Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients

McKay, Andrew; Abulfaraj, Moaz; Lipschitz, Jeremy

doi:10.1007/s00464-011-2035-0

Cited by 161 publications

(119 citation statements)

References 33 publications

(33 reference statements)

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“…However, we often encounter situations when early surgical treatment of acute cholecystitis is not possible due to patients' advanced age, severe co-morbidities, and manpower constraints, such as a shortage of surgeons or equipment. In these cases, conservative management, including PC, can be an alternative (7,9,11).…”

Section: Discussionmentioning

confidence: 99%

“…dard treatments in patients with acute cholecystitis, and early laparoscopic cholecystectomy within 48 to 96 hours after symptom onset is recommended (6)(7)(8)(9)(10), although percutaneous cholecystostomy (PC) is chosen for initial treatment in high-risk patients and when emergent surgery is not possible due to manpower constraints (7,9,11). However, the efficacy of PC before cholecystectomy in acute cholecystitis remains controversial; some surgeons advocate preoperative PC in critically ill or elderly patients, while others suggest that it has poor outcomes, with a longer hospital stay and a higher rate of conversion to open surgery (7)(8)(9)(10).…”

mentioning

confidence: 99%

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The Efficacy of Preoperative Percutaneous Cholecystostomy for Acute Cholecystitis with Gallbladder Perforation

Kim

Park

2017

J Korean Soc Radiol

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Gallbladder perforation is a complication of acute cholecystitis, occurring in 2-42% of patients with acute cholecystitis (1, 2). Since Niemeier (3) classified gallbladder perforation into three types, modified Niemeier classification of gallbladder perforation (4) has been used: type I, acute perforation into the free peritoneal cavity; type II, subacute perforation of the gallbladder surrounded by an abscess; and type III, chronic perforation with fistula formation between the gallbladder and other abdominal viscera. Purpose: Treatment of acute cholecystitis with gallbladder perforation remains controversial. We aimed to determine the feasibility of percutaneous cholecystostomy (PC) in these patients. Materials and Methods:We retrospectively reviewed patients who had acute cholecystitis with gallbladder perforation at a single institution. Group 1 (n = 27; M:F = 18:9; mean age, 69.9 years) consisted of patients who received PC followed by cholecystectomy, and group 2 (n = 16; M:F = 8:8; mean age 57.1 years) consisted of patients who were treated with cholecystectomy only. Preoperative details, including sex, age, underlying medical history, signs of systemic inflammatory response syndrome (SIRS), laboratory findings, body mass index, presence of gallstone, and type of perforation; treatment-related variables, including laparoscopic or open cholecystectomy, conversion to laparotomy, blood loss, surgical time and anesthesia time; and outcome, including postoperative complications and hospital stay were analyzed. Results: There was no significant difference in preoperative details, treatment-related variables, postoperative complications, and postoperative hospital stay. However, preoperative hospital stay (median, 14 days vs. 8 days; p < 0.05) and total hospital stay (median, 22 days vs. 14.5 days; p < 0.05) were significantly longer in group 1 than in group 2. Conclusion: The preferred treatment of acute cholecystitis with gallbladder perforation might be cholecystectomy without preoperative PC; however, preoperative PC can be a safe, optional treatment in elderly patients with signs of SIRS. Index terms

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The Efficacy of Preoperative Percutaneous Cholecystostomy for Acute Cholecystitis with Gallbladder Perforation

Kim

Park

2017

J Korean Soc Radiol

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“…Tube dislodgement is a frequent complication (Figure 2), seen as high as 80% [13]. Friedrich et al found tube dislodgement to be 59% in their study [14].…”

Section: Complicationsmentioning

confidence: 92%

“…The transhepatic approach decreases the risk of bile leaks and colon injury, which are more common in the transperitoneal approach [1,2,12,19]. Higher rates of bleeding are associated with the transhepatic approach [13].…”

Section: Techniquesmentioning

confidence: 99%

Bedside Percutaneous Cholecystostomy

Maneevese¹,

Sheth²,

Rahman³

et al. 2018

Bedside Procedures

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Although percutaneous cholecystostomy historically is an alternative to cholecystectomy, it is typically performed as a bridge to gallbladder removal. As a low mortality procedure, it proves itself a valuable tool in morbid patients such as the elderly and the critically ill who present with acute cholecystitis and as an alternate route for biliary access. In high-risk patients, PC can be performed at the patient's bedside in patients who are too unstable to be transported outside the ICU. PC is performed using ultrasound, CT, or luoroscopic guidance; however, bedside PC can only be performed using ultrasound. Ultrasound is readily available and portable and allows for real-time imaging. A 2010 study performed by Donkol et al. demonstrated success rates for CT (93%), US (46%), and luoroscopy (62%). Though US had the lowest success rate, it remains the only option for those critically ill who cannot tolerate transportation or an immediate cholecystectomy. Contraindications of PC include hemorrhage, pericholecystic abscess, gallbladder tumor, etc. Complications include bile leak, hemorrhage, sepsis, bowel perforation, etc. The gallbladder is a small organ with much pathology. Having the knowledge and skill to adequately perform this procedure is essential, especially in patients with septic shock in need of source control.

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“…The formerly prevailing procedure, placement of percutaneous cholecystostomy tubes, is fraught with complications (e.g., drain dislodgement and occlusion, leak, infection, bleeding, and discomfort) although placement can be lifesaving in the medically unfit patient [1,2]. In one study of 68 patients, success was noted in 85 % although complications occurred in 16 % [2]. Furthermore, a high percentage (41 %) of patients who did not subsequently undergo cholecystectomy developed recurrent gallbladder-related symptoms.…”

mentioning

confidence: 99%

Endoscopic Gallbladder Drainage in Medically Inoperable Patients with Symptomatic Cholelithiasis: A Tube to Avoid “Going Down the Tubes”?

Shah

2015

Dig Dis Sci

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Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients

Cited by 161 publications

References 33 publications

The Efficacy of Preoperative Percutaneous Cholecystostomy for Acute Cholecystitis with Gallbladder Perforation

The Efficacy of Preoperative Percutaneous Cholecystostomy for Acute Cholecystitis with Gallbladder Perforation

Bedside Percutaneous Cholecystostomy

Endoscopic Gallbladder Drainage in Medically Inoperable Patients with Symptomatic Cholelithiasis: A Tube to Avoid “Going Down the Tubes”?

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