OGBN P41 Cholecystostomy drain for Acute Cholecystitis and its further management: A retrospective observational study from a University Hospital

Abstract

Abstract Background Acute Cholecystitis (AC) is one of the most common surgical pathologies. The gold standard treatment of AC is cholecystectomy which can be high-risk in those with poor physiological reserve or sepsis with haemodynamic instability. Therefore, percutaneous cholecystostomy (PC) can be considered as an alternative management strategy. PC has long been used with no definitive protocol for delivery or management of patient recovery. This single center study of patients who had cholecystostomy in our trust aims to create an efficient protocol for PC drains. Methods We conducted a retrospective observational study of patients who had cholecystostomy in the Royal Devon and Exeter Hospital between 2019 and 2023. Data from 20 patients was obtained from patient records. Severity and duration of symptoms on presentation, frailty, co-morbidities, cholecystostomy technical approach, length of stay and complications were recorded and analysed. Regarding the post-insertion period, investigations, post-cholecystostomy management plan and discharge were assessed. We conducted a literature review to compare our results to the usual practice. Data are expressed as median and results were considered to be statistically significant where p≤0.05. Results PC patients were high-risk candidates (median frailty score 4) with 90% being elderly (Age > 65, median age 77). The majority were septic (median WCC 17.9 and CRP 255). Upon drain insertion, median CCI (Charlson Co-morbidity Index) was 4.5. Four cholecystostomies were transhepatic ,three were transperitoneal with the rest unrecorded.Complications included displacement, leakage, and infection (Clavien Dindo 3,2).Old age was associated with more complications (p<0.006) and drain dislocation (p<0.022). Seventeen patients were discharged with drains in, one dislodged. Two patients died. Post-insertion investigations, drain duration and follow-up differed for all patients with no protocol followed. Six patients subsequently underwent cholecystectomy. Conclusions The management of PC and the follow-up differs from one patient to another, as there is currently no definite protocol. Old age is associated with a higher rate of complications related related to cholecystostomy. Further studies should investigate the optimal duration of the drain, timing of the tubogram, subsequent removal of the cholecystostomy drain or cholecystectomy.