Impact of COVID -19 on Gallstones Patients

Background: It is well known that most of the healthcare centers have redistributed their material and human resources to face the health issues associated with COVID-19 pandemic. Aims: In the current study, we aimed to investigate the impact of COVID-19 pandemic on gall stone patients. Methods: Comparison was conducted in our own center regarding gallstones related activities before, during and after the pandemic. We reviewed also the number of elective laparoscopic cholecystectomies during these periods. Data were obtained from the hospital recording system. Results: We found a significant increase in the number of gall stones related complications during the COVID-19 pandemic when compared with non-pandemic periods. Conclusion: It is recommended that laparoscopic cholecystectomies should be considered whenever possible, taking all relevant measures to avoid contagion of patients and the health team.

P-EGS28 Management of obstructive jaundice secondary to gall stones in an ambulatory setting

Background Our data from Leeds shows a 30% increase in patient attendance to the Surgical Assesment Unit (SAU) across a 5 year period, putting unprecedented demands on the acute surgical service. A new Ambulatory Surgical Centre (ASC) was established for the advancement of ambulatory care pathways that would ensure that acute patients are seen promptly and kept safe with monitoring in an appropriate setting without needing admission to the hospital bed base. Gallstone related disease accounts for a third of patient attendance to the emergency surgical services. We present our experience with an ambulatory pathway to manage patients with obstructive jaundice caused by gall stones, and propose a protocol driven pathway. Methods The ASC operates an acute, consultant led clinic, with access to urgent blood tests and dedicated USS, CT and MRI imaging capacity, and offers a direct referral service from Primary Care Networks (PCNs) through the Primary Care Access Line (PCAL). Patients referred with clinical jaundice or RUQ/Epigastric pain are investigated for derangement in their liver function, and assessed for the presence and severity of Acute Cholangitis (AC), according to the 2018 Tokyo Guidelines. Patients without evidence of cholangitis, or with AC Grade I are planned for management in the ambulatory setting, including investigations, monitoring and endoscopic/surgical intervention. Outcome data was collected retrospectively from PCAL data source, spanning from Oct 2020 till July 2021. Results A total of 98 patients were referred to the acute surgical service during this period. Out of these, 47% had Grade II (n = 35) or Grade III (n = 17) AC. 48% were suitable for ambulatory management, with no evidence of AC(n = 5) or Grade I AC(n = 43). 20% patients were found to have a cause other than gall stone disease. 55% have undergone intervention (33 Laparoscopic cholecystectomies, 22 ERCP) while 12 are on the waiting list for surgery. Conclusions Our protocol offers a safe, comprehensive and timely pathway for the management of patients with gall stone related obstructed jaundice in an ambulatory setting. This has helped reduce the demand on hospital beds for surgical patients.

P-EGS22 Emergency cholecystectomy: A comparative study of patient outcomes during COVID-19 pandemic with pre-COVID-19 period

Background Emergency cholecystectomy is recommended for all acute admissions with symptomatic gall stones. The Royal College of Surgeons and AUGIS on 25th March 2020 recommended that all laparoscopic procedures should be avoided during the COVID-19 pandemic with the view to minimise the risk of virus transmission from aerosol-generating procedures. This retrospective study compares the outcomes of patients undergoing emergency cholecystectomy during the COVID-19 period with the pre-COVID-19 period. Methods All patients who underwent emergency cholecystectomy (EC) from March 2019 to March 2021 were included. ‘Pre-COVID-19’ period was defined as 25th March 2019 to 24th March 2020, whereas the ‘COVID-19’ period was from 25th March 2020 to 24th March 2021. Mortality was considered as the primary outcome. Secondary outcomes include the 30-day postoperative complications based on the Calvien-Dindo classification (CDC) and the length of stay (LOS). Mortality and postoperative complications were assessed using the Chi-squared test, whilst LOS was studied using the Mann-Whitney U test. A p-value of < 0.05 was considered statistically significant. Results A total of 143patients underwent EC during the 24-month study period (75patients pre-COVID-19 and 68patients during COVID-19). The 30-day mortality was nil. 9patients;12% in pre-COVID-19 period and 11patients;16% in COVID-19 period underwent conversion to open cholecystectomy (p = 0.47). 18patients;24% from pre-COVID-19 and 19patients;27.9% from COVID-19 periods developed postoperative complications (p = 0.59). Grade-2-CDC complications were seen in 12patients;17.6% during COVID-19 period and 5patients;6.7% in pre-COVID-19 period (p = 0.0043). However, grade-3,4 CDC complications requiring intervention (p = 0.39), and ICU-admission (p = 0.62) were comparable in both periods. 1patient developed COVID-19 infection but made a full recovery. Mean LOS was 6-days in both periods, with no statistical difference (p = 0.28). Conclusions This study demonstrated no significant difference in patient outcomes who underwent emergency cholecystectomy during the COVID-19 pandemic compared to the pre-COVID-19 period. Emergency cholecystectomy should be offered to all surgically fit patients with symptomatic gall stones.

A Cross Sectional Study on the Rising Frequency of Gallbladder Stones

Objective: The aim of this study was to determine the occurrence of cholelithiasis in the city of Lahore and its surrounding area. Material and Methods: This study was conducted at Shalamar Medical and dental college Lahore and data for this study was collected from different hospitals of Lahore and the duration of this study was from 2019 to 2021. The participants of this study were from both genders’ male and female from of the age of 10 years to 80 years, and the sample size for this study was 483 and 1583. The main focus of our study was to examine the occurrence of Cholelithiasis surgical in the duration of our study. A questionnaire was used to analyses the occurrence of gall stone, and also the sex, age and dietary habits of the patients. Results: In the results of this study the frequency of gall stones were observed 4.0% in males and 12.0% in females and the percentage of occurrence of gall stones in both these genders were 1% to 3.3%. the high occurrence rate of gall stones in the months are May and November, in both these months the observation of gall stones in these were very high. Both the genders were divided into two main age groups in which male age group were from 10 years to 78 years and the females age group were from 11 years to 80 years. The ideal age for the occurrence of gall stones in male were 45 years to 59 years and in females were 3 years to 44 years respectively. Conclusions: In the conclusion of this study, we examine that the overall occurrence of gall stones in both the genders were 7.01%, but at same the time occurrence rate in the females were very high as compared to the male which were 1% in males and 3.3% in females. Keywords: Cholelithiasis, Surgical Incidence, Gallstones.

Prevalence, Causes and Management of Obstruction of Common Bile Duct: Review Article

Gallstones cause biliary obstruction in about 5 out of 1000 people, whereas 10 to 15% of the adult population in the United States will have gallstones at some point in their lives. Gall stones, also known as cholelithiasis, are the precursor of choledocholithiasis, which occurs when gall stones pass through the cystic duct and lodge in the common hepatic ducts, causing an obstruction. Routine labs and some specialized labs are used in the diagnosis of biliary blockage. Severe complications can happen if left unchecked such as damaging the hepatic dysfunction, renal failure, nutritional deficiencies, bleeding problems, and infections. Treatment depends on the causing effect of bile duct obstruction. Sphincterotomy with lithotripsy, choledochotomy, choledochoduodenostomy, choledochojejunostomy, or cholecystectomy are the most used for large gall stones treatment. This review looks at the prevalence, etiology and management of the disease.

Comparison of Body Mass Index and Cholelithiasis Diagnosed on Ultrasound in the Population of Pindi Bhattian

Obesity is one of the emerging conditions in our population. Gallstones are composed of cholesterol. It is postulated that gallstones are associated with the deposition of cholesterol. Ultrasound is the first line imaging modality for the diagnosis of cholelithiasis. If gallstones are correlated with BMI, it will open up a new vista for further research. In Yaqoob Ultrasound Clinic, PindiBhattian, Pakistan, a cross sectional analytical study was conducted. All included patients were inquired regarding variables like Age, Height, Weight, Presences of stones, Wall thickness of gall bladder, and location of gall stones on grey scale ultrasound findings. Patients were asked to lie down and expose their abdomen; grey scale abdominal ultrasound was performed of these patients. All variables mentioned above for each patient was recorded and maintain in their individual case record form (CFR). Data was collected during allocated period. Statically package SPSS version 2.4 was used to check the collected data and to organize and compile results. According to results out of total 160 patients, 105 were females and 55 were male. Out of 160 patients 150 (93.8%) were present with gall stones and 10 (6.3%) were having no gall stone. In total 61 patients (38.1%) were having single gall stone whereas 89 (55.6%) were diagnosed with multiple gall stones. According to the results, minimum age was 18 years and maximum was 80 years. Our study concluded that obesity is one of the major risk factors for gall stones. Obesity is usually more common in females, so they are more likely to have gall stones and overweight patients were more prone to GB stones.

SP6.1.6 Rule of systematic intraoperative cholangiogram in patients undergoing emergency cholecystectomy

Aims Incidence of gall stone disease is estimated at 10-15%of population. Intraoperative cholangiography (IOC) diagnose choledocholithiasis, delineates the anatomy of the biliary ducts, facilitate the dissection and reduces injuries. Our aim is to assess the feasibility and role of IOC and the incidence of choledocholithiasis in acute cholecystitis (ACC). Methods Retrospective analysis of prospectively collected data for patients admitted with ACC and undergoing same-hospital-stay laparoscopic cholecystectomy (LC). IOC was systematically attempted in all cases. Results 475cases included. Female to male ratio1.9:1. Conversion to open was done in 3 cases. Preoperative cholelithiasis was confirmed in 439cases versus 34cases with no stones. USS CBD abnormality (dilated or contain stone) found in 53 cases, out of which 8(15%) cases had CBD stones. Jaundice was found in 69cases, where 25(39%) cases had confirmed choledocholithiasis. IOC was successful in all cases except one. Abnormal IOC was found in 99(21%) cases. Of those; CBD stones were confirmed in 76 (77%) cases regardless the presence of cholelithisasis on USS. Empyema was found in 237 cases and it was associated with higher risk of abnormal IOC in 59(25%) cases where CBD stones were confirmed in 45(76%) cases. Cystic duct (CD) stones found in 80cases, of those 27(34%)cases had choledocholithiasis. Conclusions Females have double the risk of ACC. Preoperative jaundice and CD stones are stronger indicators than CBD diameter for presence of choledocholithiasis. The incidence of choledocholithiasis in ACC is (20-25%) regardless the presence of gall stones on USS. IOC is feasible and highly recommended in emergency LC.

Awareness of patients with symptomatic gallstones regarding their own disease

Aim: To evaluate the awareness of patients presenting to a government sector hospital in Lahore with gall stones regarding their disease and factors influencing it. Methodology: A cross sectional observation study was conducted at the Department of General Surgery, Services Hospital, Lahore from 1st January 2020 to 30th June 2021. A simple questionnaire to collect and analyze the data of the patients admitted for cholecystectomy. The content of the questionnaire included socio-demographic characteristics and questions to access the awareness of patients regarding gallstones. Data was entered and analyzed using EXCEL 2013. Frequencies and Percentages were calculated as descriptive statistics whereas Fisher's exact test was conducted as inferential statistics. Value of p less than 0.05 was considered as significant. Results: Only 13.5% patients had a good awareness of their own disease. Direct education about the disease from doctor (p=0.0320), media (0.0316) or self-study (0.0001) were significantly related to awareness. Conclusion: The awareness of the patients with symptomatic gall stones regarding their own disease is poor. Role of physicians and lack of its impact on this needs to be investigated further. Keywords: Patient Awareness, gall stones

A clinical study on prevalence of subclinical hypothyroidism in patients with cholelithiasis in a tertiary care center in South India

Background: Gall stones are the most common biliary pathology. Hypothyroidism has been shown to promote gall stone formation and prevalence of clinical hypothyroidism in patients with cholelithiasis is extensively studied. This study aimed to find the prevalence of subclinical hypothyroidism in patients with cholelithiasis.Methods: A prospective study on 94 patients was carried in Saveetha medical college and hospital, Tamil Nadu, India between March 2017 and June 2019. All patients underwent imaging studies for confirmation of gall stone disease and serum FT3, FT4 and TSH estimation done.Results: Out of 94 patients, 47 patients were between 30-50 years (50%). 30 (31.9%) patients were hypothyroid and 64 (68.1%) were euthyroid. Among the hypothyroid patients, 3 (3.2%) had clinical hypothyroidism and 27 (28.7%) had subclinical hypothyroidism. 80 (85.1%) patients had multiple calculi and 14 (14.9%) of patients had single calculus.Conclusions: Majority of patients were in the age group of 30-50 years with females 53.2% and males 46.8%. Hypothyroidism was diagnosed in nearly one-third of patients in our study with a high prevalence of subclinical hypothyroidism (28.7%). No significant correlation was found with respect to age, gender, number of gall stones to serum TSH levels.