Page 89 - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Urgent Elective Laparoscopic Cholecystectomy during the

COVID-19 Pandemic

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Rebecca M Jones , Andrew P MacCormick , Arun Ariyarathenam , M Lee Humphreys , Grant Sanders , Tim J Wheatley ,
David SY Chan 7
AbstrAct
Aim: In April 2020 routine elective surgery in England was suspended in response to coronavirus disease-2019 (COVID-19). Low COVID-19 infection
and mortality rates in the South West of England allowed urgent elective surgery in Plymouth to continue with the necessary precautions. The
aim of this study was to assess outcomes following elective laparoscopic cholecystectomy during the initial phase of the COVID-19 pandemic.
Materials and methods: Records of 54 consecutive patients undergoing urgent elective laparoscopic cholecystectomy between March 25,
2020, and June 25, 2020, were analyzed retrospectively. Patients were telephoned after 30 days. All patients underwent COVID-19 swab testing
24 to 72 hours prior to surgery and during admission if clinically indicated. The primary outcome measure was COVID-19 related morbidity.
Secondary outcome measures were non-COVID-19 related morbidity, mortality, and length of hospital stay.
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Results: Fifty-four patients [19 male, 35 female; median age 59 years (20–79); median body mass index (BMI) 31 kg/m (22.9–46.8); median ASA 2]
underwent laparoscopic cholecystectomy during the study period. Fifty-one patients (94%) were of White-British ethnicity. One patient tested
positive for COVID-19 preoperatively. There were no COVID-19 diagnoses postoperatively and no COVID-19 related morbidity. There were no
deaths at 30 days. Forty-four patients (81%) had a day-case procedure. Forty-two (78%) procedures were performed by a supervised trainee.
Conclusion: Elective laparoscopic cholecystectomy can be performed safely and training maintained in areas of low COVID-19 prevalence with
the necessary precautions.
Clinical significance: This small study provides some evidence to aid decision-making around the provision of elective surgical services during
this ongoing pandemic.
Keywords: Cholecystectomy, Coronavirus, COVID-19, Surgery.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1490

IntroductIon 1 University Hospitals Plymouth, Plymouth Oesophago-Gastric Centre,
Perioperative coronavirus disease-2019 (COVID-19) infection results Plymouth, United Kingdom
in significant mortality and respiratory morbidity, the 30-day 2–7 Plymouth Oesophago-Gastric Centre, Plymouth, United Kingdom
mortality rate for elective patients with COVID-19 has been reported Corresponding Author: Rebecca M Jones, University Hospitals
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as 18.9%. Guidance has been published on the prioritization and Plymouth, Plymouth Oesophago-Gastric Centre, Plymouth, United
management of patients requiring surgery and the recovery of Kingdom, e-mail: rebecca.jones@doctors.org.uk
surgical services 2–10 however limited data have been published How to cite this article: Jones RM, MacCormick AP, Ariyarathenam A,
on the outcomes of elective surgery during the initial phase of et al. Urgent Elective Laparoscopic Cholecystectomy during the
the pandemic. The largest study to date included both adults and COVID-19 Pandemic. World J Lap Surg 2022;15(1):87–89.
children and did not stratify results by type of elective surgery or Source of support: Nil
country of origin. 1
The first UK lockdown was announced on March 23, 2020. It Conflict of interest: None
has been estimated that 81.5% of benign upper gastrointestinal/
hepatobiliary operations may have been cancelled or postponed cholecystectomy continued to be performed at Derriford Hospital
worldwide during the initial 12-week peak of the COVID-19 in Plymouth throughout the first wave of the pandemic. All
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pandemic. In the UK this could represent up to 50,000 laparoscopic necessary precautions were taken perioperatively as national and
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cholecystectomies. As part of our hospital’s response to increasing local guidance evolved.
resources for COVID-19 patients, routine elective surgery ceased and The aim of this study was to determine outcomes after urgent
access to the theater was initially reduced from 5 all-day operating elective laparoscopic cholecystectomy during the initial phase of
lists per week to 3 for our unit. the COVID-19 pandemic.
The UK has experienced regional variation in COVID-19
prevalence. The number of confirmed cases in the South West of
England in June 2020 was less than 20 per 100,000 compared with MAterIAls And Methods
40 or more per 100,000 in areas of London and the North West Records and laboratory results of consecutive patients who
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of England. The accompanying mortality rates have also been underwent elective laparoscopic cholecystectomy by five surgeons
much lower (41 per 100,000 in the South West of England vs 137 in a single tertiary surgical unit between March 25th 2020, and June
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per 100,000 in London, in June 2020). As such, urgent elective 25th 2020, were analyzed retrospectively. Patients were telephoned
surgery including esophagogastric cancer surgery and laparoscopic after 30 days and asked if they had postoperative COVID-19 testing
© The Author(s). 2022 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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