Operating During the COVID-19 Pandemic: An Emerging Indication for Minilaparotomy Cholecystectomy

David M Milne,Vijay Naraynsingh,Johnathan K Jarvis,Rensi E Franklin,Dexter Thomas

doi:10.7759/cureus.11500

Abstract

COVID-19 has required changes in the practice of surgery to reduce the risk of transmission of the virus. Proposed mitigation strategies include avoidance of aerosol-generating procedures such as laparoscopy. We report two cases where minilaparotomy cholecystectomy was employed to treat benign biliary disease during the pandemic. A review of the literature supports the use of this surgical technique during the COVID-19 pandemic until laparoscopy can be proven to be safe.

Highlights

The COVID-19 pandemic is the most significant public health crisis faced by all practising doctors in their careers
We report two cases where minilaparotomy cholecystectomy was employed to treat benign biliary disease during the pandemic
We describe the use of minilaparotomy cholecystectomy in their treatment, as well as review the relevant literature, making a case for this technique to be the standard of care during the COVID19 pandemic

Summary

Introduction

The COVID-19 pandemic is the most significant public health crisis faced by all practising doctors in their careers. The American College of Surgeons (ACS) has issued guidance on the management of symptomatic gallbladder disease and acute cholecystitis during the coronavirus pandemic [5]. This report outlines the cases of two patients who presented with complicated gallstone disease during the COVID-19 pandemic. Transabdominal ultrasonography showed a distended gall bladder with mural oedema and pericholecystic fluid A mass of adherent omentum was digitally peeled off the gallbladder to reveal a gangrenous patch at the fundus of a gall bladder empyema, shown in figure 2. Routine minilaparotomy cholecystectomy was completed as described in case one utilising a 4cm incision shown in figure 3. She was maintained on intravenous antibiotics and discharged after 48 hours. FIGURE 3: 4cm incision seen after closure of minilaparotomy cholecystectomy wound

Discussion

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Disclosures

11. Rimmer A: Covid- 19