Percutaneous Cholecystostomy For Acute Cholecystitis Research Articles

Percutaneous cholecystostomy in acute cholecystitis – Narrative review article

Percutaneous cholecystostomy is often performed to treat high-risk patients with acute cholecystitis who are not suitable for cholecystectomy. It is performed by the interventional radiologist and can be performed through the transhepatic or transperitoneal route (direct gallbladder puncture, without passing through the liver). Percutaneous cholecystostomy is used as a bridging procedure to stabilize high-risk patients with acute cholecystitis. We prepared this narrative review article to describe the indications for performing this procedure and the consequences of its performance and to compare it with emergency cholecystectomy.

Outcome Predictors of Percutaneous Cholecystostomy As Definitive Versus Bridging Treatment for Acute Cholecystitis.

Introduction Percutaneous cholecystostomy (PC) is a treatment option for patients with acute cholecystitis (AC) who are too unwell, or too morbid for laparoscopic cholecystectomy (LC). Some patients have PC as a definitive treatment, whereas others have PC as a bridging treatment prior to LC. The aim of this study is to investigate patient characteristics and mortality among those who received PC as definitive treatment versus bridging treatment. Methods Our study retrospectively reviewed all patients treated with PC for AC from February 2019 to November 2022 at the Torbay and South Devon NHS Foundation Trust, Torquay, England. Fifty patients underwent PC for AC, with 48 patients having follow-up data available for analysis. Of these, 26 patients (54%) only received PC (definitive PC), and 22 patients (46%) later underwent LC (bridging LC). Results In this study, 68.8% of the patients were male, with a mean age of 76 ± 9 years. The overall mean Charlson Comorbidity Index (CCI) score was 4.96 ± 1.12, and the mean American Society of Anesthesiologists (ASA) score was 2.83 ± 0.36. The median PC drain duration was 42 days. Six patients (12.5%) had a recurrence of AC with a mean of 57 days onset after PC insertion. Twelve patients (25%) experienced PC complications: 11 (23%) were minor, involving pain or a dislodged tube, and one (2%) was major, resulting in a subhepatic abscess. The median duration from PC insertion to LC surgery was 50.5 days. The bridging LC cohort had a 30-day and one-year mortality of 0%, while the definitive PC cohort had a 30-day mortality of 30.8% (eight patients) and a one-year mortality of 46.1% (12 patients). The bridging LC cohort compared to the definitive PC cohort had a significantly lower CCI (4.39 vs 5.57, p<0.05), and a significantly lower ASA (2.61 vs 3.04, p<0.05). The one-year survival cohort compared to the 30-day mortality cohort had significantly lower ASA (2.71 vs 3.25 p<0.05), and a non-significantly lower CCI (4.66 vs 5.86 p=0.094). The presence of negative predictive factors of respiratory dysfunction and hyperbilirubinemia had higher 30-day and 90-day mortality rates of 31.3% and 37.5%, compared to their absence of 9.4% and 21.4% respectively. Conclusion Our results demonstrate that PC is a safe procedure with a high success rate and low complications. We showed that PC is an effective treatment option for bridging a select cohort of patients to receive a delayed LC. Furthermore, the data suggests ASA and CCI scoring can be used as clinical adjuncts to assess whether bridging patients from PC to LC is appropriate. Finally, ASA, respiratory dysfunction, and hyperbilirubinemia can be used as significant negative predictors of post-PC mortality.

Percutaneous cholecystostomy as a bridge therapy in the geriatric age group with acute cholecystitis.

The aim of this study was to investigate the efficacy of percutaneous cholecystostomy (PC) in the geriatric patients with acute cholecystitis. The records of geriatric patients with high surgical risk who underwent percutaneous cholecystostomy for acute cholecystitis were reviewed retrospectively. The median age of 134 patients who underwent percutaneous cholecystostomy was 77 (65-98) years and 63.4% were women. The mean length of hospital stay was 5 (4-18) days, and the follow-up period until the procedure was 2 (1-6) days. Murphy's sign was positive in 79.1% of patients on physical examination, and the remaining patients (20.9%) had only tenderness on examination. As USG findings, 59.0% of the patients had a gall bladder wall thickness (> 4mm) with pericholecystic fluid. Additional imaging method, abdominal CT, was performed in 29 patients (21.6%), MRCP was performed in three patients (2.2%), and ERCP was performed in one patient (0.7%). Bacterial growth was detected in 27.6% of the bile cultures performed. During the follow-up period, laparoscopic cholecystectomy was performed in 60.4% of the patients and open cholecystectomy was performed in 5.2% of the patients electively. 34.3% of the patients did not undergo any surgery. Bile leakage was detected in two patients (1.5%) as a procedure-related complication, and no mortality was observed. Abdominal ultrasonography-guided PC is a safe and effective method in the management of acute cholecystitis in high-risk patients in the geriatric age group.

WTP3.3 Percutaneous cholecystostomy: an intervention requiring re-admission and re-intervention?

Abstract Aims A national database study reported a 723% increase in cholecystostomy procedures in England between 2000 and 2019 (Lunevicius, 2022). We aimed to evaluate short and long-term clinical outcomes following percutaneous cholecystostomy for acute cholecystitis (AC) at our centre. Methods A single-centre, retrospective cohort study was conducted utilising data from a tertiary centre database, 2012–2020. Tokyo guidelines were used to grade AC severity. Outcomes were evaluated. Results Seventy-six patients were included. The median age was 76 (IQR 67.5-83.3). The M:F ratio was 1.1:1. Twenty-nine patients (38.2%) had Tokyo Grade 3 AC. The remaining 47 patients (61.8%) had Tokyo Grade 2 AC. Forty-seven patients (61.8%) experienced at least one post-cholecystostomy complication. During index admission, seven patients (9.2%) required admission to ITU, seven patients (9.2%) died, and six (7.9%) required emergency cholecystectomy. The median length of stay was 12 days (IQR 9.33-17.0). Of the 69 patients who were discharged, 23 (33.3%) required emergency readmission due to AC recurrence; 12 of these (17.4%) were readmitted within 30 days. Eleven patients (15.9%) had recurrence of AC whilst the gallbladder catheter remained in-situ, and a further 15 patients (21.7%) had recurrence of AC after catheter removal. Twenty patients (29.0%) required additional percutaneous drainage, of which 11 (15.9%) received repeat cholecystostomy. Twelve patients (17.4%) underwent elective cholecystectomy, with a median interval between PC and elective cholecystectomy of 62.5 days (IQR 20.3-118). Conclusions PC is associated with high post-procedure mortality and morbidity. Clinicians should be discerning in patient selection criteria for PC.

192 Percutaneous cholecystostomy as a definitive treatment versus bridging treatment before cholecystectomy for acute cholecystitis: a retrospective observational study

Abstract Aims In this study, we aimed to investigate the mortality and predictors of mortality of patients receiving percutaneous cholecystostomy (PC) as definitive treatment versus patients receiving PC followed by laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) Methods The study population consisted of 48 patients receiving PC for AC (mean age 76, 68.8% male), with a median follow-up period of 22 months. Data was collected on 1,3 and 12-month mortality, Charlson Comorbidity Index (CCI) and American Society of Anaesthesiology (ASA) score, admission bilirubin and respiratory function, and conversion to LC rates. Results 22 patients (46.8%) received LC following PC treatment, and 26 patients (54.2%) had PC as their definitive treatment. All 22 LC patients (100%) survived at 30 days, 3 months, and 12 months. Definitive PC patients had a 30-day mortality of 30.8% (8 patients), and a 3-month and 12-month mortality of 46.2% (12 patients). The alive cohort of patients had a lower CCI (4.66 vs 5.86, p&amp;lt;0.094), lower ASA (2.71 vs 3.25, p&amp;lt;0.05), and fewer patients with respiratory dysfunction or jaundice (27.8% vs 62%) than the 30-day and 3-month mortality cohort. The LC cohort had significantly lower CCI (4.39 vs 5.57, p&amp;lt;0.05), lower ASA (2.61 vs 3.04, p&amp;lt;0.05), but more jaundice/respiratory dysfunction (50% vs 38.4%) than the PC cohort. Conclusions Our results suggest that patient CCI score, ASA score, admission jaundice, and respiratory dysfunction can be used as effective predictors for 30-day and 3-month mortality for patients receiving PC for AC, as well as effective adjuncts in deciding which PC patients should be considered for surgery.

What is the ideal timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis?

Acute cholecystitis (AC) is one of the most prevalent diseases in clinical practice. Poor surgical candidates may benefit from early percutaneous cholecystostomy (PC) drainage followed by interval cholecystectomy (IC), which is the definitive treatment. The optimal timing between the PC drainage and the IC has not been identified. This study aimed to investigate how the duration between PC and IC affects perioperative outcomes and identify the optimal IC timing to minimize complications. This retrospective cohort study included all adult patients diagnosed with AC who underwent PC followed by IC at a single institution center between 2014 and 2022. Patients with a history of hepatobiliary surgery, stones in the common bile duct, cirrhosis, active malignancy, or prolonged immunosuppression were excluded. The analysis did not include cases with major concurrent procedures during cholecystectomy, previously aborted cholecystectomies, or failure of the PC drain to control the inflammation. Linear and logistic regression models were used to analyze the impact of the interval between PC and IC on intra- and perioperative outcomes. One hundred thirty-two patients (62.1% male) with a mean age of 64.4 ± 15 (mean ± SD) years were diagnosed with AC (25% mild, 47.7% moderate, 27.3% severe). All patients underwent PC followed by IC after a median of 64 [48-91] days. Longer ICU stay was associated with longer time intervals between PC and IC (Coef 105.98, p < 0.001). No significant variations were detected in the intraoperative and perioperative outcomes between patients undergoing IC within versus after 8weeks from PC placement. However, a higher percentage of patients with delayed IC (after 8weeks) were discharged home (96.4% vs. 83.7%; p = 0.019). Patients may benefit from undergoing IC after the 8-week cutoff after PC. However, very long periods between PC and IC procedures may increase the risk of longer ICU stay.

Endoscopic Gallbladder Drainage Conversion versus Conservative Treatment Following Percutaneous Gallbladder Drainage in High-Risk Surgical Patients.

There are no consensus guidelines for patients with acute cholecystitis undergoing percutaneous cholecystostomy who are unfit for interval cholecystectomy. The current study aimed to compare the clinical outcomes of endoscopic gallbladder drainage, i.e. conversion from percutaneous cholecystostomy (including endoscopic transpapillary gallbladder stenting and endoscopic ultrasound-guided gallbladder drainage), and conservative treatment after percutaneous cholecystostomy tube removal. This retrospective review included patients who underwent percutaneous cholecystostomy for acute cholecystitis between January 2017 and December 2020. Consecutive patients who underwent endoscopic gallbladder drainage or percutaneous cholecystostomy tube removal without interval cholecystectomy were included. Outcome measures included recurrent acute cholecystitis and unplanned readmission due to gallstone-related diseases. During the study period, 238 patients were selected (63 underwent endoscopic gallbladder drainage conversion and 175 underwent conservative treatment). Patients who underwent endoscopic gallbladder drainage conversion had lower rates of recurrent acute cholecystitis (3 [4.76%] vs 31 [17.71%], p=0.012) and unplanned readmission due to gallstone-related diseases (6 [9.52%] vs 40 [22.86%], p=0.022) than those who underwent conservative treatment following percutaneous cholecystostomy tube removal. In the univariate and multivariate analyses, calculus cholecystitis (odds ratio, 13.75; 95% confidence interval, 1.83 to 102.83; p=0.011) and conversion of endoscopic gallbladder drainage (odds ratio, 0.23; 95% confidence interval, 0.06 to 0.78; p=0.019) were significant predictive factors for recurrent acute cholecystitis. Endoscopic gallbladder drainage conversion led to more favorable outcomes than conservative treatment after percutaneous cholecystostomy tube removal. Therefore, endoscopic gallbladder drainage conversion may be considered a promising treatment option for patients undergoing percutaneous cholecystostomy who are at a high surgical risk.

Impact of percutaneous cholecystostomy in the management of acute cholecystitis: a retrospective cohort study at a tertiary center.

Laparoscopic cholecystectomy is the gold standard for the treatment of acute cholecystitis (AC). Percutaneous cholecystostomy (PC) for management of AC is increasing; safe and less invasive than laparoscopic cholecystectomy and is very useful in selected patients with severe comorbidities, not suitable for surgery/general anesthesia. We conducted a retrospective observational study between 2016 and 2021 of patients treated with PC for AC, based on the application of the Tokyo guidelines 13/18. The aim was to analyse the clinical results and management of PC in patients undergoing elective or emergency cholecystectomy. Subsequently, a retrospective analytical study was designed to compare various cohorts: elective or emergency surgery and management with PC alone; patients with/without a high surgical risk; and elective vs emergency surgery. Hundred and ninety five patients with AC were treated with PC. Mean age was 74years, 59.5% were ASA class III/IV, and the mean Charlson comorbidity index was 5.5. Adherence to Tokyo guidelines regarding indication of PC was 50.8%. The rate of complications associated to PC was 12.3% and the 90-day mortality rate was 14.4%. Mean length of time using PC was 10.7days. Emergency surgery was performed in 4.6%. The overall success rate using PC was 66.7%, and the 1-year readmission rate due to biliary complications after PC was 28.2%. The rate of scheduled cholecystectomy after PC was 22.6%. Conversion to laparotomy and open approach was more frequent in patients who underwent emergency surgery (p = 0.009). No differences were found in 90-day mortality or in the complication rate. PC achieves improvements in the inflammation and infection associated with AC. In our series, it proved to be an effective and safe treatment during the acute episode of AC. Mortality in patients treated with PC is high due to their older age, greater morbidity, and higher Charlson comorbidity index scores. After PC, emergency surgery is uncommon but readmission due to biliary events is high. Cholecystectomy after PC is the definitive treatment and the laparoscopic approach is feasible. Clinical trial registery: The study was registered in the public accessible database clinicaltrials.gov with the ClinicalTrials.gov ID: NCT05153031. Public release date: 12/09/2021.

Cholecystectomy After Percutaneous Cholecystostomy for Acute Cholecystitis: Experience and Outcomes in an Academic Practice.

Percutaneous cholecystostomy (PC) tube insertion has been shown to be an effective treatment of acute cholecystitis (AC) as a temporary step to subsequent laparoscopic cholecystectomy (LC). However, the optimal time gap between PC implantation and LC has not been identified. Adult patients who underwent PC followed by LC for the treatment of AC between 2016 and 2020 were retrospectively reviewed and analyzed. One hundred twelve patients, consisting of 59.8% males, were included and received LC after a median of 65 [48 - 96.5] days following the PC placement. No deaths or reoperations occurred within 30days, but 16 (14.3%) patients were readmitted, and 16 (14.3%) required subsequent reintervention. Although a longer interval between PC and LC had no effect on perioperative outcomes, it was associated with considerably longer intensive care unit (ICU) stay. According to these findings, patients may benefit from early LC following PC for the treatment of AC.

Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis – A tertiary center experience

Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis – A tertiary center experience

Outcomes of endoscopic retrograde cholangiopancreatography-guided gallbladder drainage compared to percutaneous cholecystostomy in acute cholecystitis.

Endoscopic retrograde cholangiopancreatography-guided gallbladder drainage (ERGD) is an alternative to percutaneous cholecystostomy (PTC) for hospitalized acute cholecystitis (AC) patients. We retrospectively analyzed propensity score matched (PSM) AC hospitalizations using the National Inpatient Sample database between 2016 and 2019 to compare the outcomes of ERGD and PTC. After PSM, there were 3,360 AC hospitalizations, with 48.8% undergoing PTC and 51.2% undergoing ERGD. There was no difference in median length of stay between the PTC and ERGD cohorts (p = 0.110). There was a higher median hospitalization cost in the ERGD cohort, $62,562 (interquartile range [IQR] $40,707-97,978) compared to PTC, $40,413 (IQR $25,244-65,608; p < 0.001). The 30-day inpatient mortality was significantly lower in hospitalizations with ERGD compared to PTC (adjusted hazard ratio 0.16, 95% confidence interval [CI]: 0.1-0.41; p < 0.001). There was no difference in association with blood transfusions, acute renal failure, ileus, small bowel obstruction, and open cholecystectomy conversion (p > 0.05) between hospitalizations with ERGD and PTC. There was lower association of acute hypoxic respiratory failure (adjusted ratio [AOR] 0.46, 95% CI: 0.29-0.72; p = 0.001), hypovolemia (AOR 0.66, 95% CI: 0.49-0.82; p = 0.009) and higher association of lower gastrointestinal bleed (AOR 1.94, 95% CI: 1.48-2.54; p < 0.001) with ERGD compared to PTC. ERGD is a safer alternative to PTC in patients with AC. The risk complications are lower in ERGD compared to PTC but no difference exists based on mortality or conversion to open cholecystectomy.

TU8.3 The optimal timing of Laparoscopic cholecystectomy following percutaneous cholecystostomy in Acute cholecystitis

Abstract Introduction Percutaneous cholecystostomy (PC) is an effective option for high risk and/or delayed presented Acute cholecystitis (AC). However, the optimal timing for subsequent laparoscopic cholecystectomy (LC) as a definitive treatment remains controversial. Methods This study includes 41 patients underwent LC following PC for severe AC. We compared the length of tube insertion, period from PC till LC and period from PC removal till LC against co-morbidities, another attack of AC, subsequent pancreatitis/jaundice and operative difficulties in terms of intraoperative adhesions, drain insertion, conversion to open, length of operation. Results The median time of length of tube insertion was 36 days (range 5–208) while the median time of PC insertion till LC was 144 days (range 31–744) and for period from PC removal till LC was 78 days (range 0–714). Patients with prolonged tube insertion (more than a month) showed higher risk of developing subsequent pancreatitis and or jaundice (P=0.04) while intraoperative adhesions was associated with prolonged time from tube insertion till operation (more than 4 months). There was no significant association between neither the length of tube insertion, period from PC insertion till LC nor period from PC removal till LC and other studied parameters. Conclusion Prolonged time of PC insertion and/or prolonged time form PC insertion till LC in patients with AC have higher risk of pancreatitis and surgical difficulties. Further studies including larger number of patients’ sample is warranted to confirm the outcomes and determine the optimal time of LC following PC in those patients.

Acute cholangitis due to haemobilia complicating percutaneous cholecystostomy: First literature case report.

BackgroundLaparoscopic cholecystectomy is the standard treatment for acute cholecystitis. Cholecystostomy is a good option in patients with significant comorbidities. We report a case of a patient having had a percutaneous cholecystostomy for acute cholecystitis complicated with haemobilia and acute cholangitis.Presentation of a caseA woman aged 64 years old, with a history of diabetes, arterial hypertension, and chronic obstructive pulmonary disease was admitted to our institution with acute cholecystitis.We opted for transhepatic percutaneous cholecystostomy (PC) and antibiotics.On the fourth day, the patient had acute cholangitis due to haemobilia.We injected physiologic saline serum through the drain of cholecystostomy to dissolve the blood clot. There was a clinical improvement.We performed laparoscopic cholecystectomy two months later. The patient had an uneventful recovery with a follow-up of five months.DiscussionWe report the first literature report of acute cholangitis due to haemobilia complicating percutaneous cholecystostomy in a patient admitted for cholecystitis.We highlight the importance of the injection of saline physiologic serum from the catheter. Medical treatment with antibiotics may be enough knowing that blood clots can disappear spontaneously. In case of failure, ERCP with sphincterotomy should be performed.ConclusionHaemobilia causing acute cholangitis is a rare complication of percutaneous cholecystostomy. Conservative treatment with antibiotics and injection of saline physiologic serum from the catheter is a good treatment option. In case of failure, ERCP should not be delayed.

Persistent acute cholecystitis after cholecystostomy - increased mortality due to treatment approach?

Percutaneous cholecystostomy (PC) is a treatment option for acute cholecystitis (AC) in cases where cholecystectomy (CCY) is not feasible due to limited health conditions. The use of PC remains questionable. The aim was to retrospectively analyse the outcome of patients after PC. All patients who underwent PC for AC at a tertiary referral hospital over 10 years were included. Descriptive statistics, analysed mortality with and without CCY after PC, and a multivariable logistic regression for potential confounder and a landmark sensitivity analysis for immortal time bias were used. Of 158 patients, 79 were treated with PC alone and 79 had PC with subsequent CCY. Without CCY, 48% (38 patients) died compared to 9% with CCY. In the multivariable analysis CCY was associated with 85% lower risk of mortality. The landmark analysis was compatible with the main analyses. Direct PC-complications occurred in 17% patients. Histologically, 22/75 (29%) specimens showed chronic cholecystitis, and 76% AC. Due to the high mortality rate of PC alone, performing up-front CCY is proposed. PC represents no definitive treatment for AC and should remain a short-term solution because of the persistent inflammatory focus. According to these findings, almost all specimens showed persistent inflammation.

Does high surgical risk affect the management and outcomes of percutaneous cholecystostomy in acute cholecystitis? A single-center retrospective analysis

We compared the management and results of percutaneous cholecystostomy (PC) in high surgical risk (HSR) and normal surgical risk (NSR) acute cholecystitis (AC) patients. The patients were divided into two groups: 60 patients with NSR and 30 patients with HSR. Pre-PC laboratory values, PC efficiency in terms of AC complications, catheter withdrawal method and duration, catheter-related complications, AC recurrence rate, mortality rate, presence of dyspeptic complaints in definitive PC, and cholecystectomy rate were compared. Technical and clinical success were achieved in 90 (100%) patients and, 85 (94.4%) patients with PC, respectively. The mortality developed in the HSR group; however, it was not seen in the NSR group (p=0.003). Five (83.3%) out of 6 (6.7%) patients with the American Society of Anesthesiology classification system (ASA) IV score developed mortality. With PC, clinical success was achieved in all 8 (100%) patients with suspected perforated cholecystitis and 6 (75%) of 8 patients with suspected emphysematous cholecystitis on abdominal CT in the non-acute abdomen. PC complications were seen in 8 (8.8%) and recurrent cholecystitis in 8 (12.5%) patients. The hospital stay was longer, and the rate of definitive treatment with PC was higher in the HSR group (p=0.019, p=0.008). C-reactive protein and procalcitonin levels were higher in the NSR group (p&lt;0.001, p=0.001). Dyspeptic complaints did not observe in 28 (73.7%) of the 38 patients without operation during the 33.3-month follow-up. The rate was not different between the groups (p=0.713). PC provides high clinical success in AC-related major complications, severe infection, and the presence of serious comorbid diseases. Mortality was observed only in ASA IV patients. The definitive cure rate of PC was higher in patients with HSR.

Impact of Percutaneous Cholecystostomy in the Management of Acute Cholecystitis

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of acute cholecystitis (AC). Percutaneous cholecystostomy (PC) is an increasingly performed procedure for AC, safe and less invasive than LC, very useful in selected patients (severe comorbidities, not suitable for surgery/general anesthesia,..) Methods: Retrospective observational study. Period: 2016-2021. Inclusion criteria: patients treated with PC for AC. Tokyo guidelines TG13/18 is our algorithm to treat AC .The general characteristics of the sample and its clinical evolution outcomes were recorded. Results: 195 patients with AC were treated with PC. Mean age: 74 years. 59.5% ASA class III/IV and Charlson comorbidity index (CCI) of 5.46. Adherence to TG regarding indication of PC was 50,77%. Complication rate associated to PC was 13.33% and 90-days mortality rate was 14,3%. Mean length of days using PC was 10,68 days. 4,6% underwent emergency surgery. Global success rate using PC was 66,66%. 1-year readmission rate due to biliary complications after PC was 28.2%. The rate of scheduled cholecystectomy after PC was 22,6%. Conversion to laparotomy and open approach was higher in patients who underwent emergency surgery (p = 0.009). Conclusion: In our series, PC success rate is about 70% and PC related morbidity was 13%. Mortality in PC patients (older, sicker, high CCI,..) is high (14%). After PC, emergency surgery is uncommon (4.6%) but readmission due to biliary events is near 30%. In real-life situation adherence to TG is only 50%. Cholecystectomy after PC is unfrequent (22.6%) and laparoscopic approach is feasible.

Percutaneous Cholecystostomy for Acute Cholecystitis: A Three-Year Single-Centre Experience Including During COVID-19.

IntroductionPercutaneous cholecystostomy is a recognised treatment modality for acute cholecystitis. Traditionally, its use was reserved for patients deemed unfit for surgery. However, the coronavirus disease 2019 (COVID-19) pandemic had a detrimental effect on both elective and emergency surgery. The utilisation of cholecystostomy thus increased. Unanswered questions remain over timing with respect to interval cholecystectomy. We evaluated our local practice over the preceding three years.MethodsA retrospective analysis was performed of all patients who had a percutaneous cholecystostomy inserted over a three-year period (1 January 2018-1 January 2021). The primary outcome was time to cholecystectomy. Secondary outcomes were cholecystostomy-related complications, 30-day mortality, cholecystectomy-related complications and length of postoperative hospital stay.ResultsA total of 31 patients were identified during the period. Thirteen (42%) patients went on to have a laparoscopic cholecystectomy. The median time interval from cholecystostomy to cholecystectomy was 97 days (interquartile range [IQR]: 81-140, minimum: 47 and maximum: 791). One case was complicated by small bowel perforation; this occurred after an interval of 106 days. The median length of postoperative stay was one day (IQR: 1-1, minimum: 0 and maximum: 4). Cholecystostomy-related complications were observed in four (13%) patients, whereby three became displaced and one developed blockage. Thirty-day mortality following cholecystostomy insertion was zero.ConclusionsPercutaneous cholecystostomy is a safe and effective intervention for the management of acute cholecystitis. Interval cholecystectomy should be carefully considered; it may be safer to perform prior to 90 days.

Percutaneous cholecystostomy for acute cholecystitis after stent insertion in patients with malignant biliary obstruction: clinical outcomes of 107 patients.

The outcome of percutaneous cholecystostomy (PC) in malignant patients with acute cholecystitis (AC) after biliary stent insertion has not been investigated in a large group. To evaluate the clinical outcomes of PC for AC after stent insertion in patients with malignant biliary obstruction. From April 2007 to February 2019, 107 patients (57 men, 52 women; mean age = 67.5 years; age range = 27-93 years) who had undergone PC for AC after biliary stent insertion were retrospectively evaluated. Of the 107 patients, 86 underwent biliary stent insertion by the endoscopic approach and the remaining 21 patients by the percutaneous approach. All patients were classified into three groups: those with stent-induced AC; those with cancer-induced AC; and those with AC without mechanical cause (biliary stent, GB stone, or cancer invasion). The mean survival time, recurrence rate, symptom improvement, and cystic duct patency in each patient group were analyzed. Stent-induced AC (n = 40, 37.4%) developed with a mean onset time of six days (range = 0-14 days), AC without mechanical cause (n = 27, 25.2%), 87 days (range = 15-273 days), and cancer-induced AC (n = 40, 37.4%), 137 days (range = 15-447 days) after stent insertion. Symptom resolution and significant improvement in laboratory test values were achieved in 95 patients (88.8%) within four days after PC. PC is a technically safe and effective method for the treatment of AC after biliary stent insertion in patients with malignant biliary obstruction.

An Evaluation of Patient Outcomes Following Percutaneous Cholecys-Tostomy for Acute Cholecystitis at Our Health Board between 2011 and 2020

An Evaluation of Patient Outcomes Following Percutaneous Cholecys-Tostomy for Acute Cholecystitis at Our Health Board between 2011 and 2020

Percutaneous cholecystostomy results of 136 acute cholecystitis patients: A retrospective cohort study

Background/Aim: Percutaneous cholecystostomy (PC) is an alternative procedure to surgery in selected patients with acute cholecystitis (AC). This study aimed to review the clinical and surgical results of patients who underwent percutaneous cholecystostomy. Methods: The records of patients who underwent PC for AC were evaluated for age, gender, comorbidities, survey, catheterization timing, complications, control, removal timing, operation type, interval time, pathology, C-reactive protein (CRP) level and white blood cell count (WBC), ultrasonography (USG) and computed tomography (CT) results. Results: One hundred and thirty-six AC patients who underwent PC were included in the study. The median age was 73 (32-96) years and 57.3% of the patients were male. Out of the 136, 106 (78%) had an American Society of Anesthesiologists (ASA) classification score of 3 or 4. The median Charlson’s comorbidity index (CCI) score was 5 (0-13). The median timing of catheterization was 23 (20-144) hours and length of hospital stay (LOS) was 3 (1-25) days. Dislocation was the most common complication of PC, and 7.4% (n=10) had recurrent AC. The median time until tube removal was 26.5 (1-238) days. Among all, 41.2% (n=56) of the patients underwent interval cholecystectomy, which equates to 76.8% of the those performed laparoscopically. The median time until the operation was 100 (1-264) days. Chronic cholecystitis was the most common pathology of cholecystectomy after PC. Bacterial bile cultures were analyzed in 36 of the patients and showed positive results in 66.7%, with no overall effect on the outcome. Nine patients (6.6%) died. Conclusion: The importance of PC in AC increased with the Covid19 pandemic. PC was performed especially for old patients with ASA ≥3, and CCI ≥5 due to lower complication and recurrence rates. PC could be the final treatment for selected AC patients. Interval cholecystectomies performed after 8 weeks had a shorter LOS and a lower rate of complication.