Digestive surgery service including surgical management of gastrointestinal disease and digestive cancers are experiencing the impact of COVID-19 pandemic. Therefore it is necessary to formulate recommendation for digestives surgery service, as guidelines to engage in case-by-case assessment of particular patients with digestive diseases. We are aware that the knowledge and science of COVID-19 are still evolving, with new progression every day. This recommendation reflect actual condition and are subject for future adjustment in the future.
Background
Bile duct injuries (BDI) can occur after a cholecystectomy procedure performed by any surgeons. These ensured a poor experience for patients and surgeons and marred the minimally invasive surgery approach, which should have promised rapid recovery. This study aimed to evaluate the management of BDI following cholecystectomy procedure in Cipto Mangunkusumo Hospital, Jakarta, as a tertiary hospital.
Method
Descriptive retrospective cross-sectional design was used on open and laparoscopic cholecystectomy performed between January 2008 and December 2018. This study is reported in line with STROCSS 2019 Criteria.
Result
A total of 24 patients with BDI were included, with female preponderance (62,5%) with a median age 45 (21–58) years. Sixteen post-laparoscopy cases were classified according to Strasberg classification; 6 cases were type E3, 2 cases each of type E1 and E2, and one case each of Strasberg C and D. The remaining 4 were Strasberg A. Eight post-open cases were classified based on Bismuth criteria: 4 cases of Bismuth I, 1 case of Bismuth II, and 3 cases of Bismuth III. Five cases were presented with massive biloma, 7 with jaundice, and 10 cases with biliary-pancreatic fluid production through the surgical drain. The average time of problem recognition to patient's admission was 19 (7–152) days and admission to surgery was 14 days. Roux-en-Y hepaticojejunostomy was performed in 18 cases, choledocho-duodenostomy in 2 cases, and primary ligation cystic duct in 4 cases. Post-operative follow-up showed 2 patients had recurrent cholangitis, 2 superficial surgical site infection, and 2 relaparotomy due to bile anastomosis leakage and burst abdomen. The median length of hospital stay was 38 (14–53) days with zero hospital mortality. No stricture detected in long term follow-up.
Conclusion
Common bile duct was the most frequent site of BDI, and Roux-en-Y hepaticojejunostomy reconstruction performed by HPB surgeons on high volume center results in a good outcome.
Introduction
During the coronavirus disease 2019 (COVID‐19) pandemic, digestive surgery potentially exposes both health‐care professionals and vulnerable patients to COVID‐19. A survey was conducted with aim to determine the digestive surgery services provided during the COVID‐19 pandemic, optimize safety for patients and clinicians, and safeguard health‐care services.
Methods
An online survey was conceived and circulated to members of the Indonesian Society of Digestive Surgeons. The survey was conducted in two phases, in April 2020 and July 2020, to evaluate changes in response to the COVID‐19 pandemic.
Results
Early in the pandemic (April 2020), the median number of major digestive surgeries performed monthly declined from 20 cases (range. 3‐100 cases) to 1 case (range. 0‐10 cases) (P < .001; Wilcoxon signed‐rank test). Most of the cases in April 2020 addressed emergency problems, but more definitive surgeries were performed during the later period of the survey. The importance of screening for COVID‐19 with polymerase chain reaction has increased over time, and a more comprehensive screening methodology incorporating real‐time polymerase chain reaction, chest CT, and rapid antibody test were evident in 31.37% of July 2020 responses.
Conclusion
Our survey has shown that surgeons adapted to the evolving pandemic and continue to do so only with appropriate safety assurances.
Conclusion: Periampullary and pancreatic tumors are prevalent. The surgical management in hour hospital varied for each case. Because patients come to our hospital in later stage, we can only perform operation palliative to those patients. We need to raise the awareness of physicians to diagnose the case earlier and making decision to refer to the nearest center for better prognosis.
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