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European Journal of Trauma and Emergency Surgery

Published in:

01-04-2019 | Original Article

Percutaneous cholecystostomy for severe (Tokyo 2013 stage III) acute cholecystitis

Authors: F. Polistina, C. Mazzucco, D. Coco, M. Frego

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2019

Abstract

Purposes

To evaluate the impact of percutaneous cholecystostomy (PC) on severe acute cholecystitis (AC).

Methods

According to the ICD-9 classification, we retrospectively retrieved medical records of patients discharged with a diagnosis of AC from January 2007 to December 2016 at our hospital. Patients were then stratified according to the Tokyo 2013 (TG 13) AC severity criteria. Grade III AC was diagnosed according to the TG 13 criteria. Indications for PC were failure of optimal medical treatment within 48 h, worsening of clinical condition within early medical treatment, patients unfit for upfront surgery and patient’s preference. Ascites was considered a contraindication to PC while coagulopathy was considered a minor contraindication. Primary end points were: clinical improvement, morbidity and related mortality. Secondary endpoints were AC recurrences and elective laparoscopic cholecystectomies (LS). Response was evaluated by clinical and blood test improvement. Morbidity was evaluated according to the Dindo–Clavien scale.

Results

A total of 117 eligible patients were diagnosed as grade III AC. Of these, 29 (24.7%) underwent PC. The procedure was completed in all cases. Overall morbidity rate was 20.6%. Main complication was the drainage dislodgement due to involuntary patient’s movement. Overall mortality was 17.2% but no causes of death were dependent upon the procedure. Clinical improvement was reported in 95.5% of surviving patients.

Conclusion

This study confirms that PC is a valuable tool in the treatment of severe AC. Randomized trials are needed to clarify the criteria for patient selection and to optimize the timing for both cholecystostomy and cholecystectomy.

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Title: Percutaneous cholecystostomy for severe (Tokyo 2013 stage III) acute cholecystitis
Authors: F. Polistina
C. Mazzucco
D. Coco
M. Frego
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 2/2019
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-018-0912-0

At a glance: The STEP trials

Springer Medicine

Percutaneous cholecystostomy for severe (Tokyo 2013 stage III) acute cholecystitis

Abstract

Purposes

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purposes

Methods

Results

Conclusion

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