Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. Issue 7 (19th November 2012)

• Record Type: Journal Article
• Authors: Sanjay, Pandanaboyana; Mittapalli, Devender; Marioud, Aseel; White, Richard D; Ram, Rishi; Alijani, Afshin
• Is Part Of: HPB. Volume 15:Issue 7(2013:Jul.)
• Page Start: 511
• Page End: 516
• Publication Date: 2012-11-19
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/j.1477-2574.2012.00610.x
• Languages: English
• ISSNs: 1365-182X

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="hpb610-sec-0001" sec-type="section"> <title>Background</title> <p>The aim of this study was to review a series of consecutive percutaneous cholecystostomies (PC) to analyse the clinical outcomes.</p> </sec> <sec id="hpb610-sec-0002" sec-type="section"> <title>Methods</title> <p>All patients who underwent a PC between 2000 and 2010 were reviewed retrospectively for indications, complications, and short‐ and long‐term outcomes.</p> </sec> <sec id="hpb610-sec-0003" sec-type="section"> <title>Results</title> <p>Fifty‐three patients underwent a PC with a median age was 74 years (range 14–93). 92.4% (<italic>n</italic> = 49) of patients were American Society of Anesthesiologists (ASA) III and IV. 82% (43/53) had ultrasound‐guided drainage whereas 18% (10/53) had computed tomography (CT)‐guided drainage. 71.6% (<italic>n</italic> = 38) of PC's employed a transhepatic route and 28.4% (<italic>n</italic> = 15) transabdominal route. 13% (7/53) of patients developed complications including bile leaks (<italic>n</italic> = 5), haemorrhage (<italic>n</italic> = 1) and a duodenal fistula (<italic>n</italic> = 1). All bile leaks were noted with transabdominal access (5 versus 0, <italic>P</italic> = 0.001). 18/53 of patients underwent a cholecystectomy of 4/18 was done on the index admission. 6/18 cholecystectomies (33%) underwent a laparoscopic cholecystectomy and the remaining required conversion to an open cholecystectomy (67%). 13/53 (22%) patients were readmitted with recurrent cholecystitis during follow‐up of which 7 (54%) had a repeated PC. 12/53 patients died on the index admission. The overall 1‐year mortality was 37.7% (20/53).</p> </sec> <sec id="hpb610-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Only a small fraction of patients undergoing a PC proceed to a cholecystectomy with a high risk of conversion to an open procedure. A quarter of patients presented with recurrent cholecystitis during follow‐up. The mortality rate is high during the index admission from sepsis and within the 1 year of follow‐up from other causes.</p> </sec> </abstract>