Background COVID-19 pandemic has impacted the Italian National Health Care system at many different levels, causing a complete reorganization of surgical wards. In this context, our study retrospectively analysed the management strategy for patients with acute cholecystitis. Methods We analysed all patients admitted to our Emergency Department for acute cholecystitis between February and April 2020 and we graded each case according to 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. We focused on patients submitted to cholecystostomy during the acute phase of pandemic and their subsequent disease evolution. Results Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II, 8 grade III). According to Tokyo Guidelines (2018), patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage (PC) and laparoscopic cholecystectomy (LC) in 29.7%, 21.6% and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to bedside percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous cholecystostomy was of 87.5%. The mean post-procedural hospitalization length was 9 days, and no related adverse events were observed apart from transient parietal bleeding, conservatively treated. Once discharged, two patients required readmission because of acute biliary symptoms. Median time of drainage removal was 43 days and only 50% patients thereafter underwent cholecystectomy. Conclusions Percutaneous cholecystostomy has shown to be an effective and safe treatment thus acquiring an increased relevance in the first phase of the pandemic. Nowadays, considering we are forced to live with the SARS-CoV-2 virus, PC should be considered as a virtuous, alternative tool for potentially all COVID-19 positive patients and selectively for negative cases unresponsive to conservative therapy and unfit for surgery.

ObjectiveImmunosuppressive agents are known to interfere with T and/or B lymphocytes, which are required to mount an adequate serologic response. Therefore, we aim to investigate the antibody response to SARS-CoV-2 in liver transplant (LT) recipients after COVID-19.DesignProspective multicentre case–control study, analysing antibodies against the nucleocapsid protein, spike (S) protein of SARS-CoV-2 and their neutralising activity in LT recipients with confirmed SARS-CoV-2 infection (COVID-19-LT) compared with immunocompetent patients (COVID-19-immunocompetent) and LT recipients without COVID-19 symptoms (non-COVID-19-LT).ResultsOverall, 35 LT recipients were included in the COVID-19-LT cohort. 35 and 70 subjects fulfilling the matching criteria were assigned to the COVID-19-immunocompetent and non-COVID-19-LT cohorts, respectively. We showed that LT recipients, despite immunosuppression and less symptoms, mounted a detectable antinucleocapsid antibody titre in 80% of the cases, although significantly lower compared with the COVID-19-immunocompetent cohort (3.73 vs 7.36 index level, p<0.001). When analysing anti-S antibody response, no difference in positivity rate was found between the COVID-19-LT and COVID-19-immunocompetent cohorts (97.1% vs 100%, p=0.314). Functional antibody testing showed neutralising activity in 82.9% of LT recipients (vs 100% in COVID-19-immunocompetent cohort, p=0.024).ConclusionsOur findings suggest that the humoral response of LT recipients is only slightly lower than expected, compared with COVID-19 immunocompetent controls. Testing for anti-S antibodies alone can lead to an overestimation of the neutralising ability in LT recipients. Altogether, routine antibody testing against separate SARS-CoV-2 antigens and functional testing show that the far majority of LT patients are capable of mounting an adequate antibody response with neutralising ability.

BACKGROUND.COVID-19 pandemic has impacted the Italian national health care system at many different levels, causing a complete reorganization of surgical wards. In this context, in this study we retrospectively analyzed our management strategy for patients with acute cholecystitis.METHODSWe analyzed all patients admitted to our Emergency Department for acute cholecystitis from February 27th to April 30th, 2020. We graded each case according to the 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. RESULTSThirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II and 8 grade III). According to Tokyo Guidelines 2018, patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in 29.7%, 21.6 % and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous drainage was of 87.5%, the mean post-procedural hospitalization length was 9 days, and no related adverse event were observed.CONCLUSIONS.Bedside cholecystostomy has shown to be an effective and safe treatment, which acquired an increased relevance in the present acute phase of the pandemic. This strategy will potentially be taken into consideration in future phases, when the coexistence with the virus will require us to respond in an even more virtuous fashion.

BACKGROUND.COVID-19 pandemic has impacted the Italian national health care system at many different levels, causing a complete reorganization of surgical wards. In this context, in this study we retrospectively analyzed our management strategy for patients with acute cholecystitis.METHODS.We analyzed all patients admitted to our Emergency Department for acute cholecystitis from February 27th to April 30th, 2020. We graded each case according to the 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. RESULTS.Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II and 8 grade III). According to Tokyo Guidelines 2018, patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in 29.7%, 21.6 % and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous drainage was of 87.5%, the mean post-procedural hospitalization length was 9 days, and no related adverse event were observed.CONCLUSIONS.Bedside cholecystostomy has shown to be an effective and safe treatment, which acquired an increased relevance in the present acute phase of the pandemic. This strategy will potentially be taken into consideration in future phases, when the coexistence with the virus will require us to respond in an even more virtuous fashion.