Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis

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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Image Guided Percutaneous Cholecystostomy–A Single Center Experience

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0040-1705263 ◽

2020 ◽

Vol 4 (01) ◽

pp. 20-26

Author(s):

Sathya Narayanan ◽

Shyamkumar N. Keshava ◽

Vinu Moses ◽

Munawwar Ahmed ◽

Aswin Padmanabhan ◽

...

Keyword(s):

High Risk ◽

Acute Cholecystitis ◽

Tertiary Care ◽

Hemodynamic Instability ◽

Care Hospital ◽

Percutaneous Cholecystostomy ◽

Image Guided ◽

Single Center Experience ◽

Risk Patients ◽

Emergency Cholecystectomy

Abstract Purpose To assess the technical feasibility of percutaneous cholecystostomy (PCC) for acute cholecystitis and formulate an algorithm for PCC. Materials and methods This is a retrospective study of 35 patients (28 male and 7 female; mean age 60 years) who underwent image-guided PCC from 2008 to 2018 at a tertiary care hospital in South India. Descriptive summary statistics and frequencies were used to assess the technical success and complications. Results The patients (35/35) presented with fever, abdominal pain, and a few of them had severe sepsis. All these patients were high risk for surgery considering the comorbidities (17/35) and hemodynamic instability (18/35). PCC was performed under ultrasoundguidance, through transhepatic approach, and using single puncture and modified single puncture techniques. The procedure was technically successful in all 35 patients (100%). Two patients (2/35) did not improve clinically after PCC; hence, they were taken up for emergency cholecystectomy with high-risk consent. One patient required a repeat procedure after 3 days due to tube dislodgement. There were no major procedure-related complications. Conclusion Image-guided PCC can be performed safely and is effective for treating high-risk patients with acute cholecystitis.

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Use of percutaneous cholecystostomy for complicated acute lithiasic cholecystitis: solving or deferring the problem?

Polish Journal of Surgery ◽

10.5604/01.3001.0015.4211 ◽

2021 ◽

Vol 93 (SUPLEMENT) ◽

pp. 1-5

Author(s):

Adnan Malik ◽

Charalampos Seretis

Keyword(s):

Final Analysis ◽

Definitive Treatment ◽

Percutaneous Cholecystostomy ◽

Institutional Practice ◽

Subtotal Cholecystectomy ◽

Delayed Cholecystectomy ◽

High Conversion Rate ◽

Procedural Complications ◽

Bridging Strategy ◽

Emergency Cholecystectomy

Objective: Percutaneous cholecystostomies are not infrequently used as an adjunct in the treatment of severe lithiasic cholecystitis, particularly in unstable and comorbid patients. However, their out of proportion liberal use tends to substitute the performance of emergency cholecystectomy, which the definitive treatment. Our aim was to assess the short and long-term outcomes of patients who had percutaneous cholecystostomy insertion due to severe lithiasic cholecystitis, aiming to define areas for improvement of our institutional practice. Materials and Methods: Retrospective review of our institutional practice including all patients who had a percutaneous cholecystostomy for complex lithiasic cholecystitis, over a 5-year period, allowing for an additional 1-year follow up. Results: A total of 34 patients were included in our final analysis. Percutaneous cholecystostomy insertion enabled quick and efficient control of the source of biliary sepsis without major procedural complications in all cases. In 14 (41.2%) patients, cholecystostomy alone served as definitive treatment, while in 20 (58.9%) cases it was used as bridging strategy for delayed elective cholecystectomy. In the delayed cholecystectomy group of patients, we noted a high conversion rate from laparoscopic to open surgery rate of 70%, with an overall subtotal cholecystectomy rate of 60%. Conclusion: Percutaneous cholecystostomies should be reserved only for complex lithiasic cholecystitis patients who are unwilling and/or unfit for surgery. We advocate the performance of upfront emergency cholecystectomy in any other case with liberal use of operative bail-out strategies, as a delayed elective operation is anyway likely to be converted to open and/or subtotal cholecystectomy.

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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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Acute cholecystitis in elderly and high-risk surgical patients: is percutaneous cholecystostomy preferable to emergency cholecystectomy?

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-019-04424-5 ◽

2019 ◽

Vol 24 (11) ◽

pp. 2579-2586 ◽

Cited By ~ 1

Author(s):

Marina Garcés-Albir ◽

Víctor Martín-Gorgojo ◽

Raúl Perdomo ◽

José Luis Molina-Rodríguez ◽

Elena Muñoz-Forner ◽

...

Keyword(s):

High Risk ◽

Acute Cholecystitis ◽

Surgical Patients ◽

Percutaneous Cholecystostomy ◽

Emergency Cholecystectomy

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Comparison of Emergency Cholecystectomy with Delayed Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage in Patients with Moderate Acute Cholecystitis

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2017.0502 ◽

2018 ◽

Vol 28 (6) ◽

pp. 705-712 ◽

Cited By ~ 5

Author(s):

Chang-Wei Ke ◽

Shuo-Dong Wu

Keyword(s):

Acute Cholecystitis ◽

Gallbladder Drainage ◽

Delayed Cholecystectomy ◽

Percutaneous Transhepatic Gallbladder Drainage ◽

Emergency Cholecystectomy

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Outcomes of Percutaneous Cholecystostomy

Panamerican Journal of Trauma, Critical Care & Emergency Surgery ◽

10.5005/jp-journals-10030-1005 ◽

2012 ◽

Vol 1 (1) ◽

pp. 20-23

Author(s):

Rahul J Anand ◽

Laurie Punch ◽

Amy C Sisley ◽

Steven b Johnson ◽

Matthew Lissauer

Keyword(s):

Acute Cholecystitis ◽

Retrospective Chart Review ◽

Acalculous Cholecystitis ◽

Definitive Treatment ◽

Percutaneous Cholecystostomy ◽

Acute Calculous Cholecystitis ◽

Open Operation ◽

Biliary Pathology ◽

Emergency Cholecystectomy ◽

Calculous Cholecystitis

ABSTRACT Objective Emergency cholecystectomy in patients with severe comorbidities carries up to 30% mortality. Percutaneous cholecystostomy (PC) is accepted as acute management in these patients. This study evaluated outcomes of PC and the need for subsequent cholecystectomy. Methods Retrospective chart review evaluated all patients undergoing PC between June 1, 2005 and January 1, 2010. Results Fifty four patients underwent PC. Indications included acute calculous cholecystitis (44%), acalculous cholecystitis (33%) and other (22%). Twelve patients had PC related complications. Seventeen patients underwent CCY 144 ± 133 days after PC placement. 71% of those procedures were converted to open operation. 15% of patients had PC tube removed successfully without cholecystectomy, 62 ± 53 days after PC. Fifteen patients died in hospital after PC, four likely related to biliary pathology. Patients who underwent subsequent cholecystectomy were more likely to have had a diagnosis of acute cholecystitis (71% vs 33%, p < 0.05). Patients with a diagnosis of acalculous cholecystitis trended toward a higher likelihood of death compared to acute cholecystitis (8 of 18, 44% vs 4 of 24, 17%, p = 0.08). Conclusion PC can be definitive treatment in a minority of patients with acalculous cholecystitis and severe comorbidities. Interval cholecystectomy carries a high complication rate. How to cite this article Ferrada PA, Anand RJ, Punch L, Sisley AC, Johnson SB, Lissauer M . Outcomes of Percutaneous Cholecystostomy. Panam J Trauma Critical Care Emerg Surg 2012;1(1):20-23.

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