Percutaneous Cholecystostomy as an Alternative to Cholecystectomy in High-Risk Patients with Acute Cholecystitis
AJTES Vol 3, No 2, July 2019.
Full Text PDF

Keywords

Cholecystostomy
cholecystitis
general surgery

How to Cite

Tosun, S., Yener, O., Ekinci, O., Gapbarov, A., Asik, M., Eren, T., & Alimoglu, O. (2019). Percutaneous Cholecystostomy as an Alternative to Cholecystectomy in High-Risk Patients with Acute Cholecystitis. Albanian Journal of Trauma and Emergency Surgery, 3(2), 409-416. https://doi.org/10.32391/ajtes.v3i2.39

Abstract

Background: Cholecystectomy is the standard treatment for patients with acute cholecystitis. On the other hand, percutaneous cholecystostomy (PC) is an alternative for patients at high-risk for surgery. The aim of this study was to evaluate the clinical outcomes of PC.

Methods: Surgically high-risk patients with acute cholecystits having undergone PC at our institution between January 2014 – January 2017 were evaluated. Data including the indications for PC, route of insertion, technical success, clinical improvement, length of hospital stay, mortality rates, procedure related complications, subsequent admissions and performance of interval cholecystectomy were recorded and analyzed.

Results: The study group consisted of 30 patients with a mean age of 75.3 ( range: 49–99) years. The indications for PC were acute calculous cholecystitis in 28 (93.3%) and acalculous cholecystitis in 2 (6.7%) patients.  All procedures were performed via the transhepatic route. Twenty-five PCs (84.4%) resulted in clinical improvement within five days. A repeated PC was performed in two (6.7%) patients.  Seven (23.3%) patients underwent a subsequent cholecystectomy after 6 weeks. An emergent cholecystectomy was performed in one (3.3%) patient. Five (16.7%) patients died from underlying comorbid diseases, unrelated to the biliary system, during the follow-up.

Conclusions: Patients with acute cholecystitis were promptly relieved from their symptoms following PC. There were only minor complications following the procedure and an interval cholecystectomy was necessary in only 23.3% of the patients. PC is a safe alternative to choecystectomy in high-risk patients with acute cholecystitis with satisfactory results.

https://doi.org/10.32391/ajtes.v3i2.39
Full Text PDF

References

Reynolds W Jr. The first laparoscopic cholecystectomy. JSLS 2001;5:89-94.

Hasson HM. Open laparoscopy vs.closed laparoscopy: a comparison of complication rates. Adv Plan Parent 1978;13:41-50.

Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gomi H, Yoshida M, et al; Tokyo Guidelines Revision Committee. TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2013;20:1-7.

Csikesz NG, Tseng JF, Shah SA. Trends in surgical management for acute cholecystitis. Surgery 2008;144:283-9.

Radder RW. Ultrasonically guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging 1980;49:330-3.

Welschbillig-Meunier K, Pessaux P, Lebigot J, Lermite E, Aube Ch, Brehant O, et al. Percutaneous cholecystostomy for high-risk patients with acute cholecystitis. Surg Endosc 2005;19:1256-9.

Li M, Li N, Ji W, Quan Z, Wan X, Wu X, et al. Percutaneous cholecystostomy is a definitive treatment for acute cholecystitis in elderly high-risk patients. Am Surg 2013;79:524-7.

Ha JP, Tsui KK, Tang CN, Siu WT, Fung KH, Li MK. Cholecystectomy or not after percutaneous cholecystostomy for acute calculous cholecystitis in high-risk patients. Hepatogastroenterology 2008;55:1497-502.

Chang YR, Ahn YJ, Jang JY, Kang MJ, Kwon W, Jung WH, et al. Percutaneous cholecystostomy for acute cholecystitis in patients with high comorbidity and reevaluation of treatment efficacy. Surgery 2014;155:615-22.

Macrì A, Scuderi G, Saladino E, Trimarchi G, Terranova M, Versaci A, et al. Acute gallstone cholecystitis in the elderly: treatment with emergency ultrasonographic percutaneous cholecystostomy and interval laparoscopic cholecystectomy. Surg Endosc 2006;20:88-91.

Chok KS, Chu FS, Cheung TT, Lam VW, Yuen WK, Ng KK, et al. Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis. ANZ J Surg 2010;80:280-3.

Yang KW, Luk WH, Cho DHY, Loke TKL, Chan JCS. A comparison of direct gallbladder puncture with the transhepatic puncture technique in ultrasound-guided cholecystostomy for high surgical risk patients with acute calculous cholecystitis. J HK Coll Radiol 2005;8:222-5.

Leveau P, Andersson E, Carlgren I, Willner J, Andersson R. Percutaneous cholecystostomy: a bridge to surgery or definite management of acute cholecystitis in high-risk patients? Scand J Gastroenterol 2008;43:593-6.

Kim D, Iqbal SI, Ahari HK, Molgaard CP, Flacke S, Davison BD. Expanding role of percutaneous cholecystostomy and interventional radiology for the management of acute cholecystitis: An analysis of 144 patients. Diagn Interv Imaging. 2017 May 12 Epub. http://dx.doi.org/10.1016/j.diii.2017.04 .006.

McGillicuddy EA, Schuster KM, Barre K, Suarez L, Hall MR, Kaml GJ, et al. Non-operative management of acute cholecystitis in the elderly. Br J Surg 2012;99:1254-61.

Sanjay P, Mittapalli D, Marioud A, White RD, Ram R, Alijani A. Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. HPB (Oxford) 2013;15:511- 6.

Soria Aledo V, Galindo Iñíguez L, Flores Funes D, Carrasco Prats M, Aguayo Albasini JL. Is cholecystectomy the treatment of choice for acute acalculous cholecystitis? A systematic review of the literature. Rev Esp Enferm Dig 2017;109:708-18.

Abbas SH, Ghazanfar MA, GordonWeeks AN, Reddy SR, Soonawalla Z, Silva MA. Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary? Dig Surg. 2017 Jul 14 Epub. http://dx.doi.org/10.1159/000477780.

Silberfein EJ, Zhou W, Kougias P, El Sayed HF, Huynh TT, Albo D, et al. Percutaneous cholecystostomy for acute cholecystitis in high-risk patients: experience of a surgeon initiated interventional program. Am J Surg 2007; 194:672-7.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.