Cholecystostomy – an obsolete or relevant treatment?
Authors:
L. Martínek; D. Kostrouch; J. Hoch
Authors‘ workplace:
Chirurgická klinika 2. LF UK v Praze a Fakultní nemocnice Motol, Praha
přednosta: prof. MUDr. J. Hoch, CSc.
Published in:
Rozhl. Chir., 2015, roč. 94, č. 9, s. 367-371.
Category:
Original articles
Overview
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
Sources
1. Niederle B. Chirurgie žlučových cest. 1. vyd. Praha, Avicenum, 1977.
2. Sparkman RS. Bobbs centennial: the first cholecystotomy. Surgery 1967;61:965–971.
3. Malmstrom P, Olsson AM. Cholecystostomy for acute cholecystitis. Am J Surg 1973;126:397–402.
4. Gagic N, Frey CF. The results of cholecystostomy for the treatment of acute cholecystitis. Surg Gynecol Obstet 1975;140:255–7.
5. Radder RW. Ultrasonically guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging 1980;49:330–3.
6. Pessaux P, Regenet N, Tuech JJ, et al. Aparoscopic versus open cholecystectomy: a prospective comparative study in the elderly with acute cholecystitis. Surg Laparosc Endosc Percutan Tech 2001;11:252–5.
7. Decker G, Goergen M, Philippart P, et al. Laparoscopic cholecystectomy for acute cholecystitis in geriatric patients. Acta Chir Belg 2001;101:294–9.
8. Smith TJ, Manske JG, Mathiason MA, et al. Changing trends and outcomes in the use of percutaneous cholecystostomy tubes for acute cholecystitis. Ann Surg 2013;257:1112−5.
9. Winbladh A, Gullstrand P, Svanvik J, et al. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford) 2009;11:183–93.
10. Horák P, Pádr R, Hoch J. Percutaneous cholecystostomy in acute cholecystitis--a solution for risk patient groups? Rozhl Chir 2006;85:236−8.
11. Akyurek N, Salman B, Yuksel O, et al. Management of acute calculous cholecystitis in high-risk patients: percutaneous cholecystotomy followed by early laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2005;15:315–20.
12. Kim HO, Ho Son B, Yoo CH, et al. Impact of delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis. Surg Laparosc Endosc Percutan Tech 2009;19:20–4.
13. Han IW, Jang JY, Kang MJ, et al. Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage. J Hepatobiliary Pancreat Sci 2012;19:187–93.
14. Sanjay P, Mittapalli D, Marioud A, et al. Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. HPB (Oxford). 2013;15:511−6.
15. Chok KS, Chu FS, Cheung TT, et al. Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis. ANZ J Surg 2010;80:280–3.
16. Yun SS, Hwang DW, Kim SW, et al. Better treatment strategies for patients with acute cholecystitis and American Society of Anesthesiologists classification 3 or greater. Yonsei Med J 2010;51:540–5.
17. Kirkegård J, Horn T, Christensen SD, et al. Percutaneous cholecystostomy is an effective definitive treatment option for acute acalculous cholecystitis. Scandinavian Journal of Surgery 2015;0:1–6.
18. Anderson JE, Inui T, Talamini MA, et al. Cholecystostomy offers no survival benefit in patients with acute acalculous cholecystitis and severe sepsis and shock. J Surg Res 2014;190:517−21.
19. Cull JD, Velasco JM, Czubak A, et al. Management of acute cholecystitis: prevalence of percutaneous cholecystostomy and delayed cholecystectomy in the elderly. J Gastrointest Surg 2014;18:328−33.
20. Li M, Li N, Ji W, et al. Percutaneous cholecystostomy is a definitive treatment for acute cholecystitis in elderly high-risk patients. Am Surg. 2013;79:524−7.
21. Bergman S, Al-Bader M, Sourial N, et al. Recurrence of biliary disease following non-operative management in elderly patients. Surg Endosc 2015 Feb 12. [Epub ahead of print]
22. McKay A, Abulfaraj M, Lipschitz J. Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients. Surg Endosc 2012;26:1343−51.
23. Gurusamy KS, Rossi M, Davidson BR. Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis. Cochrane Database Syst Rev 2013;8:CD007088.
24. Yetim I, Dervisoglu A, Karaköse O, et al. Is advanced age a significant risk factor for laparoscopic cholecystectomy? Minerva Chir 2010;65:507–13.
25. Kirshtein B, Bayme M, Bolotin A, et al. Laparoscopic cholecystectomy for acute cholecystitis in the elderly: is it safe? Surg Laparosc Endosc Percutan Tech 2008;18:334–9.
26. Overby DW, Apelgren KN, Richardson W, et al. Society of American Gastrointestinal and Endoscopic Surgeons. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 2010;24:2368–86.
27. Yamashita Y, Takada T, Kawarada Y, et al. Surgical treatment of patients with acute cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 2007;14:91–7.
28. Borzellino G, Steccanella F, Mantovani W, et al. Predictive factors for the diagnosis of severe acute cholecystitis in an emergency setting. Surg Endosc 2013;27:3388−9.
29. Charlson ME, Pompei P, Alex KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373.
30. Welschbillig-Meunier K, Pessaux P, Lebigot J, et al. Percutaneous cholecystostomy for high-risk patients with acute cholecystitis. Surg Endosc 2005;19:1256–9.
31. Leveau P, Andersson E, Carlgren I, et al. Percutaneous cholecystostomy: a bridge to surgery or definite management of acute cholecystitis in high-risk patients? Scand J Gastroenterol 2008;43:593–6.
32. Chung YH, Choi ER, Kim KM, et al. Can percutaneous cholecystostomy be a definitive management for acute acalculous cholecystitis? J Clin Gastroenterol 2012;46:216–9.
33. Jang WS, Lim JU, Joo KR, et al. Outcome of conservative percutaneous cholecystostomy in high-risk patients with acute cholecystitis and risk factors leading to surgery. Surg Endosc 2014 Dec 9. [Epub ahead of print]
34. Morse BC, Smith JB, Lawdahl RB, et al. Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy.Am Surg 2010;76:708–12.
35. Arnaud JP, Pessaux P. Percutaneous cholecystostomy for high-risk acute cholecystitis patients. South Med J 2008;101:577.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2015 Issue 9
Most read in this issue
- Surgical options to treat constipation: A brief overview
- Cholecystostomy – an obsolete or relevant treatment?
- Choledochal cyst
- Extraintestinal GIST – case report