Cholecystostomy offers no survival benefit in patients with acute acalculous cholecystitis and severe sepsis and shock

A proposal for a preoperative clinical scoring system for acute cholecystitis

“…Evidence on the benefit of this recommendation, however, could not be identified in systematic review by Winbladh et al [18]. In a recently published nation-wide analysis Anderson et al [19] concluded that "percutaneous cholecystostomy would not benefit the sickest patient in whom cholecystectomy may never be considered". Therefore, although the TG 13 guidelines have been well established for a while now, their validation is certainly not completed.…”

Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis; percutaneous cholecystostomy

“…[7,12,[16][17][18][19] While in some studies PC procedures were suggested as initial method for AC, only a few studies offer urgent cholecystectomy. [14] In biliary sepsis especially, acute intervention is recommended to remove the focus of infection. Therefore, PC is not inevitable in geriatric and high-risk patients.…”

“…However, only few studies reported any clinical benefit of PC. [13,14] Although the timing of cholecystectomy following PC is still controversial for surgeons, general trend is delayed laparoscopic cholecystectomy (LC). Few studies on early LC after PC have been published.…”

Clinical Presentation, Imaging, and Management of Acute Cholecystitis

“…A longitudinal analysis of discharge data from 43,341 patients with AAC found that among patients with severe shock and sepsis, cholecystectomy afforded a significant 9 survival benefit compared to no intervention (hazard ratio, 0.56; P<.001), whereas percutaneous cholecystostomy (PC) did not (hazard ratio, 1.13; P=.256). 4 Cases with high surgical risk but without emergent surgical indications are routinely managed with PC (Fig. 5).…”

“…2 AAC is typically associated with high morbidity and mortality if it is not managed in a timely manner. [3][4][5] Severe right upper quadrant pain, fever, and positive Murphy's sign with an elevated white blood cell (WBC) count on laboratory examination are diagnostic of AC; however, imaging studies, including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and cholescintigraphy, play an important role in the confirmation of the diagnosis and detection of associated complications. 6 Each imaging technique has varied sensitivity and specificity values in the diagnosis of AC and has a different role to play in management; for example, while US is widely used for an initial examination in all patients suspected to have AC, MRI is reserved for patients who may have biliary obstruction.…”