Skip to main content

Percutaneous Cholecystostomy Placement in Cases of Non-operative Cholecystitis: A Retrospective Cohort Analysis

Abstract

Background

Acute (calculous) cholecystitis (AC) is an extremely common surgical presentation, managed by cholecystectomy. Percutaneous cholecystostomy (PC) is an alternative; however, its safety and efficacy, along with subsequent cholecystectomy, are underreported in South Africa, where patients often present late and access to emergency operating theatre is constrained. The aim of the study was to demonstrate the outcomes of PC in patients with AC not responding to antimicrobials.

Materials and methods

A retrospective cohort review of patient records, who underwent PC in Groote Schuur Hospital, Cape Town, between May 2013 and July 2016, was performed. Patients with PC for malignancy or acalculous cholecystitis were excluded. Technical success, clinical response, procedure-related morbidity and mortality were recorded. Interval LC parameters were investigated.

Results

Technical success and clinical improvement was seen in 29 of 37 patients (78.38%) who had PC. Malposition (8.11%) was the most common complication. Two patients required emergency surgery (5.4%), while one tube was dislodged. Median tube placement duration was 25 days (range 1–211). Post-procedure, 16 patients (43.24%) went on to have LC, of which 50% (eight patients) required conversion to open surgery and 25% (four) had subtotal cholecystectomy. Median surgical time was 130 min. There were no procedure-related mortalities but eight patients (21.62%) died in the 90-day period following tube insertion.

Conclusion

In patients with AC, PC is safe, with high technical success and low complication rate. Subsequent cholecystectomy should be performed, but is usually challenging. The requirement for PC may predict a more complex disease process.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. 1.

    Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G et al (2018) Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 25(1):41–54

    Article  PubMed  Google Scholar 

  2. 2.

    Miura F, Okamoto K, Takada T, Strasberg SM, Asbun HJ, Pitt HA et al (2018) Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci 25(1):31–40

    Article  PubMed  Google Scholar 

  3. 3.

    Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA et al (2018) Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 25(1):87–95

    Article  PubMed  Google Scholar 

  4. 4.

    Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I et al (2018) Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci 25(1):55–72

    Article  PubMed  Google Scholar 

  5. 5.

    Aroori S, Mangan C, Reza L, Gafoor N (2018) Percutaneous cholecystostomy for severe acute cholecystitis: a useful procedure in high-risk patients for surgery. Scand J Surg 108:124–129

    Article  PubMed  Google Scholar 

  6. 6.

    Cha BH, Song HH, Kim YN, Jeon WJ, Lee SJ, Kim JD et al (2014) Percutaneous cholecystostomy is appropriate as definitive treatment for acute cholecystitis in critically ill patients: a single center, cross-sectional study. Korean J Gastroenterol 63(1):32–38

    Article  PubMed  Google Scholar 

  7. 7.

    Chang YR, Ahn YJ, Jang JY, Kang MJ, Kwon W, Jung WH et al (2014) Percutaneous cholecystostomy for acute cholecystitis in patients with high comorbidity and re-evaluation of treatment efficacy. Surgery 155(4):615–622

    Article  PubMed  Google Scholar 

  8. 8.

    Cherng N, Witkowski ET, Sneider EB, Wiseman JT, Lewis J, Litwin DE et al (2012) Use of cholecystostomy tubes in the management of patients with primary diagnosis of acute cholecystitis. J Am Coll Surg 214(2):196–201

    Article  PubMed  Google Scholar 

  9. 9.

    Chou CK, Lee KC, Chan CC, Perng CL, Chen CK, Fang WL et al (2015) Early percutaneous cholecystostomy in severe acute cholecystitis reduces the complication rate and duration of hospital stay. Medicine (Baltimore) 94(27):e1096

    Article  Google Scholar 

  10. 10.

    Horn T, Christensen SD, Kirkegard J, Larsen LP, Knudsen AR, Mortensen FV (2015) Percutaneous cholecystostomy is an effective treatment option for acute calculous cholecystitis: a 10-year experience. HPB (Oxford) 17(4):326–331

    Article  Google Scholar 

  11. 11.

    Howard JM, Hanly AM, Keogan M, Ryan M, Reynolds JV (2009) Percutaneous cholecystostomy—a safe option in the management of acute biliary sepsis in the elderly. Int J Surg 7(2):94–99

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Kamer E, Cengiz F, Cakir V, Balli O, Acar T, Peskersoy M et al (2017) Percutaneous cholecystostomy for delayed laparoscopic cholecystectomy in patients with acute cholecystitis: analysis of a single-centre experience and literature review. Prz Gastroenterol 12(4):250–255

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Li JC, Lee DW, Lai CW, Li AC, Chu DW, Chan AC (2004) Percutaneous cholecystostomy for the treatment of acute cholecystitis in the critically ill and elderly. Hong Kong Med J 10(6):389–393

    CAS  PubMed  Google Scholar 

  14. 14.

    Al-Jundi W, Cannon T, Antakia R, Anoop U, Balamurugan R, Everitt N et al (2012) Percutaneous cholecystostomy as an alternative to cholecystectomy in high risk patients with biliary sepsis: a district general hospital experience. Ann R Coll Surg Engl 94(2):99–101

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Ambe PC, Zirngibl H (2016) The fate of patients managed with percutaneous cholecystostomy for acute cholecystitis. Surgery 159(5):1479–1480

    Article  Google Scholar 

  16. 16.

    Byrne MF, Suhocki P, Mitchell RM, Pappas TN, Stiffler HL, Jowell PS et al (2003) Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center. J Am Coll Surg 197(2):206–211

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Rodriguez-Sanjuan JC, Arruabarrena A, Sanchez-Moreno L, Gonzalez-Sanchez F, Herrera LA, Gomez-Fleitas M (2012) Acute cholecystitis in high surgical risk patients: percutaneous cholecystostomy or emergency cholecystectomy? Am J Surg 204(1):54–59

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Stanek A, Dohan A, Barkun J, Barkun A, Reinhold C, Valenti D et al (2018) Percutaneous cholecystostomy: a simple bridge to surgery or an alternative option for the management of acute cholecystitis? Am J Surg 216(3):595–603

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Zehetner J, Degnera E, Olasky J, Mason RA, Drangsholt S, Moazzez A et al (2014) Percutaneous cholecystostomy versus laparoscopic cholecystectomy in patients with acute cholecystitis and failed conservative management: a matched-pair analysis. Surg Laparosc Endosc Percutan Tech 24(6):523–527

    PubMed  PubMed Central  Google Scholar 

  20. 20.

    Takada T (2018) Tokyo Guidelines 2018: updated Tokyo Guidelines for the management of acute cholangitis/acute cholecystitis. J Hepatobiliary Pancreat Sci 25(1):1–2

    Article  PubMed  Google Scholar 

  21. 21.

    Loozen CS, Van Santvoort HC, Van Duijvendijk P, Besselink MG, Gouma DJ, Nieuwenhuijzen GA et al (2018) Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial. BMJ 363:k3965

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Chok KS, Chu FS, Cheung TT, Lam VW, Yuen WK, Ng KK et al (2010) Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis. ANZ J Surg 80(4):280–283

    Article  PubMed  Google Scholar 

  23. 23.

    Teoh WM, Cade RJ, Banting SW, Mackay S, Hassen AS (2005) Percutaneous cholecystostomy in the management of acute cholecystitis. ANZ J Surg 75(6):396–398

    Article  PubMed  Google Scholar 

  24. 24.

    Pinto A, Reginelli A, Cagini L, Coppolino F, Stabile Ianora AA, Bracale R et al (2013) Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature. Crit Ultrasound J 5(Suppl 1):S11

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Wang CH, Wu CY, Yang JC, Lien WC, Wang HP, Liu KL et al (2016) Long-term outcomes of patients with acute cholecystitis after successful percutaneous cholecystostomy treatment and the risk factors for recurrence: a decade experience at a single center. PLoS ONE 11(1):e0148017

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Nikfarjam M, Harnaen E, Tufail F, Muralidharan V, Fink MA, Starkey G et al (2013) Sex differences and outcomes of management of acute cholecystitis. Surg Laparosc Endosc Percutan Tech 23(1):61–65

    Article  PubMed  Google Scholar 

  27. 27.

    Figueiredo JC, Haiman C, Porcel J, Buxbaum J, Stram D, Tambe N et al (2017) Sex and ethnic/racial-specific risk factors for gallbladder disease. BMC Gastroenterol 17(1):153

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Novacek G (2006) Gender and gallstone disease. Wien Med Wochenschr 156(19–20):527–533

    Article  PubMed  Google Scholar 

  29. 29.

    Mayumi T, Okamoto K, Takada T, Strasberg SM, Solomkin JS, Schlossberg D et al (2018) Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 25(1):96–100

    Article  PubMed  Google Scholar 

  30. 30.

    Yang K, Luk W, Cho D, Loke T, Chan J (2005) A comparison of direct gallbladder puncture with the transhepatic puncture technique in ultrasound-guided cholecystostomy for high surgical risk patients with acute calculous cholecystitis. Hong Kong Coll Radiol 8:222–225

    Google Scholar 

  31. 31.

    Sanjay P, Mittapalli D, Marioud A, White RD, Ram R, Alijani A (2013) Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. HPB (Oxford) 15(7):511–516

    Article  Google Scholar 

  32. 32.

    van Overhagen H, Meyers H, Tilanus HW, Jeekel J, Lameris JS (1996) Percutaneous cholecystectomy for patients with acute cholecystitis and an increased surgical risk. Cardiovasc Intervent Radiol 19(2):72–76

    Article  PubMed  Google Scholar 

  33. 33.

    Beland MD, Patel L, Ahn SH, Grand DJ (2019) Image-guided cholecystostomy tube placement: short- and long-term outcomes of transhepatic versus transperitoneal placement. AJR Am J Roentgenol 212(1):201–204

    Article  PubMed  Google Scholar 

  34. 34.

    Loberant N, Notes Y, Eitan A, Yakir O, Bickel A (2010) Comparison of early outcome from transperitoneal versus transhepatic percutaneous cholecystostomy. Hepatogastroenterology 57(97):12–17

    PubMed  Google Scholar 

  35. 35.

    Winbladh A, Gullstrand P, Svanvik J, Sandstrom P (2009) Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford) 11(3):183–193

    Article  Google Scholar 

  36. 36.

    Akhan O, Akinci D, Ozmen MN (2002) Percutaneous cholecystostomy. Eur J Radiol 43(3):229–236

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Little MW, Briggs JH, Tapping CR, Bratby MJ, Anthony S, Phillips-Hughes J et al (2013) Percutaneous cholecystostomy: the radiologist’s role in treating acute cholecystitis. Clin Radiol 68(7):654–660

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Venara A, Carretier V, Lebigot J, Lermite E (2014) Technique and indications of percutaneous cholecystostomy in the management of cholecystitis in 2014. J Visc Surg 151(6):435–439

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No financial support was received for this research.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Karan Gandhi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was performed according to a protocol approved by the Human Research Ethics Committee (HREC), of the Health Sciences Faculty, University of Cape Town, South Africa. HREC Ref: 526/2016.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gandhi, K., Du Plessis, R., Klopper, J. et al. Percutaneous Cholecystostomy Placement in Cases of Non-operative Cholecystitis: A Retrospective Cohort Analysis. World J Surg 44, 4077–4085 (2020). https://doi.org/10.1007/s00268-020-05752-3

Download citation