World Journal of Surgery

, Volume 35, Issue 4, pp 826–833 | Cite as

Percutaneous Drainage versus Emergency Cholecystectomy for the Treatment of Acute Cholecystitis in Critically Ill Patients: Does it Matter?

  • E. Melloul
  • A. Denys
  • N. DemartinesEmail author
  • J.-M. Calmes
  • M. Schäfer



The aim if this study was to compare percutaneous drainage (PD) of the gallbladder to emergency cholecystectomy (EC) in a well-defined patient group with sepsis related to acute calculous/acalculous cholecystitis (ACC/AAC).


Between 2001 and 2007, all consecutive patients of our ICU treated by either PD or EC were retrospectively analyzed. Cases were collected from a prospective database. Percutaneous drainage was performed by a transhepatic route and EC by open or laparoscopic approach. Patients’ general condition and organ dysfunction were assessed by two validated scoring systems (SAPS II and SOFA, respectively). Morbidity, mortality, and long-term outcome were systematically reviewed and analyzed in both groups.


Forty-two patients [median age = 65.5 years (range = 32–94)] were included; 45% underwent EC (ten laparoscopic, nine open) and 55% PD (n = 23). Both patient groups had similar preoperative characteristics. Percutaneous drainage and EC were successful in 91 and 100% of patients, respectively. Organ dysfunctions were similarly improved by the third postoperative/postdrainage days. Despite undergoing PD, two patients required EC due to gangrenous cholecystitis. The conversion rate after laparoscopy was 20%. Overall morbidity was 8.7% after PD and 47% after EC (P = 0.011). Major morbidity was 0% after PD and 21% after EC (P = 0.034). The mortality rate was not different (13% after PD and 16% after EC, P = 1.0) and the deaths were all related to the patients’ preexisting disease. Hospital and ICU stays were not different. Recurrent symptoms (17%) occurred only after ACC in the PD group.


In high-risk patients, PD and EC are both efficient in the resolution of acute cholecystitis sepsis. However, EC is associated with a higher procedure-related morbidity and the laparoscopic approach is not always possible. Percutaneous drainage represents a valuable intervention, but secondary cholecystectomy is mandatory in cases of acute calculous cholecystitis.


Laparoscopic Cholecystectomy Cholecystitis Sequential Organ Failure Assessment Acute Cholecystitis Percutaneous Drainage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Kalliafas S, Ziegler D, Flancbaum L et al (1998) Acute acalculous cholecystitis. Incidence, risk factors, diagnosis, and outcome. Am Surg 64:471–475PubMedGoogle Scholar
  2. 2.
    Laurila J, Syrjälä H, Laurila PA et al (2004) Acute acalculous cholecystitis in critically ill patients. Acta Anaesthesiol Scand 48:986–991PubMedCrossRefGoogle Scholar
  3. 3.
    Cushieri A, Dubois F, Mouiel J et al (1991) The European experience with laparoscopic cholecystectomy. Am J Surg 161:385–387CrossRefGoogle Scholar
  4. 4.
    Wiseman JT, Sharuk MN, Singla A et al (2010) Surgical management of acute cholecystitis at a tertiary care center in the modern era. Arch Surg 145:439–444PubMedCrossRefGoogle Scholar
  5. 5.
    Gurusamy K, Samraj K, Gluud C et al (2010) Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 97:141–150PubMedCrossRefGoogle Scholar
  6. 6.
    Radder RW (1980) Ultrasonography guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging 49:330–333PubMedGoogle Scholar
  7. 7.
    Sugiyama M, Tokuhara M, Atomi Y (1998) Is percutaneous cholecystostomy the optimal treatment for acute cholecystitis in the very elderly? World J Surg 22:459–463PubMedCrossRefGoogle Scholar
  8. 8.
    Davis CA, Landercasper J, Gundersen LH et al (1999) Effective use of percutaneous cholecystostomy in high-risk surgical patients. Arch Surg 134:727–732PubMedCrossRefGoogle Scholar
  9. 9.
    Ghahreman A, McCall JL, Windsor JA (1999) Cholecystostomy: a review of recent experience. Aust N Z J Surg 69:837–840PubMedCrossRefGoogle Scholar
  10. 10.
    Patel M, Miedema BW, James MA et al (2000) Percutaneous cholecystostomy is an effective treatment for high-risk patients with acute cholecystitis. Am Surg 66:33–37PubMedGoogle Scholar
  11. 11.
    Pessaux P, Tuech JJ, Regenet N et al (2000) Laparoscopic cholecystectomy in acute cholecystitis. A prospective comparative study in patients with acute vs. chronic cholecystitis. Surg Endosc 14:358–361PubMedCrossRefGoogle Scholar
  12. 12.
    Chang L, Moonka R, Stelzner M (2000) Percutaneous cholecystostomy for acute cholecystitis in Veteran patients. Am J Surg 150:198–202CrossRefGoogle Scholar
  13. 13.
    Hatzidakis AA, Prassopoulos P, Petinarakis I et al (2002) Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment. Eur Radiol 12(7):1778–1784PubMedCrossRefGoogle Scholar
  14. 14.
    Spira RM, Nissan A, Zamir O et al (2002) Percutaneous cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculous cholecystitis. Am J Surg 183:62–66PubMedCrossRefGoogle Scholar
  15. 15.
    Andren-Sandberg A, Haugsvedt T, Larssen TB et al (2001) Complications and late outcome following percutaneous drainage of the gallbladder in acute calculous cholecystitis. Dig Surg 18:393–398PubMedCrossRefGoogle Scholar
  16. 16.
    Granlund A, Karlson BM, Elvin A et al (2001) Ultrasound guided percutaneous cholecystostomy in high risk surgical patients. Langenbeck’s Arch Surg 386:212–217CrossRefGoogle Scholar
  17. 17.
    Berman M, Nudelman IL, Fuko Z et al (2002) Percutaneous transhepatic cholecystostomy: effective treatment of acute cholecystitis in high risk patients. Isr Med Assoc J 4:331–333PubMedGoogle Scholar
  18. 18.
    Byrne MF, Suhocki P, Mitchell MR et al (2003) Percutaneous cholecystostomy in patients with acute cholecystitis: Experience of 45 patients at a US referral center. J Am Coll Surg 197:206–211PubMedCrossRefGoogle Scholar
  19. 19.
    Li JCM, Lee DWH, Lai CW et al (2004) Percutaneous cholecystostomy for the treatment of acute cholecystitis in the critically ill and elderly. Hong Kong Med J 10(6):389–393PubMedGoogle Scholar
  20. 20.
    Welschbilig-Meunier K, Pessaux P, Lebigot J et al (2005) Percutaneous cholecystostomy for high-risk patients with acute cholecystitis. Surg Endosc 19:1256–1259CrossRefGoogle Scholar
  21. 21.
    Ha JP, Tsui KK, Tang CN et al (2008) Cholecystectomy or not after percutaneous cholecystostomy for acute calculous cholecystitis in high-risk patients. Hepatogastroenterology 55(86–87):1497–1502PubMedGoogle Scholar
  22. 22.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRefGoogle Scholar
  23. 23.
    Rosenberg AL (2002) Recent innovations in intensive care unit risk-prediction models. Curr Opin Crit Care 8:321–333PubMedCrossRefGoogle Scholar
  24. 24.
    Den Boer S, De Keizer NF, De Jonge E (2005) Performance of prognostic models in critically ill cancer patients—a review. Crit Care 9(4):458–463CrossRefGoogle Scholar
  25. 25.
    Knaus WA, Draper EA, Wagner DP et al (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRefGoogle Scholar
  26. 26.
    Lever A, Mackenzie I (2007) Sepsis: definition, epidemiology, and diagnosis. BMJ 335:879–883PubMedCrossRefGoogle Scholar
  27. 27.
    Vincent JL, Moreno R, Takala J et al (1996) The SOFA (Sepsis related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710PubMedCrossRefGoogle Scholar
  28. 28.
    Vincent JL, De Mendonca A, Cantraine F et al (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter prospective study. Crit Care Med 26:1793–1800PubMedGoogle Scholar
  29. 29.
    Sacks D, McClenny TE, Cardella JF et al (2003) Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–S202PubMedGoogle Scholar
  30. 30.
    Vauthey JN, Lerut J, Martini M et al (1993) Indications and limitations of percutaneous cholecystostomy for acute cholecystitis. Surg Gynecol Obstet 176(1):49–54PubMedGoogle Scholar
  31. 31.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefGoogle Scholar
  32. 32.
    Ginat D, Saad WE (2008) Cholecystostomy and transcholecystic biliary access. Tech Vasc Interv Radiol 11(1):2–13PubMedCrossRefGoogle Scholar
  33. 33.
    Winbladh A, Gullstrand P, Svanvik J et al (2009) Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford) 11(3):183–193Google Scholar
  34. 34.
    Eldar S, Sabo E, Nash E et al (1998) Laparoscopic cholecystectomy for the various types of gallbladder inflammation, a prospective trial. Surg Laparosc Endosc 8:200–207PubMedCrossRefGoogle Scholar
  35. 35.
    Singer JA, Mckeen RV (1994) Laparoscopic cholecystectomy for acute or gangrenous cholecystitis. Am Surg 60:326–328PubMedGoogle Scholar
  36. 36.
    Wilson AK, Koszol RA, Salwen WA et al (1994) Gangrenous cholecystitis in an urban VA hospital. J Surg Res 56:402–404PubMedCrossRefGoogle Scholar
  37. 37.
    Merriam LT, Kanaan SA, Dawes LC et al (1999) Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery 126:680–686PubMedCrossRefGoogle Scholar
  38. 38.
    Boggi U, Di Candio G, Campatelli A et al (1999) Percutaneous cholecystostomy for acute cholecystitis in critically ill patients. Hepatogastroenterology 46:121–125PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • E. Melloul
    • 1
  • A. Denys
    • 2
  • N. Demartines
    • 1
    Email author
  • J.-M. Calmes
    • 1
  • M. Schäfer
    • 1
  1. 1.Department of Visceral Surgery and TransplantationUniversity Hospital of Lausanne (CHUV)LausanneSwitzerland
  2. 2.Department of Imaging and Interventional RadiologyUniversity Hospital of LausanneLausanneSwitzerland

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