Emerging indications for percutaneous cholecystostomy for the management of acute cholecystitis - A retrospective review

Acute cholecystitis is a frequent cause of general surgical admissions with a mortality risk that is related to the age of the patient. Percutaneous cholecystostomy (PC) has been used as a bridging technique while awaiting resolution of sepsis. We evaluated the outcome of our study population following percutaneous cholecystostomy for acute cholecystitis due to benign etiologies. Methods: Retrospective review of patients undergoing PC from January 1988 to December 2008. Patients were reviewed for demographic features, co-morbidity, resolution of symptoms, hospital stay, outcome, complications and ASA class. Results: 62 patients underwent PC for acute cholecystitis. 49 patients had calculous cholecystitis. 61% (n = 38) were ≥60 years old. 92% had resolution of symptoms within 48 h, and 8% had partial or no resolution. 84% had a decline in total leucocyte counts. The mean hospital stay was 10.6 days and 30-day mortality was 15%. 69% patients had no post-procedure complication. Of the remainder, 1 patient had post-procedure hemorrhage and the remaining developed complications that included pneumonia, hypotension and vasovagal reactions. The duration of drainage ranged from 1 to 3 months. 3 patients underwent emergency cholecystectomy during the same admission, 20 patients underwent interval cholecystectomy. 22 patients had no further intervention and had no recurrent symptoms, of these 73% (n = 16) had calculous cholecystitis. In this sub-group of non-operated patients, 76% were ASA III & IV. Conclusions: PC is a low risk management option for high risk patients with acute cholecystitis. It can be used as a temporizing measure while awaiting resolution of sepsis and optimization of co-morbidities, or as a definitive therapeutic option for acalculous cholecystitis. We also conclude that it has a good potential to be used as a definitive therapy for high risk (ASAIII & IV) patients with acute calculous cholecystitis.