Emerging indications for percutaneous cholecystostomy for the management of acute cholecystitis--a retrospective review.

Document Type

Article

Department

Surgery; Centre for Innovation in Medical Education

Abstract

Acute cholecystitis is a frequent cause of general surgical admissions with a mortality risk that is related to the age of the Patient. Percutaneous cholecystostomy (PC) has been used as a bridging technique while awaiting resolution of sepsis. We evaluated the outcome of our study population following percutaneous cholecystostomy for acute cholecystitis due to benign etiologies.

Methods:

Retrospective review of Patients undergoing PC from January 1988 to December 2008. Patients were reviewed for demographic features, co-morbidity, resolution of symptoms, hospital stay, outcome, complications and ASA class.

Results:

62 Patients underwent PC for acute cholecystitis. 49 Patients had calculous cholecystitis. 61% (n = 38) were ≥ 60 years old. 92% had resolution of symptoms within 48 h, and 8% had partial or no resolution. 84% had a decline in total leucocyte counts. The mean hospital stay was 10.6 days and 30-day mortality was 15%. 69% Patients had no post-procedure complication. Of the remainder, 1 Patient had post-procedure hemorrhage and the remaining developed complications that included pneumonia, hypotension and vasovagal reactions. The duration of drainage ranged from 1 to 3 months. 3 Patients underwent emergency cholecystectomy during the same admission, 20 Patients underwent interval cholecystectomy. 22 Patients had no further intervention and had no recurrent symptoms, of these 73% (n = 16) had calculous cholecystitis. In this sub-group of non-operated Patients, 76% were ASA III & IV. Conclusions: PC is a low risk management option for high risk Patients with acute cholecystitis. It can be used as a temporizing measure while awaiting resolution of sepsis and optimization of co-morbidities, or as a definitive therapeutic option for acalculous cholecystitis. We also conclude that it has a good potential to be used as a definitive therapy for high risk (ASAIII & IV) Patients with acute calculous cholecystitis.

Publication (Name of Journal)

International Journal of Surgery (London, England)

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