Percutaneous cholecystostomy for severe acute cholecystitis: a life saving procedure

Abstract

Background: The gold standard treatment of AC is early laparoscopic cholecystectomy, however surgery can result in high morbidity and mortality in patients with severe co-morbidites, elderly, and in patients with poor physiological reserve. In such patients percutaneous cholecystostomy (PC) can be life saving. Aim: The aim of this study is to evaluate early and late outcomes following PC. Methods: This is a retrospective study of all patients who underwent PC for AC between January 2005 and September 2014. Results: 53 patients (22 female, median age 74 years) underwent PC during the study period. Twelve patients (22.6%) had acalculous cholecystitis (ACC). The main indications for PC were; significant co-morbidities (n = 28, 52.8%) and too unwell for surgery (n = 21, 39.6%). Median time from diagnosis of AC to PC was 3.6 (0–45 days). Median length of hospital stay was 27 (range: 4–87) days. 90-day mortality was 9.3%. The mortality was higher in patients with American Society of Anaesthesiology (ASA) 4-5 (17.8% vs. 0% in ASA 2-3, p = 0.025) and in patients with ACC (25 vs. 4.5%, p = 0.032). Despite PC, ten patients (19%) had further admissions to hospital with AC. 45% of patients went on to have an elective cholecystectomy; laparoscopic = 15, and open = 9. At one year follow up seven (13.2%) patients died. Conclusion: PC can be a life-saving procedure in patients with acute cholecystitis who are not fit for surgery due to co-morbidities and severe sepsis.