Acute Cholecystitis During the COVID-19 Pandemic: A Result of Delayed Surgical Intervention

Alejandro Daniel Navarro Alcala; Korel Antonio Hernandez Lopez; Aniriam García Arellano; Daniela Tapia Cervates

doi:10.64387/tjs.2026.276763

Authors

Alejandro Daniel Navarro Alcala General Surgery Department, Universidad de Guadalajara, Hospital General de Occidente https://orcid.org/0009-0007-1221-059X
Korel Antonio Hernandez Lopez General Surgery Department, Universidad de Guadalajara, Hospital General de Occidente https://orcid.org/0000-0001-9069-2175
Aniriam García Arellano General Surgery Department, Universidad de Guadalajara, Hospital General de Occidente
Daniela Tapia Cervates General Surgery Department, Universidad de Guadalajara, Hospital General de Occidente

DOI:

https://doi.org/10.64387/tjs.2026.276763

Keywords:

Cholecystitis, SARS-CoV2 Pandemic, Laparoscopic cholecystectomy.

Abstract

Background: Biliary pathology represents 3–10% of acute abdominal pain cases in emergency departments, with a lithiasic origin in 90–95%. The SARS-CoV-2 pandemic placed immense strain on healthcare systems worldwide, leading to major reductions in surgical procedures. The Mexican Institute of Social Security (IMSS) reported a 38.38% decrease in interventions between 2019 and 2020 (546,654 fewer surgeries), while the Security and Social Services of the State Employees Institute (ISSSTE) noted an 80.53% reduction in laparoscopic cholecystectomies, from 9,896 in 2019 to 2,926 in 2020. This trend aligns with a global cancellation rate of 81.5%, which affected nearly all surgical specialties. These reductions likely influenced patient outcomes. This study assessed the impact of the pandemic on patients undergoing elective cholecystectomy.

Materials and Methods: We analyzed data from 513 patients who underwent elective laparoscopic cholecystectomy in 2019 and compared it with data from 52 patients in 2021, during the pandemic. Our findings were assessed against nationwide trends to evaluate the pandemic’s impact on these procedures.

Results: During the study period, a variety of results (210) were observed, including hepatic abscess (0.47%) and acute cholecystitis (70%), classified as mild (63.8%) and moderate (6.19%) according to the Tokyo 2018 Guidelines. Other outcomes included hydrocholecyst (12.85%), pyocholecyst (15.71%), emphysematous cholecystitis (0.47%), and gangrenous cholecystitis (0.47%). No significant difference in overall complication incidence was observed between the two years, except for moderate acute cholecystitis, which showed a statistically significant increase (p = 0.024).

Conclusion: The pandemic's effect on overall outcomes in patients who underwent delayed elective procedures during the established period was associated with a significant increase in cholecystitis severity, with a notable rise in moderate acute cholecystitis (p = 0.024). This study is the first to examine the effects of the pandemic on surgical patients whose care was delayed.

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