Multidisciplinary Approach to the Treatment of Acute Calculous Cholecystitis in the Post-Covid Period: Reasons for Changing Tactics and the Scope of Surgical Procedures Performed
Keywords:
Acute calculous cholecystitis, COVID-19, early post-COVID period, pneumonia, cholecystectomy, percutaneous cholecystostomyAbstract
Introduction. During the COVID-19 pandemic, the delivery of emergency and elective surgical procedures has been fundamentally changed. Everyone knows that conservative treatment, percutaneous drainage of the gallbladder and cholecystectomy are widely used to treat patients with acute calculous cholecystitis. However, the question of the most effective tactics for treating acute cholecystitis in the early post-Covid period remains poorly understood. It follows that, at this time, it is important to analyze the data on the use of percutaneous and transhepatic drainage of the gallbladder, determine the optimal time for cholecystectomy in acute calculous cholecystitis and compare the effectiveness of “early” and “delayed” cholecystectomy.
The purpose of the work improve the treatment algorithm, develop a new tactical approach and evaluate the results of treatment of patients with acute calculous cholecystitis in the early post-Covid period
Methods. The study included 659 patients aged 20 to 75 years with acute calculous cholecystitis who received treatment at the TMA multidisciplinary clinic in 2020. Patients were divided into two groups: main (391 patients) and control (268 patients). For patients in the control group, a standard treatment regimen for acute cholecystitis was used, while in the main group an improved technique was used, taking into account the shortcomings of the traditional approach. All patients were negative for IgM and positive for IgG. In the main group, all patients underwent routine multislice computed tomography of the chest (MSCT).
Results. All patients initially received conservative therapy; if conservative therapy was ineffective, 39 (75%) patients from the control group were operated on; percutaneous interventions were performed in 23 (42.6%) from the main group. There was no death in the main group.
Discussion. The choice of percutaneous interventions for acute calculous cholecystitis when conservative therapy is ineffective seems appropriate in most patients with post-Covid syndrome.
Conclusion. Performing PPCC in patients with severe condition in the early post-Covid period led to a reduction in the incidence of complications and deaths. The approaches outlined in the results of the work can be used as a safe method in the category of patients under discussion.
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