Gallstones is a common surgical disease in the northern belt of India. In fact this region has the highest prevalence of stones in the gallbladder in the world. The causes are multifactorial, of which diet, lifestyle, genetic predisposition, medications and typhoid are well known. Any or all these factors cause an imbalance of the liquid bile stored in the gallbladder and crystals of cholesterol or bile pigments precipitate out and form hardened deposits of stones. More than 10 million cases of gallstones are diagnosed annually in our country.
Once formed the only known treatment is removal of the gallbladder. Surgery of the gallbladder is performed through the technique of keyhole surgery and is one of the most common surgical procedures performed in our country.
The current surge of the Covid pandemic has forced a near complete shutdown of such surgical procedures. So what is happening to these patients? Luckily nearly 40% of patients of gallstones do not suffer any symptoms. These asymptomatic cases can easily wait out the pandemic peak and plan their surgeries in a cold safe period. However, patients with symptomatic gallstones require close monitoring and watchful management to prevent the more serious complications of gallstones from developing.
Of particular importance is the symptom of biliary colic. Biliary colic is defined as severe pain experienced in the upper part of the abdomen due to movement of stone from the gallbladder in to the bile duct system. The pain can also be felt in the shoulders and back and is often accompanied by vomiting. This symptom augurs of impending complications such as stone obstruction of the bile duct system and bile stone induced pancreatitis. and may require a more emergent approach towards the patient. It is best in such a situation to operate and remove the gallbladder as the associated complications can be devastating to the patients’ health. It is for such situations that a green corridor is created in the hospital to ensure safe surgical outcomes.
The concept of a green corridor is implementation of measures to create an impenetrable barrier between the Covid and non-Covid zones to prevent any cross infection to this vulnerable group of patients while they undergo safe surgical treatment. It was successfully executed during the first wave and paved the way for restarting safe elective surgical practices following the pandemic recession and is the going to be the way forward this time around too.