Tube Cholecystostomy Before Cholecystectomy for the Treatment of Acute Cholecystitis

Suzuki, Kei; Bower, Matthew; Cassaro, Sebastiano; Ri, Patel; Ms, Karpeh; Leitman, I. Michael

doi:10.4293/jsls.2014.00200

Cited by 31 publications

(25 citation statements)

References 21 publications

(34 reference statements)

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“…In-hospital mortality has been reported anywhere from 4% to 17%, 20–25 whereas 30-day mortality rates are just as broad from 7% to 26%. 19,21,26–28 However, these studies do not address mortality from grade III cholecystitis or compare outcomes to those without a tube.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis

Dimou

Adhikari

Mehta

et al. 2017

Journal of the American College of Surgeons

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Background The Tokyo guidelines recommend initial cholecystostomy tube drainage, antibiotics, and delayed cholecystectomy in patients with grade III cholecystitis. Study Design We used Medicare data (1996–2010) to identify patients ≥66 years admitted with grade III acute cholecystitis. We evaluated adherence to the Tokyo guidelines and compared mortality, readmission, and complication rates with and without cholecystostomy tube placement in a propensity-matched (1:3) cohort of patients with grade III cholecystitis. Results 8,818 patients were admitted with grade III cholecystitis; 565 patients (6.4%) had a cholecystostomy tube placed. Cholecystostomy tube placement increased from 3.9% to 9.7% over the study period. Compared to 1,689 propensity-matched controls, patients with cholecystostomy tube placement had higher 30-day (HR 1.26, 95% CI 1.05–1.50), 90-day (HR 1.26, 95% CI 1.08–1.46) and 2-year mortality (HR 1.19, 95% CI 1.04–1.36) and were less likely to undergo cholecystectomy in the 2-years after initial hospitalization (33.4% vs. 64.4%, HR 0.26, 95% CI 0.21–0.31). Readmissions were also higher at 30 days (HR 2.93, 95% CI 2.12–4.05), 90 days (HR 3.48, 95% CI 2.60–4.64), and 2 years (HR 3.08, 95% CI 2.87–4.90). Conclusions Since introduction of the Tokyo Guidelines (2007), use of cholecystostomy tubes in patients with grade III cholecystitis has increased, but the majority of patients do not get cholecystostomy tube drainage as first line therapy. Cholecystostomy tube placement was associated with lower rates of definitive treatment with cholecystectomy, higher mortality and higher readmission rates. These data suggest a need for further evaluation and refinement of the Tokyo guidelines.

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Section: Discussionmentioning

confidence: 99%

Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis

Dimou

Adhikari

Mehta

et al. 2017

Journal of the American College of Surgeons

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“…Some authors have advocated preoperative PC in high-risk patients in whom early laparoscopic cholecystectomy is not appropriate (10,17,18). Other authors have expressed doubts regarding the efficacy of preoperative PC due to the high rate of conversion to laparotomy, longer hospital stay, and more postoperative complications (7)(8)(9)19).…”

Section: The Society Of American Gastrointestinal and Endoscopicmentioning

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%

“…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). Therefore, the purpose of this study was to evaluate outcomes in patients with acute cholecystitis combined with gallbladder perforation who were treated only with cholecystectomy and those who were treated with preoperative PC followed by cholecystectomy.…”

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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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“…Tokyo Guidelines 2013 and Tokyo Guidelines 2018 included PC as a possible treatment in critically ill patients diagnosed with Grade II or Grade III AC [12,13]. However, this option remains controversial because there is lack of well-designed clinical trials, that could confirm treatment guidelines for critically ill patients with AC [10,[13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Cholecystostomy is a Reasonable Alternative for the Treatment of Acute Cholecystitis in Critically Ill Patients: a Single Center Analysis

Ignatavičius

Kiudelis

Mikuckytė

et al. 2019

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Background / objective. Laparoscopic cholecystectomy is a safe procedure and the treatment of choice for acute cholecystitis. As an alternative treatment option in critically ill patients percutaneous cholecystostomy (PC) is performed.Methods. Retrospective review of patients who had undergone PC from 2008 to 2017 at the Department of Surgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics. Patients were reviewed for demographic features, laboratory tests, ASA class, complications, outcomes, hospital stay and mortality rate.Results. Fifty-four patients were included in the study. Forty patients (74%) were ASA III and ten patients (18.5%) -ASA IV. Statistically significant decrease in white blood cell count (from 14.26±6.61 to 8.65±5.15) and C-reactive protein level (from 226.22±106.60 to 51.91±63.70) Originalūs mokslo tiriamieji darbai / P. Ignatavičius, M. Kiudelis, I. Dekerytė ir kt. Perkutaninė cholecistostomija -alternatyva, gydant sunkiomis gretutinėmis ligomis sergančius ligonius, kuriems diagnozuotas ūminis cholecistitas following PC was observed. The median hospital stay was 13.06 (range 2-68) days and 30-day mortality rate 13%. There were no deaths directly related to procedure. For eleven patients (20.4%) delayed cholecystectomy was scheduled.Conclusions. PC is a reasonable treatment option for high-risk patients with acute cholecystitis and co-morbidities. It can be used as a temporizing treatment option or as a definitive treatment with a low number of delayed cholecystectomies. Perkutaninė cholecistostomija -alternatyva, gydant sunkiomis gretutinėmis ligomis sergančius ligonius, kuriems diagnozuotas ūminis cholecistitasSantrauka. Įvadas / tikslas. Laparoskopinė cholecistektomija yra saugi operacija ir pirmo pasirinkimo gydymo metodas, gydant sergančiuosius ūminiu cholecistitu. Sunkiomis gretutinėmis ligomis sergančius pacientus, kuriems diagnozuojamas ūminis cholecistitas, galima gydyti suformuojant perkutaninę cholecistostomą.Metodai. Atliktas retrospektyvinis tyrimas, į kurį įtraukti pacientai, 2008-2017 m. gydyti Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų Chirurgijos klinikoje. Tiriamiesiems buvo suformuota perkutaninė cholecistostoma. Tirti ir vertinti pacientų demografiniai duomenys, laboratoriniai rodikliai, analizuota ASA klasė, komplikacijos, išeitys, gydymo trukmė ir mirštamumas.Rezultatai. Tyrime dalyvavo 55 pacientai. 47 pacientai (74 %) atitiko ASA III klasę, 10 pacientų (18,5 %) -ASA IV klasę. Suformavus perkutaninę cholecistostomą, pastebėtas statistiškai reikšmingas leukocitų skaičiaus (nuo 14,26±6,61 iki 8,65±5,15) ir C reaktyvinio baltymo koncentracijos (nuo 226,22±106,60 iki 51,91±63,70) sumažėjimas. Vidutinė gydymo trukmė -13,06 (intervalas 2-68) dienų. Ankstyvas mirštamumas (30 dienų) siekė 13 proc. Mirčių, tiesiogiai susijusių su atlikta procedūra, nefiksuota. 11 pacientų (20,4 %) taikyta planinė cholecistektomija.Išvados. Perkutaninė cholecistostomija yra tinkama alternatyva didelės rizikos pacientams, kuriems diagnozuotas ūminis cholecis...

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Tube Cholecystostomy Before Cholecystectomy for the Treatment of Acute Cholecystitis

Cited by 31 publications

References 21 publications

Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis

Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis

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

Percutaneous Cholecystostomy is a Reasonable Alternative for the Treatment of Acute Cholecystitis in Critically Ill Patients: a Single Center Analysis

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