Cholecystostomy – an obsolete or relevant treatment?

Česká verze

Authors: L. Martínek ; D. Kostrouch; J. Hoch
Authors place of work: Chirurgická klinika 2. LF UK v Praze a Fakultní nemocnice Motol, Praha přednosta: prof. MUDr. J. Hoch, CSc.
Published in the journal: Rozhl. Chir., 2015, roč. 94, č. 9, s. 367-371.
Category: Původní práce

Summary

Introduction:
Percutaneous cholecystostomy is considered to be an emergency treatment option when conservative treatment of acute cholecystitis fails in elderly and critically ill patients. The question is: to what extent is this technique still up-to-date or obsolete.

Methods:
We retrospectively reviewed data of patients who underwent a computer tomography (CT) guided percutaneous cholecystostomy between 1/2010−1/2015. We analyzed the patient data, the success rate, complications of the procedure, short- and long-term outcomes.

Results:
30 patients undergoing CT-guided percutaneous cholecystostomy at the Department of Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital during the study period were enrolled. The study group included 21 females (70%) and 9 males (30%) with mean age of 78 years (SD±12.3), median 82 years (range 34−93 years). Percutaneous cholecystostomy was indicated for patients with severe cholecystitis/empyema of the gallbladder not responding to conservative therapy who were poor candidates for operative cholecystectomy. Of these, 23 patients (77%) were successfully treated with initial percutaneous cholecystostomy whereas 7 patients (23%) experienced treatment failure – one was subsequently successfully treated with repeated percutaneous cholecystostomy and six underwent emergency cholecystectomy. The mean length of stay was 16.5 days (SD ±8.2), median 15 days (7–49 days). The total 30-day mortality was 17%, and indication-related mortality was 10%. Three patients (10%) had a recurrence. One patient required repeated percutaneous drainage, the second recovered on conservative treatment and the third patient underwent acute cholecystectomy. Only one patient (3%) underwent delayed laparoscopic cholecystectomy without complications.

Conclusion:
CT guided percutaneous cholecystostomy is a safe and effective therapeutic modality in patients unfit for surgery.

Key words:
cholecystostomy − cholecystitis

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