World Journal of Surgery

, Volume 40, Issue 11, pp 2735–2744 | Cite as

Outcomes of Percutaneous Cholecystostomy for Acute Cholecystitis

  • Khang Wen Pang
  • Chun Han Nigel Tan
  • Stanley Loh
  • Kin Yong Stephen Chang
  • Shridhar Ganpathi Iyer
  • Krishnakumar Madhavan
  • Wei Chieh Alfred Kow
Original Scientific Report
First Online:

Abstract

Background

Acute cholecystitis (AC) is an important cause of emergency admissions among the elderly. The use of percutaneous cholecystostomy (PC) as bridging therapy among high-risk patients is widely accepted. However, the use of PC as definitive treatment is controversial.

Aim

To determine the characteristics, clinical outcomes and predictors of recurrence of AC among patients who underwent PC.

Methods

A retrospective case series of 71 consecutive patients [73 (38–96) years, 43/71 males] treated with PC for AC at a tertiary hospital from 2007 to 2013, with data collected from case records.

Results

Patients were followed up for 37.0 (0.1–110.8) months after PC. Mortality rate was 8.5 % (6/71) during the index admission and 32.4 % (23/71) at the end of follow-up. Recurrence rate for AC was 11.9 % (7/59). Median time to recurrence was 62 (13–464) days. PC was definitive treatment in 33/59. Predictors of recurrence were higher serum alkaline phosphatase (ALP) at diagnosis (OR = 1.01, 95 % CI 1.00–1.02, p = 0.021) and acute myocardial infarction (AMI) during index admission (OR = 8.00, 95 % CI 1.19–54.0, p = 0.033). Fifteen patients (26.3 %, 15/71) had post-procedural complications including dislodgement (14 %, 10/71), tube obstruction (7.0 %, 5/71), bile leaks (2.8 %, 2/71), gallbladder perforation (1.4 %, 1/71), bowels perforation (1.4 %, 1/71) and severe post-procedural haemorrhage (1.4 %, 1/71).

Conclusion

PC is effective and relatively safe in high-risk patients with AC. However, patients with higher ALP or AMI during index admission have higher risk of recurrence and might benefit from definitive cholecystectomy.

Keywords

Laparoscopic Cholecystectomy Acute Myocardial Infarction Acute Cholecystitis Index Admission Acalculous Cholecystitis 
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.
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Notes

Acknowledgments

Funding

There were no sources of funding used for research and/or publication.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

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Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • Khang Wen Pang
    • 1
  • Chun Han Nigel Tan
    • 1
  • Stanley Loh
    • 2
  • Kin Yong Stephen Chang
    • 1
  • Shridhar Ganpathi Iyer
    • 1
  • Krishnakumar Madhavan
    • 1
  • Wei Chieh Alfred Kow
    • 1
  1. 1.Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Health System SingaporeNational University of SingaporeSingaporeSingapore
  2. 2.Department of Diagnostic ImagingNational University HospitalSingaporeSingapore

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