As data and metadata from the SARS-CoV-2 pandemic mature, the true impact on non-cancer, non-emergency surgical practice is becoming apparent. The authors present data on the impact of gallstone disease in their unit during 5 months of the COVID-19 pandemic (March 2020 to August 2020) compared with the equivalent period in 2019. Although the total number of patients presenting with gallstone disease was comparable, there was a decrease in patients with cholecystitis and perforation (although it is possibly too early for these to have presented), and there was a small but worrying increase in patients with gallstone pancreatitis. With the recent increase in alert level to 4 and increased government restrictions in an attempt to avoid a second national lockdown, a consistent national approach is required to mitigate these risks.
Background The Intercollegiate General Surgery Guidance on COVID-19 recommended either non-surgical management or cholecystostomy drains for the management of acute biliary disease replacing gold standard practice of early laparoscopic cholecystectomy within 1 week of index admission with drainage reserved for high-risk patients where surgery is not appropriate. Method This is the retrospective study presenting the impact of gallstone disease in our unit during five months of the COVID- 19 pandemic (March 2020-August 2020) compared with the equivalent period in 2019. Results Patients presenting to the HPB unit with a coded diagnosis of gallstones were included and during the study period 1447 patients presented compared with 1413 in 2019. In 2020 compared with 2019 there was a significant decrease in patients presenting with cholecystitis (240 vs 313; p = 0.031) but no significant difference in patients presenting due to gallbladder perforation (44 vs 51). Interestingly the numbers of cholecystostomies were comparable, with 11 in 2020 and 15 in 2019 representing significantly less than the 7.2% figure published by Peckham-Cooper et al. Conclusions In our study there was a decrease in patients with cholecystitis and perforation and there was an increase in patients with gallstone pancreatitis, increase waiting lists with increase in the incidence of serious complications. In our trust we currently have 656 patients awaiting cholecystectomy compared to 280 in august 2019. With the recent elevation of the alert level to 4 and increased government restrictions, a consistent National approach is required to mitigate these risks.
The effect of COVID on surgical admissions was investigated by comparing such admissions from March to August 2020 with those in the same period in 2019. A significant reduction was noted in surgical admissions. The majority of this reduction was seen in the group with non-specific abdominal pain. It is presumed that public adherence to authorities’ message and effective ambulatory care are behind this decrease.
Objectives: To assess the effect of intraperitoneal lignocaine application on pain relief postlaparoscopic cholecystectomy. Methods: Our prospective, randomized and double-blind investigation included 115 patients, of both sexes, aged 32-54 years, classed I-II by the American society of anesthesiologists and scheduled for laparoscopic cholecystectomy during the years 2015-2016, at Prince Hashem bin Abdullah II, Aqaba, Jordan. Patients were divided into two groups. Group I (n=55) patients received intraperitoneal lignocaine application [1.75 ml/kg of 0.2% lignocaine (total dose of 3.5 mg/kg)] and group II (n=60) patients received intraperitoneal saline application {the same volume of normal saline as the lignocaine solution} by the same surgical team and with the same technical procedure. A 10-point visual analogue scale (VAS) score of pain intensity was used to evaluate postoperative pain. If the VAS score was more than 3, an analgesic (morphine sulphate 2 mg, intravenously) was used at intervals of 10 min. The primary parameters of the investigation were total postoperative pain intensity evaluated at 1, 3, 6, 12, 24 and 48 h postoperatively using the VAS score. The frequency of analgesic administration was scored at the same previous intervals and compared between groups. Postoperative pain control satisfaction scores were assessed using a numerical rating scale on discharge. Descriptive parameters were subjected to chi-square test. P-values less than 0.05 were considered statistically significant. Results: Total postoperative pain intensity and frequency of analgesic administration scores were remarkably decreased in group I in comparison with group II (P<0.05). Pain control satisfaction score was more in group I than in group II. At 1 h interval after surgery, total postoperative pain intensity score was remarkably less in group I than in group II (P<0.05). At 1 h interval after surgery, frequency of analgesic administration was less in group I than in group II. Conclusions: The application of lignocaine significantly decreased pain after laparoscopic cholecystectomy in comparison with saline. Lignocaine application may be used for pain control after laparoscopic cholecystectomy but with extra job on the surgeon.
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