Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis

Pandanaboyana Sanjay, Devender Mittapalli, Aseel Marioud, Richard D. White, Rishi Ram, Afshin Alijani

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    Abstract

    Background The aim of this study was to review a series of consecutive percutaneous cholecystostomies (PC) to analyse the clinical outcomes. Methods All patients who underwent a PC between 2000 and 2010 were reviewed retrospectively for indications, complications, and short- and long-term outcomes. Results Fifty-three patients underwent a PC with a median age was 74 years (range 14-93). 92.4% (n = 49) of patients were American Society of Anesthesiologists (ASA) III and IV. 82% (43/53) had ultrasound-guided drainage whereas 18% (10/53) had computed tomography (CT)-guided drainage. 71.6% (n = 38) of PC's employed a transhepatic route and 28.4% (n = 15) transabdominal route. 13% (7/53) of patients developed complications including bile leaks (n = 5), haemorrhage (n = 1) and a duodenal fistula (n = 1). All bile leaks were noted with transabdominal access (5 versus 0, P = 0.001). 18/53 of patients underwent a cholecystectomy of 4/18 was done on the index admission. 6/18 cholecystectomies (33%) underwent a laparoscopic cholecystectomy and the remaining required conversion to an open cholecystectomy (67%). 13/53 (22%) patients were readmitted with recurrent cholecystitis during follow-up of which 7 (54%) had a repeated PC. 12/53 patients died on the index admission. The overall 1-year mortality was 37.7% (20/53). Conclusions Only a small fraction of patients undergoing a PC proceed to a cholecystectomy with a high risk of conversion to an open procedure. A quarter of patients presented with recurrent cholecystitis during follow-up. The mortality rate is high during the index admission from sepsis and within the 1 year of follow-up from other causes.

    Original languageEnglish
    Pages (from-to)511-516
    Number of pages6
    JournalHPB
    Volume15
    Issue number7
    DOIs
    Publication statusPublished - 2013

    Keywords

    • SAFETY
    • MANAGEMENT
    • HIGH-RISK PATIENTS
    • DELAYED LAPAROSCOPIC CHOLECYSTECTOMY
    • TRANSHEPATIC CHOLECYSTOSTOMY
    • RANDOMIZED CONTROLLED-TRIALS
    • CRITICALLY-ILL PATIENTS
    • SURGICAL RISK
    • METAANALYSIS

    Cite this

    Sanjay, P., Mittapalli, D., Marioud, A., White, R. D., Ram, R., & Alijani, A. (2013). Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. HPB, 15(7), 511-516. https://doi.org/10.1111/j.1477-2574.2012.00610.x