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Percutaneous cholecystostomy is safe and effective option for acute calculous cholecystitis in select group of high-risk patients

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

In high-risk patients with acute calculous cholecystitis (ACC), percutaneous cholecystostomy (PC) can serve as a bridging option to cholecystectomy [laparoscopic cholecystectomy (LC)] or as definitive treatment. The purpose of this study was to identify predictors of the need for permanent PC.

Methods

Data from 257 PCs performed for ACC (mean age 67.3 ± 14) was collected for a 10-year period. Demographic and clinical characteristics at initial admission, co-morbidities were analyzed. Patients who underwent interval LC were defined as the surgery group (SG; n = 163, 63.4 %) and the remaining patients as the non-SG (NSG; n = 94, 36.6 %).

Results

Patients in the SG were significantly younger and had a shorter length of hospital stay (p < 0.01). The rate of coronary artery disease (CAD; 63.2 vs. 20.2 %), chronic renal failure (14.9 vs. 6.1 %), and the mean number of co-morbidities (2.2 vs. 1.4) were significantly higher in the NSG. Sepsis at admission was more common in the NSG (19.1 vs. 4.9 %, p < 0.001). 56 patients (34.4 %) in the SG and 24 patients (25.5 %) in the NSG developed tube-related complications. In hospital mortality was similar between the groups. Multivariate analysis showed that age ≥75, increased alkaline phosphatase (ALK-P), history of CAD, were predictors of PC as a definite treatment in this high-risk group of patients with ACC.

Conclusions

High operative risk due to older age and CAD preclude LC in more than one-third of patients following PC especially presenting with sepsis and elevated ALK-P. This study suggests that PC could be a safe treatment option in this select group of high-risk patients.

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Authors and Affiliations

  1. Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel

    M. Bala, I. Mizrahi, H. Mazeh, J. Yuval, A. Eid & G. Almogy

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  1. M. Bala
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  2. I. Mizrahi
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  3. H. Mazeh
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  4. J. Yuval
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Correspondence to M. Bala.

Ethics declarations

The study was approved by the Hadassah Medical Center Ethics Committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

Conflict of interest

Miklosh Bala, Ido Mizrahi, Haggi Mazeh, Jonathan Yuval, Ahmed Eid and Gidon Almogy declare that they have no conflict of interest.

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Bala, M., Mizrahi, I., Mazeh, H. et al. Percutaneous cholecystostomy is safe and effective option for acute calculous cholecystitis in select group of high-risk patients. Eur J Trauma Emerg Surg 42, 761–766 (2016). https://doi.org/10.1007/s00068-015-0601-1

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  • DOI: https://doi.org/10.1007/s00068-015-0601-1

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