Percutaneous cholecystostomy in the management of acute cholecystitis - 10 years of experience.

Abstract

A b s t r a c tIntroduction: The preferred treatment for acute cholecystitis is cholecystectomy, but for patients with precluded general anesthesia due to critical illness or multiple medical comorbidities it is not suitable. Cholecystostomy could be a minimally invasive therapeutic alternative. Aim: To retrospectively evaluate the indications, technical features, efficacy, complications, patients' development and relationships among monitored parameters of percutaneous computed tomography (CT)-guided cholecystostomies in cases of acute cholecystitis and find the role of this procedure in appropriate treatment selection. Material and methods: Over the course of 10 years, 75 percutaneous cholecystostomy procedures in 69 patients were performed in cases with diagnosed acute cholecystitis, precluded general anesthesia and contraindicated cholecystectomy by an experienced surgeon and anesthesiologist. These interventions were done using only local anesthesia. The patients were men in 39 cases and women in 33 cases, aged 33 to 91 years. Results: Technical success was achieved in all cases. The indications were sepsis in 34 (45.3%) cases, bridging acute gallbladder inflammatory status in 15 (20%) interventions, serious medical comorbidities in 8 (10.7%) cases, disseminated malignancy and cardiac failure in 6 cases each (both 8%) and neurological affections in 5 (6.5%) cases. Cholecystostomy was frequently the final solution in acalculous cholecystitis (79.3%). The 30-day mortality rate was determined at 10.7% and the overall complication rate was 21.3%, but all of these complications were managed conservatively or using minimally invasive treatment. Conclusions: Percutaneous CT-guided cholecystostomy is reserved for patients with a serious medical status for various reasons that preclude surgical treatment and general anesthesia. Simultaneously, technical success and efficacy are high and the complication rate is acceptable.

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

“…The rates of PC performed for acalculous cholecystitis (ACC) varies from 3.1% to 42.5% in literature [12]. PC without cholecystectomy was reported as the final treatment of ACC in 76.3% [13,22]. In our study, 15.4% of the PC was performed for ACC, and PC was the final treatment for only 19% (n=4) of those with ACC.…”

“…PC can be performed under USG, CT or endoscopic USG (EUS) guidance. The disadvantages of CT and EUS-guided PC are radiation exposure, the need for more experience, and sedation or general anesthesia requirement [13,14]. In our study, PC was performed by an experienced interventional radiologist with 100% technical and clinical success under USG guidance with the transhepatic approach.…”

“…Hemorrhage, dislocation, dysfunction, self-removal, or bile leakage are the complications of PC. In the literature, the complication rates of transabdominal and transhepatic PC were 32.3% and 12.1%, respectively [13]. Recurrence rate varied from 18-20.6%, and the mean time until recurrence, from 65 to 660 days.…”

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

“…[1] Therefore, the 30-days mortality rate largely depends on patient selection/referral patterns and has known to have a very wide range (8-36%) depending on the population presented. [17] One of the lowest numbers for this rate was reported by Dvorak et al [22] and was 10.7%. However, those researchers had included patients as young as 33 years of age.…”

Advances in the Study of Acute Acalculous Cholecystitis: A Comprehensive Review

“…Placing a PC catheter through the abdomen can easily cause bile leakage, and the formation of the fibrous sinus tract is relatively late, compared to PTGD. Thus, PTGD is generally the first choice in clin- ical practice [56][57][58]. PC for the treatment of AAC has the following advantages: (1) it can quickly relieve the pressure in the gallbladder, with favorable effects on drainage and a decline in inflammation, (2) it is associated with less trauma and less anesthetic complications compared to surgery, ( 3) it has a short operation time, quick recovery, and a low incidence of postoperative complications, and (4) it can be used as a single treatment.…”