Short-term outcomes in percutaneous cholecystostomies: a retrospective cohort study

Authors

  • Owain Jones Department of Upper GI Surgery, Countess of Chester Hospital, Liverpool Road, CH2 1UL, Chester, England
  • Hayley Fowler Department of Upper GI Surgery, Countess of Chester Hospital, Liverpool Road, CH2 1UL, Chester, England
  • Gian Abbott Department of Radiology, Countess of Chester Hospital, Liverpool Road, CH2 1UL, Chester, England
  • Shopon Saha Department of Upper GI Surgery, Countess of Chester Hospital, Liverpool Road, CH2 1UL, Chester, England
  • Jim Evans Department of Upper GI Surgery, Countess of Chester Hospital, Liverpool Road, CH2 1UL, Chester, England
  • David Monk Department of Upper GI Surgery, Countess of Chester Hospital, Liverpool Road, CH2 1UL, Chester, England

DOI:

https://doi.org/10.18203/2349-2902.isj20185455

Keywords:

Acute cholecystitis, Cholecystectomy, Choledocholithiasis, gallstones, Percutaneous cholecystostomy

Abstract

Background: Elderly patients account for over 50% of patients presenting with acute cholecystitis. High risk surgical candidates are often treated with a percutaneous cholecystostomy (PC) as an alternative to acute surgery. This study aims to determine whether any factor during the index admission with acute calculus cholecystitis treated with PC determines whether a delayed cholecystectomy is performed, in addition to whether there are any predictive factors for the presence of ductal stones or recurrent biliary morbidity.

Methods: A single-centred retrospective cohort study on radiologically inserted PCs for calculous cholecystitis between 2011-2017. Patient, radiological, biochemical and microbiological data were collected during the index admission. Primary outcome was whether the patient underwent a cholecystectomy and secondary outcomes included readmission with a further biliary morbidity or ductal stones necessitating an ERCP within 120days of the index cholecystostomy.

Results: 32 patients (median age 77years, median Charlson Index 5) underwent PC with a median follow up of 151 days (range 27-1113). PC drain-related morbidity was 58% with no 30-days or in-hospital mortality. Patient age (p=0.007), Charlson Index (p=0.015) and a positive bile culture (p=0.032) were associated with a delayed cholecystectomy (38.7% of patients). There were no predictive variables for recurrent biliary morbidity within 90days (38.7%). CRP (p=0.045), ALP (p=0.035) and ALT (p=0.047) were predictive of the need for an ERCP for CBD stones (32.3%).

Conclusions: PC is a safe procedure and is effective in overcoming the acute pathology in this comorbid population. However, the near-term prevalence of CBD stones and risk of further biliary morbidity remains significant suggesting that definitive surgery should be considered in suitable cases.

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Published

2018-12-27

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Original Research Articles