Reply to editor letter

Dear Editor:

We appreciate the opportunity to comment on the Letter to the Editor by Dr Clara Giménez Francés et al. regarding our recently published article on the treatment of cholelithiasis and acute cholecystitis during the initial phase of the COVID-19 pandemic.¹ This letter is an interesting occasion to discuss the results of our survey.

However, the letter is based on a small caseload, where the use of statistics and the conclusions must be considered in their context. The experience presented by the Hospital Universitario Reina Sofía de Murcia confirms the trend observed by the vast majority of Spanish hospitals to suspend elective cholecystectomy surgery during the first phase of the pandemic, as we have observed in our article.² As we are seeing in the successive phases of the pandemic, the effect of this strategy has significantly increased the waiting list for surgical treatment of cholelithiasis. The result of a prolonged post-pandemic surgical waiting list to treat cholelithiasis should not lead to a worsening of the quality of life of these patients.

It is essential for hospital administrators to act quickly and efficiently to solve this problem, allocating more resources to the resumed surgical activity while providing the maximum guarantees of safety for patients and professionals.

The series presented in the Letter to the Editor reports that, contrary to the trend described by our national survey, urgent surgical treatment was offered to all patients (3) who presented with acute cholecystitis during the pandemic confinement. Although it is in survey format, our article exposes a situation that has later been confirmed in subsequent publications, including larger numbers of cases.^3,4 We find it interesting that the letter from López Morales et al. states that during the pandemic phase (group 2), a period of 2 months, only 3 patients went to the emergency room for acute cholecystitis. This datum is in line with those of our national study, where 98% of those surveyed have noted a reduction in emergency room admissions due to acute cholecystitis, decreasing even >50% in 34% of the responses.

The survey conducted during the pandemic has also been an occasion to highlight some inadequacies that still exist in the management of cholelithiasis in our setting. For example, there is a need to implement scheduled cholecystectomy in a day surgery regimen, which, according to our survey, is a rare practice and is usually only performed in 38% of hospitals. Its increased use could contribute to improved healthcare during the current pandemic.