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

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

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Funding

No financial support was received for this research.

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Authors and Affiliations

  1. Acute Care Surgery Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Anzio Road, Observatory 7925, Cape Town, South Africa

    Karan Gandhi, Rimon Du Plessis, Juan Klopper & Christo Kloppers

  2. Surgical Gastroenterology Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Cape Town, South Africa

    Karan Gandhi & Christo Kloppers

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  1. Karan Gandhi
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  2. Rimon Du Plessis
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  4. Christo Kloppers
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Correspondence to Karan Gandhi.

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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.

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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

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  • DOI: https://doi.org/10.1007/s00268-020-05752-3

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