Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis – A tertiary center experience

Abstract

Background: In surgically high-risk patients with acute cholecystitis (AC), percutaneous cholecystostomy (PC) is an effective procedure. This study aimed to study the clinical outcomes of PC and to assess predictors for recurrence following PC placement. Methodology: A retrospective data review of all patients who underwent a PC for AC between 2010 and 2020 was performed. Results: Seventy-one patients underwent a PC with a mean age of 61.35 years (standard deviation: 14.11); 59 (83.1%) were male; 32 (45.1%) were the American Society of Anesthesiologists III and IV. Forty (56.3%) patients had multiple comorbid illnesses; 70 (98.6%) patients had Grade 2, 3 cholecystitis. All patients had ultrasound-guided drainage; 63 (88.7%) had transhepatic route. The mean duration till PC removal was 51.58 (1–313) days. Eleven (15.5%) patients developed recurrence after PC placement over a median of 40 (29–102) days; 6 (54.5%) were managed nonoperatively, 3 (27%) underwent laparoscopic cholecystectomy, and 2 (18%) developed cholangitis. After index admission with AC managed by PC, thirty-nine (54.9%) patients underwent cholecystectomy; 4(5.6%) at the index admission, 35 (49.3%) elective interval cholecystectomies. The rate of conversion to open at interval cholecystectomy among patients with no recurrence in the interval period was 31.88% (7/22), and 50% for patients with recurrent AC. Five (7.04%) patients had mortality at the index admission, and the overall 1-year mortality was 8.45% (6/71). Conclusion: A high clinical success rate and less procedure-related morbidity make PC a favorable procedure in surgically high-risk patients. Patients with a recurrent episode of AC were found to have higher rates of conversion at interval cholecystectomy. No specific predictor for recurrence was identified.