Gallstone disease in COVID times

Gallstones are stones which form in the gallbladder, a pear shaped bag attached to the undersurface of the liver. The gallbladder stores bile produced in the liver and releases it into the intestine through a tube called the common bile duct. A failure by the gallbladder to keep the bile in a liquid state causes gallstones to form. Why gallstones form is not well understood. Obesity, prolonged fasting, typhoid, high fat intake, smoking, a non vegetarian diet are some of the reasons implicated. Gallstones act like a foreign body and cause symptoms like acidity, severe abdominal pain (colics) and nausea and vomiting. They also cause complications like gallbladder infection, jaundice, pancreatitis and cancer, some of which are life threatening.

More than 6% of people in the general population in North India have gallstones, one of the highest in the world. The only known treatment for gallstones at present is surgical removal of the gallbladder. The procedure is known as Laparoscopic Cholecystectomy and is one of the commonest surgeries performed by surgeons. Laparoscopic cholecystectomy is associated with a short period of discomfort and a rapid recovery.

In normal circumstances, most gallbladder surgeries are performed electively with complex and complicated cases comprising only 10% of the total number of surgeries. However this year due to the COVID pandemic, all elective surgeries were suspended during lockdown. Even after resumption of regular medical services, patients avoided undergoing any surgical procedure electively for fear of contracting COVID in a hospital setting. Consequently, patients with marked symptoms and complications were the ones who presented in the emergency and underwent surgery for relief of symptoms. From 10%, nearly 90% of laparoscopic cholecystectomies performed since the onset of the pandemic have been complex and complicated. Despite the adverse circumstances of performing these surgeries, the outcomes of these patients have been like any routine elective case. The morbidity of the complications due to gallstones which the patient suffered prior to surgery was the only unfortunate occurrence in the series of events. The protocols for a safe hospital stay have ensured none of the patient contract any secondary infection, including the COVID flu.

A word of sincere advice as a practicing surgeon to all patients knowing they have gallstones is not to wait for the stones to cause complications before seeking treatment. The surgical recovery may be unaffected, but the morbidity of the complications is an unnecessary suffering which can be totally avoided.