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.
Background: Acute cholecystitis is the most frequent complication of cholelithiasis and counts for one third of surgical emergencies. Aim: The study evaluates the outcomes and limits of laparoscopic cholecystectomy in acute cholecystitis. Materials and methods: A retrospective study was performed for 2 years, between 01.01.2016-31.12.2017 in the 2nd Surgery Department of the Sibiu County Emergency Clinical Hospital, on hospitalized patients with acute cholecystitis, who underwent surgery. The severity of acute cholecystitis was analyzed using the Tokyo Guidelines (TG13 / TG18) severity risk scale. The preoperatory evaluation of the anesthetic-surgical risk was based on American Society of Anesthesiologists Physical Status Classification (ASA PS) and Charlson Comorbidity Index (CCI) (9). Statistical analysis was performed to analyze the outcomes and limits of laparoscopic cholecystectomy and the risk factors for conversion and open surgery. Results: Out of the 262 patients in the study group, most of the patients (61%) were diagnosed with moderate acute cholecystitis, while 67 patients (26%) were diagnosed with mild form and 34 (13%) with severe acute cholecystitis. Laparoscopic cholecystectomy was performed in 96.1% of cases with no conversion to open surgery. The postoperative complications were ligature slippage (1.9%), main bile duct injury (1.9%), postoperative hemorrhage (3.9%) and surgical site infections (2.4%), most of them being managed conservatory. Conclusions: Laparoscopic cholecystectomy can be performed nowadays with minimal morbidity in acute cholecystitis. Knowledge of various factors predicting possible conversion helps in adequate pre-operative selection and counseling for open procedure with further reduction in the overall morbidity of laparoscopic cholecystectomy.
