Cholecystostomy as Bridge to Surgery and as Definitive Treatment or Acute Cholecystectomy in Patients with Acute Cholecystitis

Abstract

Purpose. Percutaneous cholecystostomy (PC) has increasingly been used as bridge to surgery as well as sole treatment for patients with acute cholecystitis (AC). The aim of the study was to assess the outcome after PC compared to acute cholecystectomy in patients with AC. Methods. A review of medical records was performed on all patients residing in Stockholm County treated for AC in the years 2003 and 2008. Results. In 2003 and 2008 altogether 799 and 833 patients were admitted for AC. The number of patients treated with PC was 21/799 (2.6%) in 2003 and 50/833 (6.0%) in 2008. The complication rate (Clavien-Dindo ≥ 2) was 4/71 (5.6%) after PC and 135/736 (18.3%) after acute cholecystectomy. Mean (standard deviation) hospital stay was 11.4 (10.5) days for patients treated with PC and 5.1 (4.3) days for patients undergoing acute cholecystectomy. After adjusting for age, gender, Charlson comorbidity index, and degree of cholecystitis, the hospital stay was significantly longer for patients treated with PC than for those undergoing acute cholecystectomy (P < 0.001) but the risk for intervention-related complications was found to be significantly lower (P = 0.001) in the PC group. Conclusion. PC can be performed with few serious complications, albeit with a longer hospital stay.

Acute cholecystitis managed in a rural surgical department

“…13 Our data showed that in such high-risk cases that even when a PC drain was deployed during the first admission, that the need for elective surgery can be selective 31 and that PC drainage can act as definitive management. 32,33 Although the treatment options are competitive, these patient groups are not, however, strictly comparable.…”

Multidisciplinary approach to acute cholecystitis in a severely cardiopathic patient. Case report and review of literature

“…admitted in 2003, and 850 in 2008. Multivariate regression analysis was performed with adjustments for age, gender, degree of cholecystitis and Charlson comorbidity index (33). Notably, although patients treated with cholecystectomy as a bridge to elective surgery, were older with a predominance of females, the complications reported in the "bridge to surgery" group were entirely con ned to the subsequent nal gallbladder operation, con rming the Authors' conclusion that PC is a safe option in high risk patients with ACC.…”

Percutaneous Cholecystostomy: A Curative Treatment Modality In Elderly & High ASA Score Acute Cholecystitis Patients.

“…[12] In another study, performed by Popowicz et al, which compared 71 cases from 2 different time periods (2003 and 2008), recurrence rate of AC was reported to be 28%. [13] Also, Yeo et al reported readmission rate of 6.8% in their study consisting of 103 cases. LC was performed in 81% and conversion rate was 15% in that study.…”