ThP5.1 - The Influence of the COVID-19 Pandemic on the Complexity of Laparoscopic Cholecystectomy

Abstract Aim The operative difficulty of Laparoscopic Cholecystectomy (LC) varies widely. This can affect the operative time, complications, post-operative course and ultimately patient outcomes. The COVID-19 pandemic caused substantial delays in the definitive management of gallstone disease. The aim of the present study was to compare the intraoperative difficulty grading of post COVID-19 pandemic LCs with previously published data. Methods This comparative study analyses a prospectively maintained database of all LCs performed by two biliary surgeons in a single centre between August 2022 to January 2024. Clinical and intra-operative findings including operative difficulty grading using the Nassar scale were recorded. This data was then compared to the previously published data from a single surgeon spanning 29 years (n=5,391). Results 149 patients were included; the median age was 56 years (IQR 45-66). 88 (51.1%) were female. 71 (47.7%) LC’s were completed as part of an emergency admission. The median Scottish Index of Multiple Deprivation was 5 (IQR 3-7). 45 (30.2%) underwent LC alone, 63 (42.2%) also received an operative cholangiography and 41 (27.5%) underwent common bile duct exploration. Grade 1 LC (4.8% vs 33.2%, p<0.001) were significantly less prevalent than grade 4 LC (37.4% vs 14.2%, p<0.001) in the post pandemic period when compared to the previous published data. Conclusion The present study suggests that LCs are more challenging post pandemic. The contributing factors are likely diverse, but extended waiting times and multiple emergency admissions leading to delays in definitive management are presumed to play significant role. Urgent attention is warranted to establish biliary pathways that guarantee timely and definitive management of gallstones for patients.