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

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.

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

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.

scholarly journals Outcomes of Percutaneous Cholecystostomy

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.

Thinking ahead: gallbladder intussusception following transperitoneal percutaneous cholecystostomy tube placement

2021 ◽  
Vol 14 (2) ◽  
pp. e238885
Author(s):  
Ryan William England ◽  
Caleb Heiberger ◽  
Harjit Singh
Keyword(s):  
Tube Placement ◽  
Pigtail Catheter ◽  
Percutaneous Cholecystostomy ◽  
Transperitoneal Approach ◽  
Proper Position ◽  
Image Guided ◽  
Risk Patients ◽  
Procedural Complications ◽  
Cholecystostomy Tube ◽  
Percutaneous Cholecystostomy Tube

Percutaneous cholecystostomy (PC) is a common minimally invasive, image-guided procedure performed primarily on high-risk patients with acute cholecystitis for gallbladder decompression. Herein, we present a case of a patient undergoing PC placement using a transperitoneal approach. On subsequent upsizing attempts, the gallbladder fundus was found to invaginate during advancement of replacement drains, causing gallbladder intussusception. The use of a balloon and locked pigtail catheter were required to reposition the gallbladder to proper position. The patient’s planned percutaneous cholecystoscopy was delayed by 4 weeks until intended upsizing could be performed. This case demonstrates the advantage of achieving transhepatic gallbladder access to support tract formation and limit procedural complications.

scholarly journals Early versus delayed cholecystectomy in acute cholecystitis: a comparative study in a tertiary care hospital

2020 ◽  
Vol 7 (8) ◽  
pp. 2656
Author(s):  
Jamal Uddin Ahmed ◽  
Subal Rajbongshi ◽  
Najim Hiquemat
Keyword(s):  
Acute Cholecystitis ◽  
Elective Surgery ◽  
Tertiary Care ◽  
Definitive Treatment ◽  
P Value ◽  
Care Hospital ◽  
Early Cholecystectomy ◽  
Delayed Cholecystectomy ◽  
Surgery Group ◽  
Duration Of Surgery

Background: For patients with acute cholecystitis the timing of operative intervention has two broad approaches- early cholecystectomy and elective or delayed cholecystectomy. The main advantage of early cholecystectomy is that, it offers a definitive treatment during the same admission and avoids the problem of failed conservative treatment. The present study is an endeavour to discuss and to compare the outcome of management of acute cholecystitis with early and delayed cholecystectomy.Methods: 100 patients with clinical diagnosis of acute cholecystitis, admitted in the surgical wards of Gauhati Medical College and Hospital during the period of 1st July 2017 to 30th June 2018 were selected for the study. 40 patients underwent early cholecystectomy (within 7 days of onset of symptoms) and 60 patients underwent elective or late cholecystectomy (after a gap of 6-8 weeks from the acute attack).Results: In the present series the average duration of surgery was 90.37±11.96 minutes in the early group and 65.3±7.83 minutes for the elective group which is found to be statistically significant (p value<0.05). In the early surgery group 8.33% required conversion to open surgery. In the elective surgery group 3.63% required conversion. Wound infection, biliary leakage, bile duct injury, and respiratory tract infection was found to be statistically not significant between the two groups.Conclusions: Early cholecystectomy is feasible and safe for acute cholecystitis and is better method of treatment because of its shorter hospital stay, which is a major economic benefit to both the patient and health care system.

Percutaneous Cholecystostomy Without Interval Cholecystectomy as Definitive Treatment of Acute Cholecystitis in Elderly and Critically Ill Patients

2008 ◽  
Vol 101 (6) ◽  
pp. 586-590 ◽  
Author(s):  
John Griniatsos ◽  
Athanasios Petrou ◽  
Paris Pappas ◽  
Konstantinos Revenas ◽  
Ioannis Karavokyros ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Definitive Treatment ◽  
Percutaneous Cholecystostomy

Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1)

Gut ◽  
2020 ◽  
Vol 69 (6) ◽  
pp. 1085-1091 ◽  
Author(s):  
Anthony Y B Teoh ◽  
Masayuki Kitano ◽  
Takao Itoi ◽  
Manuel Pérez-Miranda ◽  
Takeshi Ogura ◽  
...  
Keyword(s):  
High Risk ◽  
Adverse Events ◽  
Acute Cholecystitis ◽  
Clinical Success ◽  
Controlled Trial ◽  
Definitive Treatment ◽  
Percutaneous Cholecystostomy ◽  
Gallbladder Drainage ◽  
Pain Scores ◽  
Very High

ObjectiveThe optimal management of acute cholecystitis in patients at very high risk for cholecystectomy is uncertain. The aim of the current study was to compare endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) to percutaneous cholecystostomy (PT-GBD) as a definitive treatment in these patients under a randomised controlled trial.DesignConsecutive patients suffering from acute calculous cholecystitis but were at very high-risk for cholecystectomy were recruited. The primary outcome was the 1-year adverse events rate. Secondary outcomes include technical and clinical success, 30-day adverse events, pain scores, unplanned readmissions, re-interventions and mortalities.ResultsBetween August 2014 to February 2018, 80 patients were recruited. EUS-GBD significantly reduced 1 year adverse events (10 (25.6%) vs 31 (77.5%), p<0.001), 30-day adverse events (5 (12.8%) vs 19 (47.5%), p=0.010), re-interventions after 30 days (1/39 (2.6%) vs 12/40 (30%), p=0.001), number of unplanned readmissions (6/39 (15.4%) vs 20/40 (50%), p=0.002) and recurrent cholecystitis (1/39 (2.6%) vs 8/40 (20%), p=0.029). Postprocedural pain scores and analgesic requirements were also less (p=0.034). The technical success (97.4% vs 100%, p=0.494), clinical success (92.3% vs 92.5%, p=1) and 30-day mortality (7.7% vs 10%, p=1) were statistically similar. The predictor to recurrent acute cholecystitis was the performance of PT-GBD (OR (95% CI)=5.63 (1.20–53.90), p=0.027).ConclusionEUS-GBD improved outcomes as compared to PT-GBD in those patients that not candidates for cholecystectomy. EUS-GBD should be the procedure of choice provided that the expertise is available after a multi-disciplinary meeting. Further studies are required to determine the long-term efficacy.Trial registration numberNCT02212717

Percutaneous Cholecystectomy in the Intensive Care Patient

1998 ◽  
Vol 13 (2) ◽  
pp. 78-84
Author(s):  
John P. Mcgahan
Keyword(s):  
Intensive Care ◽  
Acute Cholecystitis ◽  
Intensive Care Patient ◽  
Acalculous Cholecystitis ◽  
Care Patient ◽  
Definitive Treatment ◽  
Acute Acalculous Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
Diagnostic Dilemma ◽  
Definitive Therapy

The diagnosis of acute cholecystitis in the intensive care patient is often problematic. While most patients with acute cholecystitis present with fever, increased white count, or symptomatology pertaining to the gallbladder, occasionally these patients may be comatose and often present a diagnostic dilemma. Surgical cholecystectomy is the treatment of choice for acute cholecystitis, but this therapy carries with it a high mortality rate in the desperately ill patient. Thus surgical cholecystostomy has been advocated as a temporizing procedure to be performed until these patients stabilize. More recently percutaneous cholecystostomy, performed at the patient's bedside under ultrasound guidance, has been successfully performed using small-size catheters. This is a low-risk temporizing procedure when performed by well-trained personnel. In fact, percutaneous cholecystostomy has been shown to be a definitive treatment in patients with acute acalculous cholecystitis. Patients with calculous cholecystitis may require more definitive therapy, such as cholecystectomy. Presented is a review of the development and the current applications of percutaneous cholecystostomy in intensive care patients with suspected acute cholecystitis.

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

2013 ◽  
Vol 18 (2) ◽  
pp. 328-333 ◽  
Author(s):  
John D. Cull ◽  
Jose M. Velasco ◽  
Alexander Czubak ◽  
Dahlia Rice ◽  
Eric C. Brown
Keyword(s):  
Acute Cholecystitis ◽  
The Elderly ◽  
Percutaneous Cholecystostomy ◽  
Delayed Cholecystectomy
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