Non-operative management of acute cholecystitis in the elderly

McGillicuddy, Edward A.; Schuster, Kevin M.; Barre, Kimberly; Suarez, Luis; Hall, Michael R.; Kaml, G. J.; Davis, Kimberly A.; Longo, Walter E.

doi:10.1002/bjs.8836

Cited by 105 publications

(86 citation statements)

References 30 publications

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“…25 The rate of complications following LC in the elderly is estimated to be 22%. 5,7,9,[26][27][28] In the present study, a similar rate of major morbidity was observed (23%) to the rates reported for other series of patients undergoing interval cholecystectomy after PCY (Table 4). [2][3][4][5][6][7][8][9]29 Routine drainage at cholecystectomy did not prevent abscess formation in five patients.…”

Section: Surgical Techniquesupporting

confidence: 89%

High rate of common bile duct stones and postoperative abscess following percutaneous cholecystostomy

FurtadoR

DunnG

et al. 2016

annals

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INTRODUCTION The short and long-term outcomes in patients managed with percutaneous cholecystostomy (PCY) at a single institution are described. METHODS A retrospective study was conducted for patients treated between February 2000 and November 2012. Patient charts, imaging and biochemical data were reviewed. Patient demographics, presenting clinical features and treatment variables were noted. Outcome variables were length of admission, 30-day mortality, 30-day unplanned readmission, tube dislodgement, abscess formation, subsequent endoscopic retrograde cholangiography and surgery, complications after surgery and median overall survival. RESULTS PCY was performed for 55 patients for acute cholecystitis where surgical risk was very high. The 30-day readmission rate was 20% (n=11), the 30-day mortality rate was 9% (n=5) and median survival was 59 months (95% confidence interval: 30-88 months). The median follow-up duration was 68 months. Tubes were dislodged in 15 patients (27%) and an abscess occurred after PCY in 5 patients (9%). Subsequent endoscopic common bile duct stone extraction was required in 20 patients (36%). Cholecystectomy was planned in 22 patients and an abscess occurred following the cholecystectomy in 5 (23%). CONCLUSIONS Although a PCY is lifesaving, significant morbidity can arise during recovery. This study demonstrates a high rate of choledocholithiasis (44%), tube dislodgement (27%) and postoperative abscess (23%) compared with previous reports.

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Section: Surgical Techniquesupporting

confidence: 89%

High rate of common bile duct stones and postoperative abscess following percutaneous cholecystostomy

FurtadoR

DunnG

et al. 2016

annals

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“…Many authors confirm the safety and effectiveness of cholecystostomy for the initial treatment (7,8,9). Proper patient selection is important in the ACC group to reduce the risk of recurrence and to avoid urgent cholecystectomy (11,14,16). There are many controversies in the current literature.…”

Section: Resultsmentioning

confidence: 99%

Percutaneous cholecystostomy: single centre experience in 111 patients with an acute cholecystitis

Peters

Kolderman

Peters³

et al. 2014

Journal of the Belgian Society of Radiology

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2 (1,8%) patients. There were 4 (3,6%) abscesses and 2 (1,8%) fistulas post PC. Drain dislodgment was found without sequelae in 8 (7,2%) patients. Elective cholecystectomy was performed in 35/111 (31,5%). Fifty-one of 87 (58,6%) patients with gallstones underwent cholecystectomy; 36/87 (41,3%) did not undergo surgery due to a too short follow-up or death of nonbiliary disease. In the AAC group, there was no recurrent cholecystitis in 17/24 (70,8%) patients; 3/24 (12,5%) underwent surgery and 4/24 (16,6%) patients died in the ICU. Conclusion: PC is a minimally invasive treatment with low complication rate for patients with acute cholecystitis whom considered being at high-risk for urgent cholecystectomy. Good selection (ASA III and IV) and indication is needed in patients with ACC before PC because the majority will be operated later on. AAC can be managed nonoperatively and further treatment might not be needed.

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“…16 In certain cases, PC may be the definitive treatment if the patient is not a surgical candidate even after the acute event. 17 In other cases, patients may be considered for a cholecystectomy after the acute septic episode has resolved. However, there remains no consensus in selecting these patients for either group.…”

mentioning

confidence: 99%

“…There are studies that have reviewed outcomes in elderly patients undergoing a cholecystectomy 17,18 but there are few studies that have reviewed outcomes for elderly patients treated conservatively. In particular, there are sparse data on the rate of recurrent AC in elderly patients.…”

mentioning

confidence: 99%

Patient outcomes after treatment with percutaneous cholecystostomy for biliary sepsis

Flexer

Peter

Durham-Hall

et al. 2014

annals

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1 Bradford Teaching Hospitals NHS Foundation Trust, UK 2 Doncaster and Bassetlaw Hospitals NHS Foundation Trust, UK ABSTRACT INTRODUCTION Acute cholecystitis is among the most common general surgical presentations. There is a cohort of patients who develop systemic sepsis and complications of acute cholecystitis. These patients are often elderly and co-morbid. Conservative management with percutaneous cholecystostomy has been shown to be a safe and effective management option in the acute setting. However, there is currently no consensus for the further management of these patients. In particular, there is a paucity of data on readmission rates and subsequent operative or non-operative management. METHODS A retrospective study was carried out of patients treated with a percutaneous cholecystostomy for biliary sepsis over a three-year period in a UK teaching hospital. Outcome measures were subsequent operative or conservative management, conversion rates, operative complications and readmission rates. RESULTS Twenty-five patients had a percutaneous cholecystostomy for the treatment of acute biliary sepsis. The median follow-up duration was 35 months. Thirteen patients (52%) had operative treatment. In the operative group, 6/13 had a laparoscopic cholecystectomy, 2/13 had a planned open cholecystectomy, 2/13 had abandoned procedures and 3/13 had a converted procedure. Complications in the operative group included: postoperative mortality (1/13), common bile duct injury requiring drainage and endoscopic stenting (1/13) and one patient required readmission with recurrent pain. In the non-operative group, 5/12 patients were readmitted with biliary sepsis, 5/12 had no readmissions, 1/12 died in the community and 1/12 was readmitted with biliary colic. CONCLUSIONS Percutaneous cholecystostomy is a recognised treatment modality for elderly, co-morbid patients with biliary sepsis. Nevertheless, the readmission rate in this group is relatively high at 5/12 (42%). Patients who undergo subsequent operative management have a conversion rate of 3/13 (23%) and a significant complication rate of 2/13 (15%). The further management of patients having undergone percutaneous cholecystostomy requires careful consideration on an individual case basis. The P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) may aid decision making.

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Non-operative management of acute cholecystitis in the elderly

Abstract: Despite selection of the best elderly candidates for cholecystectomy, postoperative morbidity was significant. Medical management, with interval cholecystectomy only for recurrent AC, may be appropriate in selected patients.

Cited by 105 publications

References 30 publications

High rate of common bile duct stones and postoperative abscess following percutaneous cholecystostomy

High rate of common bile duct stones and postoperative abscess following percutaneous cholecystostomy

Percutaneous cholecystostomy: single centre experience in 111 patients with an acute cholecystitis

Patient outcomes after treatment with percutaneous cholecystostomy for biliary sepsis

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