Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis |
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Authors: | Pandanaboyana Sanjay Devender Mittapalli Aseel Marioud Richard D White Rishi Ram Afshin Alijani |
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Affiliation: | 1.Upper GI & HPB Unit, Ninewells Hospital and Medical School, Dundee, UK;2.Department of Radiology, Ninewells Hospital and Medical School, Dundee, UK;3.HPB Unit, Auckland City Hospital, Auckland, New Zealand |
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Abstract: | BackgroundThe aim of this study was to review a series of consecutive percutaneous cholecystostomies (PC) to analyse the clinical outcomes.MethodsAll patients who underwent a PC between 2000 and 2010 were reviewed retrospectively for indications, complications, and short- and long-term outcomes.ResultsFifty-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).ConclusionsOnly 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. |
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