818 in post-masking cohort. During this time period, a total of 143 (9.3%) patients developed SSI, 3.6% incisional and 5.7% deep organ space infections (OSI) (p=0.6601). Incisional and OSI rates did not differ significantly between the two groups (incisional 3.47% vs 3.67%, p=0.891;OSI 5.41% vs 5.99%, p=0.6608). Sub-analysis of top 5 procedures (by volume - laparoscopic cholecystectomy, hepatectomy, thromboendarterectomy, colectomy with anastomosis, and colectomy with ileocolostomy) demonstrated a significant decrease in incisional infections (3.7% vs 1.62%, p=0.0354). Conclusion(s): While the incidence of SSI did not differ significantly in the overall cohort after implementation of universal masking precautions, there was a decrease in incisional infections in commonly performed procedures at our institution. Future research is needed to identify whether continued masking precautions may minimize the risk of SSI in specific patient populations.
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BACKGROUND: Laparoscopic cholecystectomy (LC) is the standard of care for benign gallstone disease. There are no robust Indian data on the 30-day morbidity and mortality of this procedure. A prospective multicentre observational study was conducted by the Indian Association of Gastro-Intestinal Endo Surgeons (IAGES) to assess the 30-day morbidity and mortality of LC in India. MATERIALS AND METHODS: Participating surgeons were invited to submit data on all consecutive LCs for benign diseases performed between 09/12/2020 and 08/03/2021 in adults. Primary outcome measures were 30-day morbidity and mortality. Univariate and multivariate analyses were performed to identify variables significantly associated with primary outcomes. RESULTS: A total of 293 surgeons from 125 centres submitted data on 6666 patients. Of these, 71.7% (n = 4780) were elective. A total LC was carried out in 95% (n = 6331). Laparoscopic subtotal cholecystectomy was performed in 1.9% (n = 126) and the procedure were converted to open in 1.4% of patients. Bile duct injury was seen in 0.3% (n = 20). Overall, 30-day morbidity and mortality were 11.1% (n = 743) and 0.2% (n = 14), respectively. Nature of practice, ischemic heart disease, emergency surgery, postoperative intensive care, and postoperative hospital stay were independently associated with 30-day mortality. Age, weight, body mass index, duration of symptoms, nature of the practice, history of Coronavirus Disease-2019, previous major abdominal surgery, acute cholecystitis, use of electrosurgical or ultrasonic or bipolar energy for cystic artery control; use of polymer clips for cystic duct control; conversion to open surgery, subtotal cholecystectomy, simultaneous common bile duct exploration, mucocele, gangrenous gall bladder, dense adhesions, intraoperative cholangiogram, and use of drain were independently associated with 30-day morbidity. CONCLUSION: LC has 30-day morbidity of 11.1%, 30-day mortality of 0.2%, conversion to open rate of 1.4%, and bile duct injury rate of 0.3% in India.
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Introduction: We present the first case of appendiceal intussusception associated with myeloid sarcoma in a young patient. Minimally invasive techniques used along the clinical course are highlighted. Case description: A 2.5-year-old boy was admitted after three weeks of COVID-19 infection with ongoing symptoms of MIS-C. Due to constipation, distended belly and vomiting, US was done which showed ileocolic intussusception. After unsuccessful hydrostatic reduction laparoscopic exploration was performed, where the vermiform appendix was found to be thickened and partially intussuscepted into the coecum. The ileocecal region was exteriorized transumbilically. After manual reduction of the intussusception, a long, thickened, fragile appendix was removed. Histopathology revealed myeloid sarcoma. Bone marrow investigation identified acute myeloid leukemia. During the oncological treatment, laparoscopic cholecystectomy was necessary due to cholecystitis and cholelithiasis. The child recovered uneventfully in terms of surgical complications, with good cosmetic result. Conclusion(s): No similar case in childhood was found in the English literature. Unusual symptoms and radiological findings of intussusception can conceal unexpected disorders. Minimally invasive technique offered advantages in the treatment of the presented patient and can be recommended to treat intussusception or cholelithiasis, if applicable, during an ongoing oncological treatment as well.Copyright © 2023 The Authors
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The development and innovation of laparoscopic vision platform has promoted the innovation of surgical concept and technology from laparotomy to minimally invasive surgery. From the initial use of reflector device with candlelight to observe the interior of the human body cavity, to the high-definition and ultra-high-definition laparoscopic vision system, from laparoscopic cholecystectomy, to the popularization and promotion of various laparoscopic surgery for malignant tumor, surgery has undergone great changes due to minimally invasive technology. In the new era, the application of three-dimensional and 4K laparoscope brings a new perspective to minimally invasive surgery, so as to promote the development of surgery in the direction of accurate anatomy and functional protection. In the future, stimulated by concept renovation in post-epidemic era of COVID-19, virtual reality technology and robotic surgery supported by the fifth generation wireless systems, as well as tele-surgery and distance training and teaching based on it, will become a new perspective for the development of minimally invasive surgery.Copyright © 2020 by the Chinese Medical Association.
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Purpose: We examined the effect of COVID-19 on diseases treated with hepato- biliary- pancreatic surgery from the experience of nosocomial infection at our hospital. Method(s): We examined the treatment of 106 patients admitted by the Division of Hepato- Biliary- Pancreatic Surgery to The Jikei University Hospital for elective surgery from January through May 2020. Result(s): Of the 106 operations, 90 (85%) were performed as scheduled and did not include COVID-19-positive patients. Operations for 16 patients (15%) were postponed, but 5 (31%) of these operations were urgent or quasiurgent and were performed during the study period. Of 95 patients who underwent surgery, 50 (53%) had a malignant tumor, 3 (3%) had a borderline malignant tumor, and 42 (44%) had a benign lesion, of which 41 were gallstones or gallbladder polyps and 1 was an intraductal papillary mucinous neoplasm that caused pancreatitis. Surgery for the latter tumor was postponed while conservative treatment improved conditions, but pancreatitis recurred 2 weeks after discharge, leading to a quasiurgent surgery. Conclusion(s): Owing to COVID-19, 15% of the scheduled elective hepato- biliary- pancreatic operations were postponed. Even lesions considered benign or not requiring emergency surgery should be treated promptly. Thus, the timing of treatment should be determined so that the risks of exacerbation and COVID-19 can be balanced.Copyright © 2022 Jikei University School of Medicine. All rights reserved.
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Background: Patients waiting for elective cholecystectomy for symptomatic gallstone disease may need admission with biliary symptoms or complications whilst on the waiting list. The longer the length from listing to procedure the higher the risk of symptoms and possible admission with complications. Many elective operations were cancelled or delayed during the pandemic leading to increased waiting times. The trust noticed a significant number of patients presenting to hospital who were already listed for surgery. This study looks at emergency admission data of 100 patients awaiting elective cholecystectomy. Method(s): Hospital admission data on 100 successive patients from the cholecystectomy waiting list were analysed from Dec 2021-January 2022. Data was collected on when were they added to the list and whether they had presented to hospital in the waiting period before cholecystectomy. Of those that were admitted, reasons for admission, demographics of people who needed admission and length of stay in hospital were recorded. Result(s): Of the 100 patients many had been waiting more than a year with Covid 19 a predominant delaying factor (cholecystectomy is a P3 or P4 procedure and many elective procedures were cancelled or delayed during the pandemic). This cohort of patients had 32 separate presentations to hospital while on the waiting list (some patients presenting multiple times). 9 patients required emergency hospital admission for clinical reasons such as pancreatitis and cholecystitis. This totaled 67 bed days for the admitting hospital, some data was unavailable due to admissions to other hospitals. Conclusion(s): NICE guidelines recommend laparoscopic cholecystectomy within 1 week for patients presenting with acute gallstone disease. Early elective cholecystectomy is recommended for patients with symptomatic gallstones. Delays in elective cholecystectomy operations during Covid 19 have caused delays to definitive treatment and led to excess bed usage during the treatment pathway with the associated financial costs and patient morbidity.
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The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on elective surgery for benign disease. We examined the effects of COVID-19 related delays on the outcomes of patients undergoing elective laparoscopic cholecystectomy (LC) in an upper gastrointestinal surgery unit in the UK. We have analysed data retrospectively of patients undergoing elective LC between 01/03/2019 to 01/05/2019 and 01/04/2021 to 11/06/2021. Demographics, waiting time to surgery, intra-operative details and outcome data were compared between the two cohorts. Indications for surgery were grouped as inflammatory (acute cholecystitis, gallstone pancreatitis, CBD stone with cholangitis) or non-inflammatory (biliary colic, gallbladder polyps, CBD stone without cholangitis). A p value of <0.05 was used for statistical significance. Out of the 159 patients included, 106 were operated pre-pandemic and 53 during the pandemic recovery phase. Both groups had similar age, gender, ASA-grades and BMI. In the pre-pandemic group, 68 (64.2%) were operated for a non-inflammatory pathology compared to 19 (35.8%) from the recovery phase cohort (p < 0.001). The waiting time to surgery was significantly higher amongst patients operated during the recovery phase (p = 0000.1). Less patients had complete cholecystectomy during the pandemic recovery phase (p = 0.04). There were no differences in intraoperative times and patient outcomes. These results demonstrate the impact of COVID-19 related delays to our cohort, however due to the retrospective nature of this study, the current results need to be backed up by higher evidence in order for strong recommendations to be made.
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Background: Acute Biliary disease, a surgical emergency, is predominantly treated conservatively initially. Specialist units aim to follow guidelines set by The Royal College of Surgeons and NICE to provide a cholecystectomy within a set time. Clinical practice at St Thomas' Hospital was reviewed along with The difficulties during The COVID-19 pandemic. Aim(s): Reassess practice at a specialist unit failing to meet guidelines during The start of COVID-19. Prospective data collection, on patients booked for a laparoscopic cholecystectomy (LC) after Emergency attendances. Method(s): Initial retrospective data analysis, reviewing pre-COVID (PC19) practice (03/19-02/20), initial COVID-19 (IC19) management (03/20-12/20). Prospective data (01/21-11/21) after implementing changes (AC19). Identifying demographics, pathology, length of stay during acute admission, average wait for Surgery and readmission rate prior to surgery. Patients receiving Surgery within 6 weeks, which has been set by our Trust as an acceptable standard. Result(s): Patients with acute presentation (acute cholecystitis, gallstone pancreatitis, cholangitis) 162 (PC19), 80 (IC19), 145 (AC19). Gender Ratio M:F 1:2 for all groups. Average wait to Surgery 93 (PC19), 44 (IC19), 69 (AC19) days. Patients receiving Surgery within 6 weeks 24.7% (PC19), 32.5% (IC19), 51.7% (AC19). Patients who were still awaiting Surgery at The end of each time frame 49% (PC19), 51% (IC19), 48% (AC19). Mean length of surgical stay 1.75 (AC19) days. Conclusion(s): Further changes are required, as guidelines are still not being met, with average wait times significantly above The recommended wait to undergo laparoscopic cholecystectomy.
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Background: British Association of Day Surgery and Royal College of Anaesthetists guidelines specify that 75% of elective Surgery should be done as a day-case. Our Trust reported a laparoscopic cholecystectomy day-case rate of 25% pre-pandemic. Following The first wave of The pandemic our waiting list increased significantly. Therefore, to address this, we aimed to improve The day-case rate by developing The booking pathway, such as introducing The Cholecystectomy As A Day-case (CAAD) score. Method(s): Retrospective data for laparoscopic cholecystectomy were reviewed between 19th March and 9th July 2021. Specific documents reviewed were The operation booking forms, hospital-specific 'boarding cards' for booking and CAAD score completion, and a day-case rate was calculated. Result(s): A total of 86 procedures were performed. There was an overall day-case rate of 54.7%. of those booked to be day-cases (n=39), 61.5% remained day-case post-operatively and 28.2% were discharged The next day. of The patients that were not discharged The same day (n=39), 18 cases had no documented reason for The additional stay. Incomplete booking forms (n=42) demonstrated a day-case rate of 50% versus 60.5% with complete forms (n=38). Conclusion(s): Overall, The day-case rate has improved. We believe this is from adhering to The boarding card and introduction of The CAAD score to guide appropriate booking. However, for further improvement we are going to revise The booking form and create a Standard Operating Procedure (Sop) for The booking of these operations. Together with CAAD scoring, this should improve day-case rates further to reach The nationally accepted standard.
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Aims: Gallbladder pathology is a common cause of Emergency admission under General surgery-however management had to be drastically changed given The unexpected pressures of The SARS-CoV-2 pandemic. This study aimed to compare management strategies in patients presenting with Biliary pathology pre and intra-SARS-CoV-2 pandemic in one NHS truSt. Method(s): A database of patients admitted to The acute surgical admissions ward in The months of November 2019 and 2021 was accessed, patients with Biliary presentations were isolated and information about these admissions analysed. Result(s): In 2019 4 of 57 (8.7%) of patients admitted with Biliary pathology had a laparoscopic cholecystectomy during that acute admission, compared to 8 of 65 (12.3%) in 2021. For all interventions (including ERCp and cholecystostomy) these values were 14 of 57 (25%) in 2019 and 24 of 65 (37%) in 2021. of 54 patients in 2019 who did not have laparoscopic cholecystectomy on index admission, 9 were readmitted (16.7%). The median duration of admission for all Biliary patients on index admission was 4 days in 2019 compared to 5.9 days in 2021. Conclusion(s): SARS COV2 has precipitated a change in management of acute Biliary patients. There is now an increased rate of intervention during The index admission and subsequent increase in admission duration. This is seen as an improvement in The pathway for patients in The long term, reducing The burden on The elective waiting list and reducing re-admission which will of fset The modest increase in length of stay on The index admission.
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Aim: The Association of Upper Gastrointestinal Surgeons (AUGIS) recommends performing a laparoscopic cholecystectomy within 72 hours of admission for acute cholecystitis. COVID-19 has drastically affected The way healthcare is able to be delivered worldwide. This project was designed to audit The impact of COVID-19 on The Surgical management of acute cholecystitis against AUGIS guidelines. Method(s): All General Surgical admission from November 2020 were retrospectively analysed. Admission records were screened for those presenting with acute cholecystitis. Those identified had their records analysed for laparoscopic cholecystectomy. Patients who died before surgery, had an alternative procedure performed, or who were unfit for surgery, were excluded. Result(s): During this time, 28 patients were admitted with acute cholecystitis. In total, 3 patients were excluded: 1 died before any possible intervention, 1 was unfit for surgery, and 1 received a cholecystostomy. of The 25 included patients, only 11% (n=3) patients received a laparoscopic cholecystectomy within seven days from their hospital admission. The remaining 89% (n=22) of patients were managed conservatively with fluids, analgesia, and antibiotics. Conclusion(s): It can be concluded that COVID-19 has severely impacted The Surgical management of acute cholecystitis as only 11% of those patients presenting were managed in accordance with AUGIS guidelines. Whether conservative management is an alternative long-term option for management remains to be seen as further long-term studies are needed.
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SESSION TITLE: Infections In and Around the Heart Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Acute bacterial myocarditis due to Salmonella bacteremia is a rare cause of ST-segment elevation that can manifest as acute decompensated heart failure, life threatening arrhythmias, and sudden cardiac death. CASE PRESENTATION: A 62-year-old male with a past medical history of HTN, HLD, DM2, and TIA presented with nausea, vomiting, nonbloody diarrhea, and right upper quadrant pain for five days. He quickly decompensated in the ED, becoming increasingly hypotensive, tachycardic, and lethargic concerning for sepsis. Broad spectrum antibiotics and IV fluids were initiated. Chest X-ray revealed multifocal pneumonia. Labs revealed a metabolic acidosis consistent with acute hypoxic respiratory failure warranting emergent intubation. CTA chest showed multifocal pneumonia and Covid-19 antigen testing was negative. Troponin I was elevated at.211 ng/mL (n <.08) and ECG showed new onset atrial fibrillation, for which cardiology was consulted. On admission to the ICU, repeat labs showed acute renal failure and he was anuric warranting hemodialysis initiation. Despite medical optimization, his Troponin I trended up to 1.458 ng/mL, and repeat ECG showed 2:1 atrial flutter with new ST-elevations in leads II, III, and aVF, consistent with an acute inferior STEMI. Labs did not show hyperkalemia nor hypercalcemia. Transthoracic echocardiography revealed normal systolic and diastolic function, with a left ventricle ejection fraction of 65-70%. A heparin infusion was started and he was taken for a cardiac catheterization which showed no evidence of occlusive CAD. His blood cultures revealed Salmonella enteritidis for which he was switched to ciprofloxacin. Abdominal ultrasound appeared benign, but CT abdomen with contrast showed findings of cholecystitis, which was confirmed on HIDA scan. Gastroenterology and Surgery were consulted who recommended a cholecystostomy tube placement, with a delayed laparoscopic cholecystectomy (LC) when stable. Repeat ECG following the LC showed complete resolution of the previous STEMI. He was discharged to a rehabilitation facility where he made a full recovery. DISCUSSION: Acute bacterial myocarditis can mimic acute coronary syndromes and warrants a high index of suspicion in the setting of Salmonella bacteremia. Our patient presented with signs of acute cholecystitis and an ECG concerning for acute STEMI. Bacterial etiologies of myocarditis are less reported in the literature compared to viral infections, and are seen more often in patients with severe sepsis such as our patients. Common findings associated with Salmonella myocarditis include ST-segment elevation on ECG and elevated troponin levels. Serial ECG findings can distinguish myocarditis from acute myocardial infarction. Early diagnosis is essential to improve outcomes and reduce mortality. CONCLUSIONS: Acute bacterial myocarditis can mimic acute coronary syndromes. Reference #1: Villablanca P, Mohananey D, Meier G, Yap JE, Chouksey S, Abegunde AT. Salmonella Berta myocarditis: Case report and systematic review of non-typhoid Salmonella myocarditis. World J Cardiol. 2015;7(12):931-937. doi:10.4330/wjc.v7.i12.931 Reference #2: Sundbom P, Suutari AM, Abdulhadi K, Broda W, Csegedi M. Salmonella enteritidis causing myocarditis in a previously healthy 22-year-old male. Oxf Med Case Reports. 2018;2018(12):omy106. Published 2018 Nov 26. doi:10.1093/omcr/omy106 Reference #3: Majid A, Bin Waqar SH, Rehan A, Kumar S. From Gut to Heart: Havoc in a Young Patient with Typhoid-associated Cardiomyopathy. Cureus. 2019;11(7):e5049. Published 2019 Jul 1. doi:10.7759/cureus.5049 DISCLOSURES: No relevant relationships by Mohamed Faher Almahmoud No relevant relationships by JONATHAN BROWN No relevant relationships by Hytham Rashid No relevant relationships by Syed Raza
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Background: SARS-CoV-2 virus infection was detected and discovered in Wuhan, China, in December 2019, and it was declared a pandemic by WHO in March 2020. Since then a lot of changes were noticed in surgical practice. Various recommendations were released by eminent surgical associations all over the world. This study was designed to study and analyze the findings and experience after resuming elective minimal invasive surgery during the pandemic. Materials and methods: This observational study was conducted at St Joseph’s Hospital, Ghaziabad, from May 2020 to May 2021. Various preoperative and postoperative findings were noticed and analyzed. The presence of SARS-CoV-2 virus was also analyzed in endotracheal aspirate and surgical smoke. Observation and results: A total of 287 cases underwent surgery. Most commonly performed surgery was laparoscopic cholecystectomy. The positivity rate for SARS-CoV-2 during preoperative work-up was 2.87%. Slightly more than 5% of cases in postoperative period had COVID-19-like symptoms. None of those patients were found positive on RT-PCR, and X-ray/CT findings were also suggestive of early postoperative changes only. Presence of SARS-CoV-2 virus was not detected in either endotracheal aspirate or surgical smoke. Neither surgery team nor OT staff had infection during this period. There was no mortality, and only 1 patient was found to be infected 2 weeks after discharge. Conclusion: Minimal invasive surgery for elective cases can be safely performed by taking precautions like PPE and smoke evacuation system during the COVID-19 pandemic. There is no evidence of transmission of infection through endotracheal aspirate or surgical smoke.
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Purpose: Cholecystitis accounts for more than 200,000 hospital admissions per year in the United States with increasing rates and hospital charges over the past two decades (Wadhwa et al. 2017). Recent evidence-based guidelines have advocated for early surgical cholecystectomy (SC), reserving percutaneous cholecystostomy (PC) for the critically ill or patients with prohibitive co-morbidities. Purpose: To identify management trends of cholecystitis to validate current practice patterns and reimbursement rates Materials and Methods: All patients undergoing PC placement in a tertiary care hospital from 2010 to 2020 were reviewed. Inclusion criteria consisted of age >18, indication of cholecystitis, and no past PC. Additionally, all patients undergoing SC (laparoscopic or open approach) were reviewed, with surgical data becoming available in 2014. Inclusion criteria included age >18 and indication of cholecystitis. Medicare reimbursement was determined by Current Procedural Terminology (CPT) code. Years with multiple reimbursement rates were averaged. Linear regression analysis was performed. Results: A total of 2522 patients presenting for procedural treatment of cholecystitis were included. 391 underwent PC with interventional radiology with an average age (± stdev) of 64 ± 14.9 years (range: 20-96). 2131 patients underwent SC, average age 55.1 ± 17.6 years (range: 20-100). Over the follow up period, there was a significant increasing trend in PC placement (R2=0.58, P=0.006). Trend of surgical data is notable for a non-linear, though upward trend, increasing from a rate of 181 cases/year in 2014 and 2015, peaking at 481 in 2018, then followed by sharp decline over the subsequent two years, with 260 cases in 2020. From 2010-2020, Medicare reimbursement stayed relatively stable with overall small decreases in payment. There were notable declines for PC reimbursement from 2010 to 2011, decreasing from $551.2 to $392.77 and laparoscopic cholecystectomy reimbursement from $817.28 to $728.69 between 2012 and 2013. Conclusion: The increasing rate of cholecystitis over the past decades is associated with increases in both PC and SC and declines in the rates of reimbursement. After trending upward, surgical intervention was shown to decline after 2018, possibly secondary to availability of PC, or macroeconomic factors such as changes in management guidelines, reimbursement rates, or the COVID-19 pandemic.
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PURPOSE: To determine effects on admission, treatment, and outcome for acute cholecystitis during the course of the COVID-19 pandemic in 2020 and 2021. METHODS: Retrospective analysis of claims data from 74 German hospitals. Study periods were defined from March 5, 2020 (start of first wave) to June 20, 2021 (end of third wave) and compared to corresponding control periods (March 2018 to February 2020). All in-patients with acute cholecystitis were included. Distribution of cases, type of surgery, comorbidities, surgical outcome, and length of stay of all cases with acute cholecystitis and cholecystectomy were compared. In addition, we analyzed the type of treatment (non-surgical, cholecystostomy, or cholecystectomy) for all cases with main diagnosis of acute cholecystitis. RESULTS: We could not demonstrate differences in daily admissions over the course of the pandemic (11.2-12.7 patients vs. 11.9-12.6 patients for control periods). Proportion of patients with non-surgical treatment was low and not increased (11.7-17.3% vs. 14.5-18.4%). Cholecystostomy was rare throughout all periods (0-0.5% of all patients). We did not observe an increase in open surgery (proportion of open cholecystectomies 3.4-5.5%). Mortality was generally low (1.5-1.9%) with no differences between periods. Median length of stay was 4 days throughout all periods. CONCLUSION: The numerous restrictions during the COVID-19 pandemic did not result in an increase of admissions or surgery for acute cholecystitis. Laparoscopic cholecystectomy has been safely applied during the pandemic. Our results may assure the ability to maintain high quality of surgical care even in times of disruptions to the health care system.
Subject(s)
COVID-19 , Cholecystectomy, Laparoscopic , Cholecystitis, Acute , Cholecystostomy , COVID-19/epidemiology , Cholecystectomy, Laparoscopic/methods , Cholecystitis, Acute/etiology , Cholecystostomy/methods , Hospitals , Humans , Pandemics , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Gangrenous cholecystitis has a high risk of perforation and sepsis; therefore, cholecystectomy in the early stage of the disease is recommended. However, during the novel coronavirus disease 2019 (COVID-19) pandemic, the management of emergent surgeries changed to avoid contagion exposure among medical workers and poor postoperative outcomes. CASE PRESENTATION: A 56-year-old man presented to our hospital with abdominal pain. Computed tomography revealed intraluminal membranes, an irregular or absent wall, and an abscess of the gallbladder, indicating acute gangrenous cholecystitis. Early laparoscopic cholecystectomy seemed to be indicated; however, a COVID-19 antigen test was positive despite no obvious pneumonia on chest computed tomography and no symptoms. After discussion among the multidisciplinary team, antibiotic therapy was started and percutaneous transhepatic gallbladder drainage (PTGBD) was planned for the following day because the patient's vital signs were stable and his abdominal pain was localized. Fortunately, the antibiotic therapy was very effective, and PTGBD was not needed. The cholecystitis improved and the patient was discharged from the hospital on day 10. One month later, laparoscopic delayed cholecystectomy was performed after confirming a negative COVID-19 polymerase chain reaction test result. The postoperative course was uneventful, and the patient was discharged on postoperative day 2 in satisfactory condition. CONCLUSION: We have reported a case of acute gangrenous cholecystitis in a patient with asymptomatic COVID-19 disease. This report can help to determine treatment strategies for patients with gangrenous cholecystitis during future pandemics.