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

UNLABELLED

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.