Clinical and therapeutic particularities of acute gallstones disease during COVID-19 pandemic

Gallstones disease (GD) is a common pathology, with an incidence of approx. 20% in developed countries, a third of these cases being symptomatic. The paper aims to identify the diagnostic and therapeutic features of acute manifestations of gallstones during the COVID-19 pandemic. Materials and method: A retrospective, comparative study was performed of the cases presented to the emergency room (ER) and hospitalized for acute manifestations of gallstones in April-June 2020 vs similar period of 2019. The data regarding clinical form, associated pathology, therapeutic management were analyzed from the ER presentation register, hospitalization sheets and surgical protocols. Results: During the COVID-19 pandemic, the number of hospitalized cases for acute cholecystitis and other acute manifestations of GD was significantly lower than in the same period last year (21 vs 49 patients). In both study groups the main form of presentation was acute catarrhal cholecystitis (52.4% vs 63.2%). During the SARS-Cov-2 pandemic, we report an increased incidence of complicated forms, mainly hydrops (23.8% vs. 4.1%, p <0.05) and angiocholitis (19% vs. 4.1%, p <0.05). Conservative treatment was chosen more frequently during the pandemic (48% vs. 29%). For operated patients, laparoscopic cholecystectomy was the main option, performed in 85.7% in both groups. Conclusions: We maintain that laparoscopic cholecystectomy remains the gold standard for acute cholecystitis, even in the COVID-19 pandemic, as it guarantees the best outcomes for the patients. Conservative management may be an option for mild cases, but it carries the risk of recurrence of symptoms and increased incidence of severe complications.