Management of Acute Cholecystitis: Prevalence of Percutaneous Cholecystostomy and Delayed Cholecystectomy in the Elderly

Key Learning Points: 1. Acute cholecystitis is often a complication of gallstones disease 2. Most of patients with symptomatic gallstones disease are prone to further complications and cholecystectomy is indicated 3. Laparoscopic early cholecystectomy in acute cholecystitis is superior to delayed cholecystectomy in terms of symptom control, hospital stay and re-admissions, with similar morbidity and mortality and should be attempted in all cases of acute cholecystitis. Difficult cases should be managed by experienced surgeons, in advanced centers, and bail-out procedures should be attempted as per Tokyo guidelines. 4. Percutaneous cholecystostomy should only be used in patients unfit for surgery who fail to improve 5. The data available to support optimal antibiotical treatment is scarce, and local microbiology guidelines should be used.

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Percutaneous Cholecystostomy is a Reasonable Alternative for the Treatment of Acute Cholecystitis in Critically Ill Patients: a Single Center Analysis

Lietuvos chirurgija ◽

10.15388/lietchirur.2019.18.17 ◽

2019 ◽

Vol 18 (4) ◽

pp. 246-253

Author(s):

Povilas Ignatavicius ◽

Mindaugas Kiudelis ◽

Inga Dekeryte ◽

Deimante Mikuckyte ◽

Jolita Sasnauskaite ◽

...

Keyword(s):

Hospital Stay ◽

Acute Cholecystitis ◽

Critically Ill ◽

Treatment Option ◽

Critically Ill Patients ◽

Definitive Treatment ◽

Safe Procedure ◽

Percutaneous Cholecystostomy ◽

Delayed Cholecystectomy ◽

Alternative Treatment Option

Background / objective. Laparoscopic cholecystectomy is a safe procedure and the treatment of choice for acute cholecystitis. As an alternative treatment option in critically ill patients percutaneous cholecystostomy (PC) is performed.Methods. Retrospective review of patients who had undergone PC from 2008 to 2017 at the Department of Surgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics. Patients were reviewed for demographic features, laboratory tests, ASA class, complications, outcomes, hospital stay and mortality rate.Results. Fifty-four patients were included in the study. Forty patients (74%) were ASA III and ten patients (18.5%) – ASA IV. Statistically significant decrease in white blood cell count (from 14.26±6.61 to 8.65±5.15) and C-reactive protein level (from 226.22±106.60 to 51.91±63.70) following PC was observed. The median hospital stay was 13.06 (range 2–68) days and 30-day mortality rate 13%. There were no deaths directly related to procedure. For eleven patients (20.4%) delayed cholecystectomy was scheduled.Conclusions. PC is a reasonable treatment option for high-risk patients with acute cholecystitis and co-morbidities. It can be used as a temporizing treatment option or as a definitive treatment with a low number of delayed cholecystectomies.

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Role of percutaneous cholecystostomy in high surgical risk patients affected by acute cholecystitis

10.26226/morressier.5fbe94fe1199233b624ee62e ◽

2020 ◽

Author(s):

Antonio Borzell

Keyword(s):

Acute Cholecystitis ◽

Percutaneous Cholecystostomy ◽

Surgical Risk ◽

High Surgical Risk ◽

Risk Patients

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Early experience of laparoscopic cholecystectomy in acutely inflamed gallbladder

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v9ispl1.1283 ◽

2018 ◽

Vol 9 (SPL1) ◽

Author(s):

Ali Abdul Hussein Handoz ◽

Ahmed Kh Alsagban

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Gall Stone ◽

The Elderly ◽

Stone Disease ◽

Definitive Treatment ◽

Adjacent Structures ◽

Common Causes ◽

Gall Stone Disease ◽

Male To Female

Gallstones are now among the most important disease in the era of surgery. Definitive treatment of gall stone disease remains cholecystectomy. One of the common causes of emergency surgical referral is acute cholecystitis of which 50-70% cases are seen in the elderly patients.50 patients were treated with laparoscopic cholecystectomy from October 2013 to October 2015. The patient’s age was from 20 to 65 years old with a mean age of 34 ±3 years old. The patients received in the emergency unit and their attack not more than 72 hrs of acute gall stone inflammation were included in this study.From the 50 patients,15 were males (34%) and females were 35 (74%) so the ratio of 1:2of male to female. Problems and complications that facing in this study at time of laparoscopy were mainly adhesions to the adjacent structures like stomach, colon, and omentum. Adhesion into CBD also considered.Early intervention for acute cholecystitis of calculus type by laparoscopy now regarding safe and gold standard approach that should be kept in mind when dealing with such cases.

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Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice

Tropical Doctor ◽

10.1177/00494755211010002 ◽

2021 ◽

pp. 004947552110100

Author(s):

Shamir O Cawich ◽

Avidesh H Mahabir ◽

Sahle Griffith ◽

Patrick FaSiOen ◽

Vijay Naraynsingh

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Gold Standard ◽

Standard Treatment ◽

Gallstone Disease ◽

Acute Attack ◽

Early Laparoscopic Cholecystectomy ◽

Delayed Surgery ◽

Delayed Cholecystectomy ◽

Delayed Laparoscopic Cholecystectomy

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.

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