Response to “National survey on the treatment of cholecystectomy in Spain during the initial period of the COVID-19 pandemic”

To the Editor,

After reading with interest the article published by Ielpo et al¹ about the national survey on the treatment of cholelithiasis and acute cholecystitis during the initial phase of the COVID-19 pandemic, we would like to share our experience.

Like 96.7% of the hospitals included in the survey, elective cholecystectomies were also suspended at our medical center. To analyze the management of patients with acute cholecystitis, we carried out a retrospective observational study comparing the cases diagnosed during a period prior to the pandemic (March 12 to May 12, 2019 — period 1) with those of the initial phase of the COVID-19 pandemic (March 12 to May 12, 2020 — period 2).

The series included 16 patients: 13 belonging to group 1, and 3 to group 2. The distribution in terms of age and sex was similar in both groups, with a mean age of 71.92 years in group 1 and 62.33 years in group 2 (ranges: 35–94 and 54–78 years, respectively) with a male:female ratio of 2.25:1 and 2:1, respectively. The mean Charlson comorbidity index in group 1 was 4.54 versus 2.33 in group 2, with no statistically significant differences. No patient was diagnosed with COVID-19 either pre- or postoperatively.

According to the severity criteria of the Tokyo guidelines,² in the first group 4 patients had mild cholecystitis, 8 moderate, and 1 severe. In group 2, we found one patient with moderate cholecystitis and 2 severe cases. There were only statistically significant differences when severe cases were compared between the two groups (P = .018).

The laparoscopic approach was used in all patients who underwent surgery (11 in group 1 and all patients in group 2), and conversion was required in one case of each group. The remaining 2 cases in group 1 were treated by cholecystostomy and antibiotic therapy. Mean hospital stay was 6.2 and 6.6 days, respectively.

In conclusion, the number of patients diagnosed with acute cholecystitis at our hospital during the initial phase of the global SARS-CoV-2 pandemic dropped by 81.25%. We did not find statistically significant differences between the two groups in terms of the Charlson index or severity according to the Tokyo guidelines, which we attribute to the fact that it is a small sample. The management of our patients did not change, as we opted for surgical treatment for all patients in group 2 while adopting the preventive measures recommended by the AEC.³ However, conservative treatment should be evaluated in cases with suspected or confirmed SARS-CoV-2 infection due to the risk of unfavorable postoperative evolution.⁴