EP-319 Evaluating the outcomes of patients treated with surgical vs IR cholecystostomy during the COVID-19 pandemic

Abstract

Aims We evaluated the outcomes of patients treated with laparoscopic cholecystostomy versus percutaneous (IR) cholecystostomy during the COVID-19 pandemic. Methods Electronic records of patients undergoing cholecystostomy during the COVID-19 peak in 2020 were analysed. Our primary outcomes were the number of readmissions and subsequent completion of laparoscopic cholecystectomy. Results 6 patients underwent laparoscopic cholecystostomy between January and December. 3 were performed following failure of cholecystectomy, 2 were unfit for cholecystectomy and one underwent surgery due to lack of radiologist availability. 9 IR cholecystostomies occured between March and July. 4 were unfit surgical candidates, 5 were due to COVID related restrictions on operating. 6 readmissions came from the surgical cohort, 4 for infection compared to 3 from the IR cohort with only 1 for infection. Notably, of the 4 IR-drained patients deemed unfit, only one had a subsequent gallbladder related admission. 3 surgical patients underwent definitive surgery, 2 subtotal and 1 total cholecystectomy with a mean time to definitive treatment of 27.5 weeks. 4 IR patients underwent surgery with 1 abandoned, 1 subtotal and 2 total cholecystectomies with a mean time to definitive management of 20.25 weeks. Conclusions IR cholecystostomy showed reduced readmission rates compared to laparoscopic cholecystostomy, especially related to infection with rates of 11% and 66%, respectively. More patients underwent total laparoscopic cholecystectomy following IR drainage. However, adhesion formation proved troublesome in both methods. IR cholecystostomy showed a reduced time to definitive surgery. Finally, most high-risk patients undergoing IR cholecystostomy had no further gallbladder related admissions therefore proving its utility in such groups.