Role of Percutaneous Cholecystostomy Tube Placement in the Management of Acute Calculus Cholecystitis in High Risk Patients.

OBJECTIVE

To evaluate the utility of percutaneous cholecystostomy tube in patients with acute calculus cholecystitis, who are considered unfit for immediate surgery.

STUDY DESIGN

Observational study.

PLACE AND DURATION OF STUDY

The Aga Khan University Hospital, Karachi, Pakistan, from January 2010 to December 2014.

METHODOLOGY

All adult patients who underwent percutaneous cholecystostomy tube placement for acute calculous cholecystitis were included. These patients were divided into two groups for further analysis. Group-I consisted those who had interval cholecystectomy after tube placement and Group-II were those who had no further treatment. Recurrence of symptoms, infections and operation related complications were noted.

RESULTS

Sixty-five patients met the inclusion criteria. Mean age was 58.5 years. Forty-four patients (67.7%) were males. Forty-three patients underwent interval cholecystectomy (Group-I) and 22 did not (Group-II). Mean operative time was 134.9 +57.8 minutes. Five (11.6%) patients were converted to open cholecystectomy, two (4.6%) developed CBD injury, and seven (16.2%) developed surgical site infection. In Group-II, three patients (13.6%) developed recurrence of symptoms and 19 (86.4%) remained symptom-free. Catheter related problems occurred in four (18%) patients. Mean follow-up was 19 +8 months.

CONCLUSION

Percutaneous cholecystostomy is a good alternative for patients unfit to undergo immediate surgery. Recurrence of symptoms after tube removal are in a low range; therefore, it can be considered a definitive management for high risk patients. Laparoscopic cholecystectomy after tube placement becomes technically challenging.