scholarly journals Percutaneous Cholecystostomy as an Alternative to Cholecystectomy in High-Risk Patients with Acute Cholecystitis

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Salih Tosun ◽  
Oktay Yener ◽  
Ozgur Ekinci ◽  
Aman Gapbarov ◽  
Murat Asik ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Clinical Improvement ◽  
Length Of Hospital Stay ◽  
Acalculous Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
Safe Alternative ◽  
Acute Calculous Cholecystitis ◽  
High Risk Patients ◽  
Risk Patients

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.

scholarly journals Percutaneous Cholecystostomy for Severe Acute Cholecystitis: A Useful Procedure in High-Risk Patients for Surgery

2018 ◽  
Vol 108 (2) ◽  
pp. 124-129 ◽  
Author(s):  
S. Aroori ◽  
C. Mangan ◽  
L. Reza ◽  
N. Gafoor
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Length Of Hospital Stay ◽  
Acalculous Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
High Risk Patients ◽  
Risk Patients ◽  
Physiological Reserve ◽  
American Society

Background: Acute cholecystitis has the potential to cause sepsis and death, particularly in patients with poor physiological reserve. The gold standard treatment of acute cholecystitis (cholecystectomy) is often not safe in high-risk patients and recourse is made to percutaneous cholecystostomy as either definite treatment or temporizing measure. The aim of this study is to evaluate early and late outcomes following percutaneous cholecystostomy in patients with acute cholecystitis treated at our institution. Methods: All patients who underwent percutaneous cholecystostomy for acute cholecystitis (excluding patients with malignancy) between January 2005 and September 2014 were included in the study. Results: A total of 53 patients (22 female, median age, 74 years; range, 27–95 years) underwent percutaneous cholecystostomy during the study period. In total, 12 patients (22.6%) had acalculous cholecystitis. The main indications for percutaneous cholecystostomy were significant co-morbidities (n = 28, 52.8%) and patients too unstable for surgery (n = 21, 39.6%). The median time to percutaneous cholecystostomy from diagnosis of acute cholecystitis was 3.6 days (range, 0–45 days). The median length of hospital stay was 27 (range, 4–87) days. The overall 90-day mortality was 9.3% with two further deaths at 12-month follow up. The mortality was significantly higher in patients with American Society of Anesthesiology grade 4–5 (18% vs 0% in American Society of Anesthesiology grade 2–3, p = 0.026) and in patients with acalculous cholecystitis (25% vs 4.5%, p = 0.035). The overall readmission rate was 18%. A total of 24 (45.2%) patients had surgery: laparoscopic cholecystectomy, n = 11; laparoscopic converted to open, n = 5; open total cholecystectomy, n = 5; open cholecystectomy, n = 1; laparotomy and washout, n = 1; laparotomy partial cholecystectomy and closure of perforated small intestine and gastrostomy, n = 1. Conclusion: Percutaneous cholecystostomy is a useful temporary or permanent procedure in patients with acute cholecystitis of both calculous and acalculous origin, who are unfit for surgery.

scholarly journals Percutaneous cholecystostomy as an alternative to cholecystectomy in high risk patients with biliary sepsis: a district general hospital experience

2012 ◽  
Vol 94 (2) ◽  
pp. 99-101 ◽  
Author(s):  
W Al–Jundi ◽  
T Cannon ◽  
R Antakia ◽  
U Anoop ◽  
R Balamurugan ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Improvement ◽  
Acalculous Cholecystitis ◽  
Definitive Treatment ◽  
Bridge To Surgery ◽  
Percutaneous Cholecystostomy ◽  
Emphysematous Cholecystitis ◽  
Acute Calculous Cholecystitis ◽  
High Risk Patients ◽  
Risk Patients

INTRODUCTION Cholecystectomy is the standard treatment for patients with acute cholecystitis. However, percutaneous cholecystostomy (PC) is an alternative for patients at high risk for surgery. We present our five-year clinical experience with the aim of evaluating the efficacy of PC in high risk patients. METHODS A retrospective review was performed on 30 consecutive patients who underwent PC at our institution. The indications for cholecystostomy, route of insertion, technical success, clinical improvement, length of hospitalisation, in-hospital or 30-day mortality, complications, subsequent admissions and performance of interval cholecystectomy were recorded. The median follow-up period was 25 months (range: 1–52 months). RESULTS Thirty-two PCs were performed in thirty patients (mean age: 76.1 years; range: 52–90 years). The indications for PC were acute calculous cholecystitis (29/32), acalculous cholecystitis (1/32) and emphysematous cholecystitis (2/32). The route of insertion was transperitoneal for 22/32 PCs (68.8%) and transhepatic for 10/32 (31.2%). The procedure was technically successful in all patients although 2/22 transperitoneal drains (9.1%) were dislodged subsequently. Twenty-seven PCs (84.4%) resulted in clinical improvement within five days. The in-hospital or 30–day mortality rate was 16.7% (5/30). Eleven patients (36.7%) had a subsequent cholecystectomy: 6 were laparoscopic and 5 converted to open procedures at a median interval of 58 days (range: 1–124 days). CONCLUSIONS PCs are straightforward with few complications. Most patients improve clinically and the procedure can therefore be used as a definitive treatment in unfit patients or as a bridge to surgery in those who might subsequently prove fit for a definitive operation.

scholarly journals Emergency Cholecystectomy Versus Percutaneous Cholecystostomy for Treatment of Acute Cholecystitis in High-Risk Surgical Patients

2019 ◽  
Vol 103 (11-12) ◽  
pp. 534-541
Author(s):  
Cevher Akarsu ◽  
Ahmet Cem Dural ◽  
Aysun Erbahceci Salik ◽  
Mustafa Gokhan Unsal ◽  
Osman Kones ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Length Of Hospital Stay ◽  
Treatment Method ◽  
Surgical Patients ◽  
Percutaneous Cholecystostomy ◽  
High Risk Patients ◽  
Severity Scores ◽  
Risk Patients

Our aim is to present our experience with laparoscopic cholecystectomy (LC) and percutaneous cholecystostomy (PC) in high-risk patients with acute cholecystitis (AC). The guidelines for AC are still debatable for high-risk patients. We aimed to emphasize the role of LC as a primary treatment method in patients with severe AC instead of a treatment after PC according to the Tokyo Guidelines (TG). AC patients with high surgical risk [American Society of Anesthesiologists (ASA) III-IV] who were admitted to our department between March 2008 and November 2014 were retrospectively evaluated. Disease severity in all patients was assessed according to the 2007 TG for AC. Patients were either treated by emergency LC (group LC) or PC (group PC). Demographic data, ASA scores, treatment methods, rates of conversion to open surgery, duration of drainage, length of hospital stay, and morbidity and mortality rates were compared among groups. Age, ASA score, and TG07 severity scores in the PC group were significantly higher than that in the LC group (P < 0.001, P < 0.001, and P < 0.001, respectively). Sex distribution (P = 0.33), follow-up periods (P = 0.33), and morbidity (P = 0.86) were similar. In the patients with early surgical intervention, mortality was significantly lower (P < 0.001). Length of hospital stay was significantly shorter in the LC group compared with the PC group (P < 0.001). In high-risk surgical patients, PC can serve as an alternative treatment method because of its efficiency in the prevention of sepsis-related complications due to AC. However, LC still should be an option for severe AC with comparable short-term results.

Percutaneous cholecystostomy for high-risk patients with acute cholecystitis

2005 ◽  
Vol 19 (9) ◽  
pp. 1256-1259 ◽  
Author(s):  
K. Welschbillig-Meunier ◽  
P. Pessaux ◽  
J. Lebigot ◽  
E. Lermite ◽  
Ch. Aube ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Is percutaneous cholecystostomy acceptable as a bridge treatment for acute cholecystitis in high risk patients who has a biliary problem?

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S334
Author(s):  
Kwangyeol Paik ◽  
Ji Seon Oh ◽  
Chul Seung Lee ◽  
Sung Hoon Yoon ◽  
Dong Do You
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Long-term outcome following percutaneous cholecystostomy in high-risk patients with acute cholecystitis

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e669
Author(s):  
V. Costas-Fernandez ◽  
S. Cea-Pereira ◽  
M. Casal-Rivas ◽  
E. Casal-Nuñez ◽  
F. Ausania
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals APACHE IV system helps to determine cholecystostomy role in elderly patients with acute cholecystitis

2020 ◽  
Author(s):  
Hua Jiang ◽  
Guo Guo ◽  
Zhimin Yao ◽  
Yuehua Wang
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Therapeutic Effect ◽  
Scoring System ◽  
Scoring Systems ◽  
Percutaneous Cholecystostomy ◽  
High Risk Patients ◽  
Before And After ◽  
Risk Patients ◽  
Apache Iv

Abstract Background Cholecystostomy offers an alternative method for patients unfit to undergo immediate cholecystectomy. Nevertheless, the role of cholecystostomy in the clinical management of high-risk surgical patients remains unclear. One of the main problems concerning the therapeutic effect in critically ill patients with acute cholecystitis is the lack of validated, well-established scoring systems to stratify the severity of patient disease states. APACHE IV scoring system was useful to estimate the hospital mortality for high-risk patients. We try to evaluate the performance of the APACHE IV scoring system in patients over 65 years of age with acute cholecystitis and the therapeutic effect of percutaneous cholecystostomy. Methods 597 patients over 65 years of age with acute cholecystitis between January 2011 and December 2018 were retrospectively analyzed with the APACHE IV scores. Results Among the 597 patients, 52 successfully underwent cholecystectomy (2 died, 3.85%), 65 underwent percutaneous cholecystostomy (1 died, 1.54%), and 480 received conservative therapy (27 died, 5.63%). The fitness of the APACHE IV score prediction is good with the area under the ROC curve of 0.894. The APACHE IV models were well-calibrated (with the Hosmer-Lemeshow statistic). Using the method of binary regression analysis, for the patients whose estimated mortality rate was more than 10%, cholecystostomy was an important factor for prognosis (P = 0.048). The estimated mortality of PC patients before and after operation was compared, which indicated that the estimated mortality after puncture was significantly decreased, either in the whole patient group (P = 0.004) or in the group with an estimated mortality greater than 10% (P = 0.008). Conclusion The APACHE IV scoring system showed that cholecystostomy was a safe and effective treatment for elderly high-risk patients with acute cholecystitis.

Sign in / Sign up

Export Citation Format

Share Document