Percutaneous Cholecystostomy for Acute Cholecystitis: A Three-Year Single-Centre Experience Including During COVID-19

Abstract

IntroductionPercutaneous cholecystostomy is a recognised treatment modality for acute cholecystitis. Traditionally, its use was reserved for patients deemed unfit for surgery. However, the coronavirus disease 2019 (COVID-19) pandemic had a detrimental effect on both elective and emergency surgery. The utilisation of cholecystostomy thus increased. Unanswered questions remain over timing with respect to interval cholecystectomy. We evaluated our local practice over the preceding three years. MethodsA retrospective analysis was performed of all patients who had a percutaneous cholecystostomy inserted over a three-year period (1 January 2018-1 January 2021). The primary outcome was time to cholecystectomy. Secondary outcomes were cholecystostomy-related complications, 30-day mortality, cholecystectomy-related complications and length of postoperative hospital stay. ResultsA total of 31 patients were identified during the period. Thirteen (42%) patients went on to have a laparoscopic cholecystectomy. The median time interval from cholecystostomy to cholecystectomy was 97 days (interquartile range [IQR]: 81-140, minimum: 47 and maximum: 791). One case was complicated by small bowel perforation; this occurred after an interval of 106 days. The median length of postoperative stay was one day (IQR: 1-1, minimum: 0 and maximum: 4). Cholecystostomy-related complications were observed in four (13%) patients, whereby three became displaced and one developed blockage. Thirty-day mortality following cholecystostomy insertion was zero. ConclusionsPercutaneous cholecystostomy is a safe and effective intervention for the management of acute cholecystitis. Interval cholecystectomy should be carefully considered; it may be safer to perform prior to 90 days.

Acute cholecystitis during the COVID-19 pandemic: is percutaneous cholecystostomy a good alternative for treatment?

“…A CCI above 6 is a factor associated with increased postoperative complications, and there is a strong correlation between the ASA grade and the decision for radiological and potential surgical treatment (13). In our study, the mean CCI of the patients was 7.32±2.1, and the ASA score was mostly IIE and above.…”

Die Auswirkungen der COVID-19 Pandemie führten zu signifikanten Veränderungen der Operations- und Liegezeiten bei Patienten nach Cholezystektomie

“…Konservative Therapieoptionen mittels Antibiose wurden gehäuft angewendet. Bei erwartbar schweren Operationen rückten interventionelle Therapieverfahren mehr in den Vordergrund [ 10 , 11 ]. Es gibt eine Anzahl an Publikationen [ 5 , 6 , 12 ], die den Einfluss der COVID-19-Pandemie auf die operativen Fächer, speziell auch auf die Gallenblasenchirurgie untersucht haben.…”

“…Es ist sicher nicht übertrieben, zu sagen, dass durch die COVID-19-Pandemie einige chirurgische Standards in ihren Grundfesten erschüttert wurden. Die Verstärkung konservativer Therapieverfahren bei der akuten Appendizitis und der akuten Cholezystitis sind als Beispiel zu nennen; die Ergebnisse sind für Patienten und Chirurgen mit gemischten Erfolgen verbunden [ 3 , 5 , 10 , 19 , 20 ]. Einige dieser Veränderungen werden sich wahrscheinlich dennoch durchsetzen und sich ggf.…”

“…Aktuell hat sich die Situation erfreulicherweise stabilisiert, die derzeitigen Regeln sind gut verständlich und werden weiter bedarfsadaptiert angepasst [1,2,6,14,15]. Eine der Regeln [1,9,16] [3,5,10,19,20]. Einige dieser Veränderungen werden sich wahrscheinlich dennoch durchsetzen und sich ggf.…”