Impact of Percutaneous Cholecystostomy in the Management of Acute Cholecystitis

Abstract

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of acute cholecystitis (AC). Percutaneous cholecystostomy (PC) is an increasingly performed procedure for AC, safe and less invasive than LC, very useful in selected patients (severe comorbidities, not suitable for surgery/general anesthesia,..) Methods: Retrospective observational study. Period: 2016-2021. Inclusion criteria: patients treated with PC for AC. Tokyo guidelines TG13/18 is our algorithm to treat AC .The general characteristics of the sample and its clinical evolution outcomes were recorded. Results: 195 patients with AC were treated with PC. Mean age: 74 years. 59.5% ASA class III/IV and Charlson comorbidity index (CCI) of 5.46. Adherence to TG regarding indication of PC was 50,77%. Complication rate associated to PC was 13.33% and 90-days mortality rate was 14,3%. Mean length of days using PC was 10,68 days. 4,6% underwent emergency surgery. Global success rate using PC was 66,66%. 1-year readmission rate due to biliary complications after PC was 28.2%. The rate of scheduled cholecystectomy after PC was 22,6%. Conversion to laparotomy and open approach was higher in patients who underwent emergency surgery (p = 0.009). Conclusion: In our series, PC success rate is about 70% and PC related morbidity was 13%. Mortality in PC patients (older, sicker, high CCI,..) is high (14%). After PC, emergency surgery is uncommon (4.6%) but readmission due to biliary events is near 30%. In real-life situation adherence to TG is only 50%. Cholecystectomy after PC is unfrequent (22.6%) and laparoscopic approach is feasible.