Percutaneous cholecystostomy in the management of acute cholecystitis - 10 years of experience

Petr Dvorak; Petr Hoffmann; Ondrej Renc; Tomas Dusek; Stanislav Rejchrt; Ondrej Slezak; Pavel Vyroubal

doi:10.5114/wiitm.2019.84704

Percutaneous cholecystostomy in the management of acute cholecystitis - 10 years of experience

Wideochir Inne Tech Maloinwazyjne. 2019 Dec;14(4):516-525. doi: 10.5114/wiitm.2019.84704. Epub 2019 May 5.

Authors

Petr Dvorak¹, Petr Hoffmann¹, Ondrej Renc¹, Tomas Dusek², Stanislav Rejchrt³, Ondrej Slezak¹, Pavel Vyroubal⁴

Affiliations

¹ Department of Radiology, University Hospital, Hradec Kralove, Czech Republic.
² Department of Surgery, University Hospital, Hradec Kralove, Czech Republic.
³ 2 Department of Internal Medicine - Gastroenterology, University Hospital, Hradec Kralove, Czech Republic.
⁴ 3 Department of Internal Medicine - Metabolic Care and Gerontology, University Hospital, Hradec Kralove, Czech Republic.

Abstract

Introduction: The preferred treatment for acute cholecystitis is cholecystectomy, but for patients with precluded general anesthesia due to critical illness or multiple medical comorbidities it is not suitable. Cholecystostomy could be a minimally invasive therapeutic alternative.

Aim: To retrospectively evaluate the indications, technical features, efficacy, complications, patients' development and relationships among monitored parameters of percutaneous computed tomography (CT)-guided cholecystostomies in cases of acute cholecystitis and find the role of this procedure in appropriate treatment selection.

Material and methods: Over the course of 10 years, 75 percutaneous cholecystostomy procedures in 69 patients were performed in cases with diagnosed acute cholecystitis, precluded general anesthesia and contraindicated cholecystectomy by an experienced surgeon and anesthesiologist. These interventions were done using only local anesthesia. The patients were men in 39 cases and women in 33 cases, aged 33 to 91 years.

Results: Technical success was achieved in all cases. The indications were sepsis in 34 (45.3%) cases, bridging acute gallbladder inflammatory status in 15 (20%) interventions, serious medical comorbidities in 8 (10.7%) cases, disseminated malignancy and cardiac failure in 6 cases each (both 8%) and neurological affections in 5 (6.5%) cases. Cholecystostomy was frequently the final solution in acalculous cholecystitis (79.3%). The 30-day mortality rate was determined at 10.7% and the overall complication rate was 21.3%, but all of these complications were managed conservatively or using minimally invasive treatment.

Conclusions: Percutaneous CT-guided cholecystostomy is reserved for patients with a serious medical status for various reasons that preclude surgical treatment and general anesthesia. Simultaneously, technical success and efficacy are high and the complication rate is acceptable.

Keywords: acute cholecystitis; cholecystostomy; gallbladder drainage; indications.