Percutaneous Cholecystostomy for acute calculous cholecystitis. Analysis of complications.

Abstract

Abstract Aims Acute cholecystitis (AC) is the second most frequent pathology in Surgical Emergencies.Laparoscopic cholecystectomy (LC) is the gold standard treatment, but not all patients are fit for surgery. Percutaneous Choleystostomy (PC) is an alternative to LC but has high comorbidity and the efficacy of bridge therapy is still in debate. This study aims to analyse the complications of non-surgical treatment in AC. Methods Single-centre retrospective study of 1652 adults with AC during 2011 to 2022, including baseline demographic characteristics, comorbidity severity defined as Charlson Comorbidity Index (CCI), ASA Score, Tokyo Guidelines’ severity classification. The primary outcome is to study the complications of non-surgical treatment. Results The 94,6% of the series had LC. Only 88 patients received NST, and were 12 yearls old older, had a higher CCI and the 44% were severe cholecystitis the 83% were pure-cholecystitis, and 44% were successfully treated with antibiotics alone. A 55% needed a PC, in 7 patients was for resuscitation before surgery. The Hospital stay was 6 days longer and the 45% had a complication. The mortality was 11%. Risk factors for complications were severe cholecystitis, diabetes, and age over 70. Only 3 patients were studied with a cholangiography before remove the drainage. The recurrence was 28%. Conclusions NST has a high complication rate, it should be only for a diminutive subgroup of patients with an AC. A severe cholecystitis, diabetes, and age over 70 are risk factors for complications. Resucitative cholecystostomy could be an option in selective patients.