Introduction: The COVID-19 pandemic has affected the Turkish National Health System on many different levels, causing a complete reorganization of surgical services. The study analyzed the management of acute cholecystitis.
Materials and Methods: We analyzed all patients admitted to our Emergency Department for Acute cholecystitis between February 1, 2020, and December 31, 2021, and graded each case according to the 2018 Tokyo Guidelines. All patients were tested for SARS-CoV-2 positivity and received initial conservative treatment. We focused on patients who underwent cholecystectomy during the acute phase of the pandemic and subsequent disease.
Results: The mean age of our patients was 56 (range: 38-79), male patients were 20 (43%) and female patients were 26 (57%). Patients were classified according to TG-18: 11 grade I, 20 grade II, and 15 grade III.
6 patients tested positive for SARS-CoV-2 and were admitted to the Internal Medicine COVID ward, where they were treated conservatively (antibiotics, fluid resuscitation, and bowel rest). This procedure improved the clinical picture and the patient was discharged 5 days after the nasopharyngeal swab test was negative. In SARS-CoV-2 negative patients, complete resolution of AC was achieved with antibiotic therapy alone in 30 of 40 cases (75%). Laparoscopic cholecystectomy (LC) was performed in 5 patients (12%) with low surgical risk (ASA 1-2) after the first antibiotic treatment. Emergency cholecystectomy was performed in 6 patients (13%) from SARS-CoV-2 negative patients, according to the severity of TG-18 AC.
Conclusion: Percutaneous gallbladder drainage was shown to be an effective and safe treatment during the SARS-CoV-2 epidemic. Although many centers had to prefer non-surgical methods in the treatment of acute cholecystitis, we did not turn to alternative treatments because there was no emergency surgery restriction in our hospital. This approach has allowed us to precisely treat patients, thus helping to reduce the burden on the healthcare system.
Key words: COVID-19, acute cholecystitis, cholecystectomy
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