COVID response leads to innovative surgical pathway
Clinicians have responded to the on-going pandemic by establishing a novel surgical pathway for patients suffering from complicated gallstones in the bile duct.
Stones that slip out of the gall bladder and into the bile duct can cause obstruction leading to serious conditions including pancreatitis, jaundice and abnormal liver function tests and, in some cases, can be fatal.
To ensure the safe management of patients during the on-going pandemic, clinicians have developed a new streamlined referral pathway to easily refer patients with pancreatitis due to gallstones and patients presenting with possible common bile duct (CBD) stones causing possible bile duct obstruction.
In most UK hospitals bile duct patients are treated by first having an MRI of the pancreas, liver and bile ducts, called a magnetic resonance cholangiogram.
If this shows stones within the bile duct the patient, then has an ERCP (endoscopic procedure to remove the stones).
The patient will then need to return to hospital to have the gallbladder removed (cholecystectomy) to prevent further recurrence.
The new pathway means the only imaging required before surgery for most patients will be an ultrasound to confirm the presence of gallstones. This approach reduces the need for the MRI and ERCP (which is an aerosol generating procedure) avoiding extra admissions and a reduction in potential exposure of patients and staff to Covid-19.
Mr Alberto Martinez-Isla, Consultant Laparoscopic Upper GI Surgeon, said: “We’re a leading centre for laparoscopic bile duct exploration and prior to Covid-19 was performing around 50-70 procedures a year.
“The impact of the pandemic has required a redesign of our care pathways to enable non-Covid patients to continue to have timely and safe access to surgery.”
Mr Stuart Gould, Clinical Lead for Emergency Surgery and Deputy Divisional Director of Surgery added: “In responding to the pandemic it is crucial that we make our hospital services available and safe for non-covid patients and our staff. This novel pathway will help to manage a complex group of patients during the second wave of the pandemic and beyond.
“It is a very efficient process for treating patients who require urgent surgery to avoid the risk of their condition recurring and possible severe complications.”