Management of Patients With Acute Cholecystitis After Percutaneous Cholecystostomy: From the Acute Stage to Definitive Surgical Treatment

Abstract

Percutaneous cholecystostomy (PC) has become an important procedure for the treatment of acute cholecystitis (AC). PC is currently applied for patients who cannot undergo immediate laparoscopic cholecystectomy. However, the management following PC has not been well-reviewed. The efficacy of PC tubes has already been indicated, and compared to complications of other invasive biliary procedures, complications related to PC are rare. Following the resolution of AC, patients who can tolerate anesthesia and the surgical risk should undergo interval cholecystectomy to reduce the recurrence of biliary events. For patients unfit for surgery, whether owing to comorbidities, anesthesia risks, or surgical risks, expectant management may be applied; however, a high incidence of recurrence has been noted. In addition, several interesting issues, such as the indications for cholangiography via the PC tube, removal or maintenance of the PC catheter before definitive treatment, and timing of elective surgery, are all discussed in this review, and a relevant decision-making flowchart is proposed. PC is an effective and safe intervention, whether as expectant treatment or bridge therapy to definitive surgery. High-level evidence of post-PC care is still necessary to modify current practices.

Diagnosis of a single gallbladder with double cystic ducts and dominant accessory duct draining into the right hepatic duct: a case report

“…In addition, a fluoroscopic cholangiography for bile duct evaluation before definitive laparoscopic cholecystectomy is often recommended. 10 The present report clearly demonstrates this rare anomaly of a single gallbladder with double cystic ducts, in which the accessory duct is dominant and drains into the normal right intrahepatic ductal system. Laparoscopic cholecystectomy is widely applied for acute cholecystitis, and is feasible for this rare anomaly of a single gallbladder with double cystic ducts.…”

Double Cystic Duct: Preoperative use of MRCP Without Being Aware of the Anatomic Anomaly: A Case Report

“…Hence, clinicians should be cautious in anatomic variability of the cystic duct. Simultaneously, we follow the first principles that we should not cut or electrocoagulate unclear tissue during the surgical procedure ( 8 ). This is critical to avoid anatomic variability damage as well.…”

Safe and effective short-time percutaneous cholecystostomy: A retrospective observational study

“…As predicted by a wide variety of studies, the incidence of PCT-related complications varies between 2.5% and 69%. [19] Fortunately, the most commonly reported complication is the catheter displacement (more than 50% of complications). [19,20] Bile leakage is another common adverse event, [20,21] whereas events such as catheter obstruction, infection, bleeding, organ perforation and lethal outcome are relatively rare.…”