Percutaneous Cholecystostomy is a Feasible and Safe Option for High-Risk Acute Cholecystitis Patients

Year 2023, Volume: 13 Issue: 4, 782 - 785, 29.12.2023

Ömer Aydıner , Hüseyin Kemal Raşa

https://doi.org/10.33808/clinexphealthsci.1347081

Cited By: 1

Abstract

Objective: The best option for treating high-risk patients with acute cholecystitis is still being determined. We evaluated our high-risk acute cholecystitis patients in whom we preferred percutaneous cholecystostomy and aimed to determine whether this approach was safe and feasible.
Methods: We retrospectively reviewed our 71 patients in whom we performed percutaneous cholecystostomy between May 2019 and July 2023. All procedures were performed with local anaesthesia under ultrasonographic guidance via the transhepatic route. The catheters were removed when the signs of acute cholecystitis were significantly regressed or when the catheters were found to be ineffective. The catheters of those eligible for surgery were removed during the operations.
Results: All procedures were successful without failure, and no significant complications developed in the post-intervention period. Pain at the catheter insertion site (20 patients) was the leading minor complication, and in one patient, bilioma was detected and percutaneously drained. The procedure was ineffective in 7 patients (9.85%), and the catheters were removed. In 22 patients (31%), interval cholecystectomy surgery was performed. In the subgroup of patients whose catheters were adequate and were not operated (5 patients), the catheters were removed after an average of 27.2 days. The mean length of stay was 9.6 days, and four patients died (5.6%) during the index hospitalization.
Conclusion: Our findings suggest that percutaneous cholecystostomy is a feasible, safe and highly effective treatment option for acute cholecystitis in high-risk patients.

Keywords

: Acute cholecystitis, percutaneous cholecystostomy, patient outcomes

References

• Shaffer EA. Epidemiology and risk factors for gallstone disease: Has the paradigm changed in the 21st century? Curr Gastroenterol Rep. 2005;7(2):132–40 DOI: 10.1007/s11894-005-0051-8.
• Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi, S, Boerna, D, et al .2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020;15(1):61. doi: 10.1186/s13017-020-00336-x.
• Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, et al. Tokyo Guidelines 2018: Flowchart for the management of acute cholecystitis. J. Hepato-Biliary-Pancreat. Sci. 2017;25:55–72 DOI: 10.1002/jhbp.516.
• Loozen CS, Van Santvoort HC, Van Duijvendijk P, Besselink MG, Gouma DJ, Ap Nieuwenhuijzen G, et al. Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): Multicentre randomized clinical trial. BMJ. 2018;8:363:k3965. DOI: 10.1136/bmj.k3965.
• Cirocchi R, Amato L, Ungania S, Buononato M, Tebala GD, Cirillo B, et al. Management of Acute Cholecystitis in High-Risk Patients: Percutaneous Gallbladder Drainage as a Definitive Treatment vs. Emergency Cholecystectomy-Systematic Review and Meta-Analysis. J Clin Med. 2023;12(15):4903. DOI: 10.3390/jcm12154903.
• Winbladh A, Gullstrand P, Svanvik J, Sandström P. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford). 2009;11(3):183-93. DOI: 10.1111/j.1477-2574.2009.00052.x.
• Alvino DML, Fong ZV, McCarthy CJ, Velmahos G, Lillemoe KD, Mueller PR, Fagenholz PJ. Long-term outcomes following percutaneous cholecystostomy tube placement for treatment of acute calculous cholecystitis. J Gastrointest Surg. 2017;21(5):761-769. DOI: 10.1007/s11605-017-3375-4.
• McKay A, Abulfaraj M, Lipschitz J. Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients. Surg Endosc 2012;26:1343–1351. DOI: 10.1007/s00464-011-2035-0.
• Jang WS, Lim JU, Joo KR, Cha JM, Shin HP, Joo SH. Outcome of conservative percutaneous cholecystostomy in high-risk patients with acute cholecystitis and risk factors leading to surgery. Surg Endosc 2015;29:2359–2364. DOI: 10.1007/s00464-014-3961-4.
• Giannopoulos S, Makhecha K, Madduri S, Garcia F, Baumgartner TC, Stefanidis D. What is the ideal timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis? Surg Endosc. 2023 Aug 11. [Epub ahead of print] DOI: 10.1007/s00464-023-10332-2.