The impact of a percutaneous cholecystostomy catheter in situ until the time of cholecystectomy on the development of recurrent acute cholecystitis: a historical cohort study.

Mustafa Hasbahceci,Naim Memmi,Enver Kunduz,Fatma Umit Malya,Merve Busra Cengiz

doi:10.17235/reed.2018.5644/2018

Mustafa Hasbahceci, Naim Memmi + Show 3 more

Open Access

https://doi.org/10.17235/reed.2018.5644/2018

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Abstract

the optimal duration of percutaneous cholecystostomy in patients with acute cholecystitis is unknown. this study was a retrospective analysis of patients (age ≥ 18 years) who underwent percutaneous cholecystostomy due to acute calculous cholecystitis. Patients were grouped according to treatment modality: percutaneous cholecystostomy as a definitive treatment (group 1), subsequent surgical treatment after the removal of the catheter (group 2) and those remaining in situ (group 3). The development of gallstone-related complications was the main outcome. there were 24 females (43.6%) and 31 males (56.4%) included in the study with a mean age of 64.8 ± 15.9 years. There were 16 (29.1%), 19 (34.5%) and 20 (36.4%) patients in groups 1, 2, and 3, respectively. The catheter withdrawal time for group 1 and group 2 was 18.2 ± 6.9 and 20.7 ± 13.4 days, respectively. Surgical treatment was performed after a mean of 85.4 ± 93.5 days following catheter removal in group 2 and a mean of 64 ± 32.5 days while the PC tube was in place in group 3. There were one (6.3%) and two cases of a recurrence (10.5%) in groups 1 and 2, respectively. Two patients developed choledocholithiasis (10%) in group 3. maintaining percutaneous cholecystostomy tubes in place until the time of surgery in surgically fit patients may help to prevent a recurrence after acute calculous cholecystitis.

Highlights

Acute calculous cholecystitis (ACC) is an inflammatory process of the gallbladder and is one of the most common emergency admissions in surgical clinics (1-4)
Percutaneous cholecystostomy (PC) may offer a good solution for the relief of the inflammatory response in patients with a complicated cholecystectomy or high-risk patients with perioperative morbidity or mortality
We investigated the patients with and without a PC tube during the interval period for recurrence of biliary events or gallstone-related complications

Summary

Introduction

Acute calculous cholecystitis (ACC) is an inflammatory process of the gallbladder and is one of the most common emergency admissions in surgical clinics (1-4). Laparoscopic cholecystectomy (LC), especially during the initial phase of development, is the gold standard treatment for ACC due to its safety and efficacy (1,2,5,6). Early cholecystectomy could result in a morbidity up to 41% with a perioperative mortality of up to 18% in elderly patients with severe comorbidities (1,4). Percutaneous cholecystostomy (PC) was introduced in the 1980s as a minimally invasive procedure that avoids general anesthesia for the decompression and drainage of gallbladders in patients with ACC (5,7). PC may offer a good solution for the relief of the inflammatory response in patients with a complicated cholecystectomy or high-risk patients with perioperative morbidity or mortality. Apart from some studies that focus on the timing of late cholecystectomy after PC, there are no reported data about the timing for removal of the PC tube (9)

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