Abstract
INTRODUCTION: Biliary pathology creates a significant burden on the NHS in terms of acute admissions, investigative imaging and elective operating. During the COVID-19 pandemic, surgical services were adapted to minimise hospital admissions. Our aim is to review the safety and efficacy of the surgical ambulatory service in the management of varying biliary pathology. METHOD: Data was retrospectively collected on consecutive patients referred to the surgical team with presumed biliary pathology between 30(th) April and 16(th) August 2020. Patients with presumed cholecystitis were discharged with oral antibiotics following local guidance with follow-up telephone consultations. Unsuccessful ambulation was determined by representation at 30 days. RESULTS: One-hundred-and-seventy patients were referred to the acute surgical team with presumed biliary pathology; 81 were suitable for ambulatory management and their first line imaging (abdominal ultrasound, MRCP or CT) was performed within a median of 4 days; 17% of these patients underwent second line imaging in the form of MRCP. Fourteen percent of these patients failed ambulatory management and were admitted to hospital; 3 underwent a cholecystectomy and 2 had an ERCP. CONCLUSIONS: Patients presenting with biliary disease can be safely managed in an ambulatory setting. Access to imaging early can facilitate successful discharge and ongoing ambulatory investigation and definitive management.