Can Percutaneous Cholecystostomy be a Definitive Management for Acute Cholecystitis in High-risk Patients?

Abstract

PC is a safe and efficient treatment option for patients with AC who are less eligible for surgery. After patients recover from PC, further treatment such as cholecystectomy may not be needed.

What is the optimal treatment for acute cholecystitis in elderly patients?

“…On the basis of our long-term experience [2][3][4][5], we would like to highlight certain issues of the possibility of percutaneous cholecystostomy (PC) as the treatment modality for AC in elderly patients. In these high-risk patients, PC as a less aggressive method compared with surgery, performed without general anesthesia, has been shown to be a lifesaving, minimally invasive, alternative management.…”

“…Since then, numerous reports have shown the efficacy of PC for the treatment of AC in high-risk and elderly patients [2][3][4][5][6][7][8][9]. However, to date, it remains controversial whether this method should be used as a temporary measure to postpone the definitive cholecystectomy to an elective setting or whether this procedure itself may be the definitive treatment [2,[4][5][6][7][8][9].…”

“…However, to date, it remains controversial whether this method should be used as a temporary measure to postpone the definitive cholecystectomy to an elective setting or whether this procedure itself may be the definitive treatment [2,[4][5][6][7][8][9].…”

“…Recently, we conducted a trial [2] to evaluate the efficacy, long-term outcome, and safety of PC in elderly and high-risk surgical patients. The conclusion of our study was that PC was successful and complete as a treatment for AC, whereby surgical cholecystectomy was avoided in over 60% of the patients.…”

Acute cholecystitis managed in a rural surgical department

“…11 For such cases, PC drainage may be used either as a bridge towards a delayed LC or in higher-risk patients (ASA Grades III and IV) as definitive therapy. 12,13 The role in selected patients of an entirely conservative approach demands further prospective study. In this respect, Hatzidakis et al 14 showed no difference in outcome when comparing PC plus antibiotic therapy with conservative treatment alone with Akyurek and colleagues 15 suggesting that PC followed by early LC has a generally more favourable outcome than conservative treatment and a delayed LC approach.…”