Percutaneous cholecystostomy: a nonsurgical therapeutic option for acute cholecystitis in high-risk and critically ill patients

Abstract

Percutaneous cholecystostomy offers a potentially important type of therapy for critically ill patients with acute cholecystitis who present high risk when undergoing laparotomy or laparoscopy under general anesthesia. It offers a distinct advantage for these kinds of patients by avoiding the risks of the surgical intervention. Percutaneous cholecystostomy is a safe and effective minimally invasive procedure with a high success rate and low procedure-related complications. It should be considered not only in temporary management of calculous cholecystitis, but also in definitive treatment in cases of acalculous cholecystitis.

Role of percutaneous transhepatic gallbladder aspiration in the early management of acute cholecystitis

“…Acute cholecystitis (AC) is a disease frequently encountered in general surgical practice. The mainstay of therapy for AC is cholecystectomy; however, emergency operations for the elderly or critically ill patients with multiple comorbidities have been reported to be associated with increased morbidity and mortality . Some surgeons prefer to use conservative approach for AC initially, that is, intravenous fluid and antibiotic therapy are administered, and cholecystectomy is performed after the patient's full recovery and adequate preoperative evaluation and preparation.…”

Index cholecystectomy in grade II and III acute calculous cholecystitis is feasible and safe

“…Clinical resolution of the acute episode does not prevent further episodes of biliary colic or gallstone related complications. The literature suggests that ACC recurrence rates of up to 9.5% to 40% (at between 1 and 3 years) occur after PC . Clearly, this implies that provided the patient survives and is subsequently fit for surgery, s/he will require definitive cholecystectomy.…”

“…The literature suggests that ACC recurrence rates of up to 9.5% to 40% (at between 1 and 3 years) occur after PC. 12,26,27 Clearly, this implies that provided the patient survives and is subsequently fit for surgery, s/he will require definitive cholecystectomy. Again quoting from the above studies, in Silberfein's series, 16 (33%) patients underwent interval cholecystectomy, of which only nine (56%) were successfully performed laparoscopically.…”

“…The rationale for this is that percutaneous cholecystostomy (PC) is a short procedure that can be performed under local anaesthetic, while laparoscopic cholecystectomy is an operative procedure under general anaesthetic and is associated with a larger physiological insult . This is also supported by other authors . However, the appropriateness of these guidelines in the centres experienced in acute laparoscopic cholecystectomy is unclear as there is little direct evidence to suggest that one approach is superior to the other .…”

“…10,11 This is also supported by other authors. [12][13][14] However, the appropriateness of these guidelines in the centres experienced in acute laparoscopic cholecystectomy is unclear as there is little direct evidence to suggest that one approach is superior to the other. 6 Moreover, other alternatives such as laparoscopic subtotal cholecystectomy were not addressed.…”