OGBN P03 Surgeons’ perceptions of elective laparoscopic cholecystectomy in the post-COVID era

Abstract

Abstract Background The COVID-19 pandemic has significantly impacted healthcare systems worldwide, leading to modifications in surgical practices. Laparoscopic cholecystectomy (LC), a common elective procedure, has faced challenges in the post-COVID era, with increased waiting times and episodes of acute gallstone disease in patients awaiting their procedure. This poses the question as to whether modifications to routine practice should be made. This study aims to explore surgeons' perceptions on performing laparoscopic cholecystectomy in the current post-pandemic landscape. Methods An anonymous survey was conducted among general surgeons with expertise in LC across multiple healthcare institutions nationally. The survey included questions relating to surgeons’ speciality, and their experience with elective LCs, intraoperative cholangiograms (IOC) and laparoscopic common bile duct exploration (LCBDE) in post-COVID era. Further opinions were sought on complicated intraoperative findings, rate of aborting procedure, rate of conversion to open and number of elective LCs completed by trainees. The data obtained was analysed using descriptive statistics and Fisher’s exact test for statistical significance calculations. Results 40 surgeons with varying levels of experience with LC completed the survey: 8 (20%) <50, 16 (40%) 100-500 LCs,10 (25%) 500->1000. Overall, 21 (53%) perceived LC to be more challenging. Analysis between the different groups found no significant difference (p = 0.68) between those who performed <50 LCs (6/8) and 500- >1000 LCs (6/10). 8 (20%) respondents found no increase in complicated intraoperative findings. Of those not working in specialist centres, 11/36 perceived an increase in referral to a hepatobiliary unit. 14 (35%) perceived an increase in unplanned admission. 21 (53%) perceived a reduction in completion of LC by trainees. Conclusions This study demonstrates that a significant proportion of respondents believe that LC has become more technically challenging. In patients with increased time till surgery or episodes of acute gallstone disease, MRCP should be considered at pre-assessment. Furthermore, during challenging LCs, options to ‘bail-out’ or convert to open should be considered. This study also raises awareness on the reduction in training opportunities and the need to ensure trainees progress appropriately. Limitations include small sample size and subjective nature of responses. Further research on patient outcomes is required to provide strong recommendations to optimise surgical practice of LC in the post-pandemic era.