The Therapeutic Efficacy of Percutaneous Transhepatic Gallbladder Drainage in Acute Cholecystitis

Abstract

Introduction: Acute cholecystitis is an acute inflammation of the gallbladder. In 96% of patients, the cystic duct is obstructed with gallstones. This results in a high risk of mortality and morbidity in debilitated and elderly patients. Percutaneous transhepatic gallbladder drainage (PTGBD) combined with intensive antibiotic treatment may allow the patients to receive elective surgery in a better clinical condition. The aim of the present study was to investigate the therapeutic efficacy of PTGBD in debilitated and elderly patients with acute cholecystitis.Patients and Methods: A total of 496 patients with acute cholecystitis were enrolled in this study. Patients who received conservative treatment and who had common bile duct (CBD) stones (evidenced by endoscopic retrograde cholangiopancreatography [ERCP] or magnetic resonance cholangiopancreatography [MRCP]) and Mirizzi's syndrome were excluded. PTGBD was performed under ultrasound or computed tomography (CT) guidance in 65 patients. The clinical features, biochemical data, and outcomes were analyzed.Results: Among the 65 patients, 27 patients underwent cholecystectomy after PTGBD and 18 patients (67%) underwent surgery within 28 days. Fourteen (22%) patients died during follow up; they had significantly higher levels of total bilirubin, aspartate amminotransferase (AST), and alkaline phosphatase (ALP), and a higher incidence of sepsis. The clinical and laboratory features were similar between patients with and without surgery after PTGBD. However, patients without surgery had higher rates of sepsis and mortality, which was associated with more comorbidities.Conclusion: Elective surgery after PTGBD may be necessary for debilitated patients with acute cholecystitis. PTGBD together with antibiotics can convert a septic into a non-septic cholecystitis, particularly in elderly and debilitated patients. Surgery alone has a lower mortality rate and may be a better treatment choice for patients with acute cholecystitis who are younger and have fewer comorbidities.