SRS380 - Post–COVID-19 laparoscopic cholecystectomy: rising complexity and the role of biliary specialists

Abstract Aim Laparoscopic cholecystectomy (LC) is a common procedure, with complexity influenced by disease severity and timing. COVID-19 related delays increased presentations with advanced inflammation, fibrosis, and adhesions, raising operative difficulty. This study evaluated operative complexity and outcomes in post–COVID LC compared with pre-pandemic benchmarks. Methods A retrospective cohort of consecutive patients undergoing LC, with or without laparoscopic common bile duct exploration (LCBDE), by two specialist biliary surgeons (Aug 2022–Jul 2025). Demographics, clinical features, Nassar operative difficulty grade, complications, and 30-day outcomes were recorded. Comparisons were made with the multicentre CholeS dataset (n = 8909, 2014) as a pre-pandemic reference. Results Post–COVID patients were more often male (35.0% versus 26.3%, P < 0.001), obese (BMI ≥ 30: 55.6% versus 41.3%, P < 0.001), and comorbid (ASA ≥ III: 14.8% versus 10.5%, P = 0.007). They presented with more severe disease (cholecystitis 35.0% versus 29.0%, P = 0.009; pancreatitis 23.3% versus 9.6%, P < 0.001) and more prior admissions (≥2: 45.9% versus 9.6%, P < 0.001). Operative difficulty was higher, with fewer Grade 1 LCs (11.2% versus 39.9%, P < 0.001) and more Grade ≥4 cases (35.3% versus 9.2%, P < 0.001). Intra-operative cholangiography was more frequent (72.5% versus 10.8%, P < 0.001), and LCBDE was required in 29.9% versus 3.2% (P < 0.001). Despite this, readmission rates and biliary complications (bile leak, pancreatitis, retained stone) were comparable, and no bile duct injuries occurred. Conclusions Post–COVID LC is markedly more complex due to delayed management and recurrent inflammation. Subspecialist biliary surgeons maintain excellent outcomes despite increased risk. Early index-admission LC and access to dedicated biliary expertise are essential to optimise safety.