Percutaneous Cholecystostomy: A Curative Treatment Modality In Elderly & High ASA Score Acute Cholecystitis Patients.

Abstract

BACKGROUND: Acute cholecystitis (AC) is a common emergency seen by general surgeons. Optimal treatment is laparoscopic cholecystectomy (LC); however, in cases where surgery cannot be performed due to high risk of morbidity and mortality, such as in elderly patients with comorbid diseases, other treatment modalities may be used. Percutaneous cholecystostomy (PC) is one alternative method to treat AC. PC can be used to provide drainage of the gall bladder and control infection. Subsequently, interval cholecystectomy can be performed when there are better conditions. Presently described is experience and results with PC in high risk, elderly patients with AC.

Management of Patients With Acute Cholecystitis After Percutaneous Cholecystostomy: From the Acute Stage to Definitive Surgical Treatment

“…The reported incidence of PC-related complications varies from 2.5 to 69% (15, 20,25,38,49,[66][67][68]. Among all the complications, dislodgement of the cholecystostomy tube is the most common occurrence, which can account for more than half of all events in some publications (20,27,38,66,68).…”

Delayed Spontaneous Passage of Gallstones via Cholecystocutaneous Fistula

“…Percutaneous cholecystostomy is a safe and effective way to manage acute cholecystitis in patients unsuitable for surgery. 1 The incidence of cholecystocutaneous fistulas is low, and most form spontaneously due to untreated cholecystitis or are associated with malignancy of the gallbladder. 2 , 3 An alternative management option for patients who are not suitable for surgery is to use endoscopic gallbladder drainage with a lumen-apposing metal stent (LAMS).…”

Systematic review and meta-analysis of early vs late interval laparoscopic cholecystectomy following percutaneous cholecystostomy

“…Of these, 22 studies reported on outcomes following early interval LC 7,[15][16][17][18][19][20][21][22][23][24][25]36,[43][44][45]47,[49][50][51][52][53] , and 22 studies following late interval LC 3,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]45,46,48 . Three studies reported and compared outcomes in both groups 25,36,45 .…”

“…There were 4 studies that did not report any morbidity outcomes 31,39,40,52 . In the remaining 37 studies, the overall reported 90-day morbidity was 268 out of 2028 (13.2%) patients in the early interval LC group and 236 out of 1772 (18.4%) patients in the late J o u r n a l P r e -p r o o f interval LC group.…”