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Surgical Endoscopy

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01-08-2015

Outcome of conservative percutaneous cholecystostomy in high-risk patients with acute cholecystitis and risk factors leading to surgery

Authors: Won Seok Jang, Jun Uk Lim, Kwang Ro Joo, Jae Myung Cha, Hyun Phil Shin, Sun Hyung Joo

Published in: Surgical Endoscopy | Issue 8/2015

Abstract

Background

Laparoscopic cholecystectomy (LC) is the treatment of choice for acute cholecystitis. However, the morbidity and mortality rates are high in elderly patients or in those with co-morbidities at the time of surgery. Percutaneous cholecystostomy (PC) is a safe treatment for acute inflammation of the gall bladder. This study aimed to evaluate the safety and efficacy of PC for acute cholecystitis and investigate the post-PC factors leading to subsequent LC.

Materials and methods

Ninety-three patients with acute cholecystitis who underwent PC between August 2006 and December 2012 were retrospectively reviewed for clinical course, outcomes, and prognosis. We evaluated patient age, the presence of co-morbidities, American Society of Anesthesiologists (ASA) score, duration of drainage of the PC tube, performance of LC, conversion rate, hospital stay, recurrence, and 30-day mortality. We compared these characteristics in two study groups: 31 were treated with only conservative PC (group I) and 62 with PC followed by elective LC (group II).

Results

Patients in group I were older than those in group II (80.38 ± 10.05 vs. 70.50 ± 11.81 years, p < 0.001). More group I patients had an ASA score of III or IV (deemed high risk for surgery) compared to group II patients (80.6 %, n = 25 vs. 37.0 %, n = 23, p = 0.0012). Age, ASA score, and cerebrovascular accident (CVA) were significantly correlated when analyzing factors used to decide surgery (R ² = 0.15, p < 0.001; R ² = 0.21, p < 0.001; R ² = 0.05, p = 0.05, respectively). Two patients in group I died within 30 days. Six patients (19.3 %) in group I experienced recurrent cholecystitis after PC tube removal.

Conclusions

PC is a safe and effective therapeutic option in high-risk patients with acute cholecystitis, or for preoperative management. The decisive risk factors for surgery after PC were age, ASA score, and CVA.

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Title: Outcome of conservative percutaneous cholecystostomy in high-risk patients with acute cholecystitis and risk factors leading to surgery
Authors: Won Seok Jang
Jun Uk Lim
Kwang Ro Joo
Jae Myung Cha
Hyun Phil Shin
Sun Hyung Joo
Publication date: 01-08-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3961-4

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Outcome of conservative percutaneous cholecystostomy in high-risk patients with acute cholecystitis and risk factors leading to surgery

Abstract

Background

Materials and methods

Results

Conclusions

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Abstract

Background

Materials and methods

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Conclusions

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