Percutaneous cholecystostomy as a complementary or alternative method to laparoscopic cholecystectomy in elderly and comorbid patients with acute calculous cholecystitis

Abstract

Objectives:The technical and the clinical efficacy of percutaneous cholecystostomy (PC) in the management of acute calculous cholecystitis, factors affecting postprocedural morbidity and complications, and predictive factors that affect long-term results including recurrence of disease and eventual cholecystectomy were evaluated in a cohort of elderly with comorbid diseases. Methods:The study group consisted of 80 PC patients, aged 50 or older. They were graded/classified according to Tokyo Guidelines 2018 for Acute Cholecystitis (TG18), Charlson Comorbidity Index (CCI), and the American Society of Anesthesiologists Physical Status Classification System. Results:The technical success rate was 100%. The clinical efficacy was 65%, and the partial clinical efficacy was 93.33%. The 30-day mortality due to comorbid conditions was 11.25% and the mean time to death was 14.78±5.91 days. Patients who died and who survived were significantly different regarding mean ASA scores (p=0.003) and mean TG18 grades (p=0.032). Major complication was seen in only 2.5% and minor complication was seen in 3.75% patients. The median time from PC to discharge was 5 days. During a 12-month course, 18.75% of patients died. Of the remaining patients, 86.15% were able to be managed only with a temporary PC. The 1-year interval cholecystectomy rate was 13.85%. The median time to cholecystectomy was 72.50 days with a range between 7 and 340 days. There was no relationship between TG18/CCI and the subsequent need for cholecystectomy.Conclusion: PC provides a significant clinical improvement in the early course and is life-saving in elderly and comorbid patients with acute calculous cholecystitis.