Index admission cholecystectomy with or without single session bile duct exploration for Emergency gall stone complications neutralised the adverse effects of COVID

ABSTRACT

Aims: The COVID-19 pandemic impacted surgical practice globally. We aim to study The effects this had on The presentations, practice and results of Biliary Surgery on a unit adopting index admission laparoscopic cholecystectomy (LC) and single session management of bile duct stones for Emergency presentations. Method(s) Prospectively collected data of Biliary Surgery over a period of 12 months pre-COVID (PRE) and 12 months post-COVID (PoST) was analysed. The presentation, type of admission, type of operating list and operative and postoperative data were compared. Result(s) 257 LCs were done PRE and 270 PoSt. All Emergency presentations increased;acute cholecystitis 8.5% to 25.9%, acute pancreatitis 6.2% to 11.8% and jaundice 22.5% to 27.7%. Elective LC decreased from 53% to 20%. With an increase in patients with previous admissions (13.6% PRE vs 20.7% PoST), 87% of PRE vs 80% PoST had index admission LC, utilising 192 Emergency theatre sessions and 29 CEpoD lists. In spite of increased LC difficulty grades (grades 4 and 5 from 20.2% to 30.5%), bile duct explorations (34%), operating time and median total hospital stay The morbidity, mortality and median presentation to resolution intervals were not affected. Conclusion(s) COVID-19 caused an increase in all acute Biliary presentations requiring Emergency admissions, almost certainly The result of a significant decline in elective LC. However, similar numbers of LC PRE and PoST were maintained due to a policy of index admission Surgery and bile duct exploration, utilising Emergency theatre scheduling, optimised clinical outcomes in spite of some logistical parameters being affected.