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Inicio Cirugía Española (English Edition) Management of cholelithiasis in times of COVID-19: A challenge for the system
Journal Information
Vol. 99. Issue 9.
Pages 699-700 (November 2021)
Vol. 99. Issue 9.
Pages 699-700 (November 2021)
Letter to the Editor
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Management of cholelithiasis in times of COVID-19: A challenge for the system
Gestión de la colelitiasis en tiempos de COVID-19. Un reto para el sistema
Mikel Prietoa,
Corresponding author

Corresponding author.
, Irene Ortegab, Jose Maria Balibreac, Benedetto Ielpod
a Unidad de Cirugía Hepatobiliar y Trasplante Hepático, Hospital Universitario Cruces, Biocruces Bizkaia HealthResearch Institute, Bilbao, Universidad del País Vasco, Bilbao, Spain
b Unidad de Cirugía Hepatobiliopancreática, Hospital Universitario Infanta Sofía Universidad Europea de Madrid, San Sebastián de los Reyes, Madrid, Spain
c Departamento de Cirugía Gastrointestinal, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
d Unidad de Cirugía Hepatobiliopancreática, Hospital del Mar, Universidad Pompeu Fabra, Barcelona, Spain
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To the Editor:

Since the declaration of the SARS-CoV-2 pandemic on March 11, 2020, by the WHO1, COVID-19 has shaken the Spanish healthcare system and negatively impacted the availability of health resources, which we have described in our article2.

While living with the virus for more than a year, we have adopted several measures to reduce the risk of perioperative infection, such as systematic preoperative PCR testing, the creation of selective patient circuits, the correct use of personal protection equipment, technical modifications for safe laparoscopic procedures, and the determination of the optimal moment for elective surgery after SARS-CoV-2 infection3,4.

Unfortunately, throughout this year many hospitals have had persistently high bed occupancy rates due to COVID-19, although without reaching complete saturation like at the beginning of the pandemic. This situation has meant that only certain surgical activities have been maintained, mostly for oncological and urgent disease as well as some preferential benign conditions that do not require hospitalization.

Consequently, the waiting lists have increased significantly5,6 for non-urgent benign diseases like symptomatic cholelithiasis, as previously announced in our publication2.

A long delay before definitive surgical care can aggravate the clinical situation of patients with cholelithiasis, who have an increased risk of experiencing episodes of cholecystitis or acute pancreatitis and may require more complex cholecystectomies with a higher risk of intraoperative complications7.

This situation makes it necessary for us to demand that national healthcare authorities immediately develop a strategy aimed at reducing waiting times for elective cholecystectomy, while guaranteeing equal access to surgical treatment across the national territory8.

Effective measures should be implemented in the short and long term. We recommend: promoting cholecystectomy programs in outpatient surgery (a practice that was only common in 37.9% of the centers surveyed in our study2); developing programs to ‘crush’ the waiting list by scheduling surgeries in the evenings or on weekends, with extra pay for hospital staff or by hiring specific staff; reaching patient referral agreements with other public or private hospitals that have a greater availability of beds and operating rooms; and promoting cholecystectomies during hospitalization for mild pancreatitis or uncomplicated acute cholecystitis by assigning specific operating rooms.

Likewise, it is essential to develop a clinical monitoring program in order to prioritize patients on the cholecystectomy waiting list9,10, which would enable us to speed up the intervention in more symptomatic patients or those at a greater risk of complications.

The surgical waiting list for elective cholecystectomy is currently a significant problem in Spanish hospitals. All of us—politicians, healthcare administrators and surgeons—must make it our priority to get involved.

[1] Geneva: Director general de la OMS; 11 marzo 2020 [accessed 13 May 2021]. Available from:—11-march-2020.
B. Ielpo, M. Prieto, I. Ortega, J.M. Balibrea, I. Rubio-Pérez, M. Juvany, et al.
National survey on the treatment of cholelitiasis in Spain during the initial period of the COVID-19 pandemic.
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Surgical management of patients with COVID-19 infection. recommendations of the Spanish Association of Surgeons.
Cir Esp., 98 (2020), pp. 251-259
COVID Surg Collaborative, Global Surg Collaborative.
Timing of surgery following SARS-CoV-2 infection.
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Listas de Espera del Sistema Nacional de Salud: Indicadores Resumen. Junio 2020 [accessed 13 May 2021]. Available from:
Tiempos de respuesta asistencial de listas de espera en las intervenciones quirúrgicas en Andalucía. Datos de diciembre de 2020 [accessed 13 May 2021]. Available from:
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BOE-A-2011-14190 Real Decreto 1039/2011, de 15 de julio, por el que se establecen los criterios marco para garantizar un tiempo máximo de acceso a las prestaciones sanitarias del Sistema Nacional de Salud [accessed 13 May 2021]. Available from:
J. Alcalde Escribano, R. Villeta Plaza, P. Ruiz López, E. Rodríguez Cuellar, J.I. Landa García, E. Jaurrieta Mas.
Informe sobre los criterios para establecer prioridades al incluir pacientes en lista de espera de cirugía.
Cir Esp., 72 (2002), pp. 349-358
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Evaluación del gastrointestinal quality of life index como sistema de selección para la priorización de pacientes en lista de espera de colecistectomía laparoscópica [Evaluation of the gastrointestinal quality of life index as a system to prioritize patients on the waiting list for laparoscopic cholecystectomy].
Cir Esp., 91 (2013), pp. 308-315

Please cite this article as: Prieto M, Ortega I, Balibrea JM, Ielpo B. Gestión de la colelitiasis en tiempos de COVID-19. Un reto para el sistema. Cir Esp. 2021;99:702–703.

Copyright © 2021. AEC
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