Skip to main content
Erschienen in: World Journal of Surgery 8/2020

07.04.2020 | Original Scientific Report

Retrospective Analysis of Outcomes Following Percutaneous Cholecystostomy for Acute Cholecystitis

verfasst von: L. L. Kuan, T. Oyebola, A. Mavilakandy, A. R. Dennison, G. Garcea

Erschienen in: World Journal of Surgery | Ausgabe 8/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

Percutaneous cholecystostomy (PC) is often performed for patients with acute cholecystitis who are too high risk for cholecystectomy. The purpose of this retrospective study was to evaluate the outcomes of this cohort of patients over a 5-year period.

Methods

A retrospective analysis of all patients treated with PC for acute cholecystitis in a tertiary centre teaching hospital was conducted. The study period ranged from January 2010 to December 2015. Clinical data were extracted from the hospitals′ electronic database system, as well as reviewing clinical notes and imaging reports. The aims of this study were to detect the reason PC was undertaken as opposed to surgery, the subsequent definitive management of patients initially treated with PC, the incidence of common bile duct stones (CBDS), the complications from PC, and the 30-day mortality.

Results

A total of 96 patients were identified. The total number of patients with CBDS was 27 (28.1%). Fourteen (14.6%) patients were shown to have CBDS on initial imaging. CBDS was detected in 12 patients (12.5%) at cholangiogram during their PC procedure. One patient had CBDS detected during a check cholangiogram at 6 weeks, which was not seen on initial imaging. Twenty-eight patients (29.2%) underwent an endoscopic retrograde cholangiopancreatography (ERCP), during their index admission. The main reasons for PC were a high American Society of Anaesthesiologists (ASA) score (49%), sepsis requiring organ support (19.8%), empyema of the gallbladder (29.1%), failed external biliary drainage for biliary obstruction (2.1%), and concomitant palliative malignancy (5.2%). Interval cholecystectomy was performed in 24 patients (25%). The total 30-day in-hospital mortality was 16.7%.

Conclusion

PC is an effective and safe alternative as salvage therapy in high-risk elderly patients who have multiple comorbidities. It is valuable as a temporising measure before definitive treatment in high-risk patients. A high index of suspicion for CBDS (and further imaging with MRCP or a check cholangiogram) is warranted to detect missed CBDS. This is particularly relevant in this vulnerable group of patients where CBDS may represent a future source of recurrent sepsis.
Literatur
1.
Zurück zum Zitat Wadhwa V, Jobanputra Y, Garg SK, Patwardhan S, Mehta D, Sanaka MR (2017) Nationwide trends of hospital admissions for acute cholecystitis in the United States. Gastroenterol Rep 5(1):36–42CrossRef Wadhwa V, Jobanputra Y, Garg SK, Patwardhan S, Mehta D, Sanaka MR (2017) Nationwide trends of hospital admissions for acute cholecystitis in the United States. Gastroenterol Rep 5(1):36–42CrossRef
2.
Zurück zum Zitat Loozen CS, Van Ramshorst B, Van Santvoort HC, Boerma D (2017) Early cholecystectomy for acute cholecystitis in the elderly population: a systematic review and meta-analysis. Dig Surg 34(5):371–379 Loozen CS, Van Ramshorst B, Van Santvoort HC, Boerma D (2017) Early cholecystectomy for acute cholecystitis in the elderly population: a systematic review and meta-analysis. Dig Surg 34(5):371–379
3.
Zurück zum Zitat Schirmer BD, Winters KL, Edlich RF (2005) Cholelithiasis and cholecystitis. J Long Term Eff Med Implants 15(3):329–338CrossRef Schirmer BD, Winters KL, Edlich RF (2005) Cholelithiasis and cholecystitis. J Long Term Eff Med Implants 15(3):329–338CrossRef
4.
Zurück zum Zitat Williams E, Beckingham I, El Sayed G, Gurusamy K, Sturgess R, Webster G et al (2017) Updated guideline on the management of common bile duct stones (CBDS). Gut 66(5):765–782 Williams E, Beckingham I, El Sayed G, Gurusamy K, Sturgess R, Webster G et al (2017) Updated guideline on the management of common bile duct stones (CBDS). Gut 66(5):765–782
5.
Zurück zum Zitat Lammert F, Miquel J-F (2008) Gallstone disease: from genes to evidence-based therapy. J Hepatol 48(Suppl 1):S124–S135CrossRef Lammert F, Miquel J-F (2008) Gallstone disease: from genes to evidence-based therapy. J Hepatol 48(Suppl 1):S124–S135CrossRef
6.
Zurück zum Zitat Escartín A, González M, Cuello E, Pinillos A, Muriel P, Merichal M et al (2019) Acute cholecystitis in very elderly patients: disease management, outcomes, and risk factors for complications. Surg Res Pract 2019:9709242PubMedPubMedCentral Escartín A, González M, Cuello E, Pinillos A, Muriel P, Merichal M et al (2019) Acute cholecystitis in very elderly patients: disease management, outcomes, and risk factors for complications. Surg Res Pract 2019:9709242PubMedPubMedCentral
7.
Zurück zum Zitat Agrawal R, Sood KC, Agarwal B (2015) Evaluation of early versus delayed laparoscopic cholecystectomy in acute cholecystitis. Surg Res Pract 2015:349801PubMedPubMedCentral Agrawal R, Sood KC, Agarwal B (2015) Evaluation of early versus delayed laparoscopic cholecystectomy in acute cholecystitis. Surg Res Pract 2015:349801PubMedPubMedCentral
8.
Zurück zum Zitat Serralta AS, Bueno JL, Planells MR, Rodero DR (2003) Prospective evaluation of emergency versus delayed laparoscopic cholecystectomy for early cholecystitis. Surg Laparosc Endosc Percutan Tech 13(2):71–75CrossRef Serralta AS, Bueno JL, Planells MR, Rodero DR (2003) Prospective evaluation of emergency versus delayed laparoscopic cholecystectomy for early cholecystitis. Surg Laparosc Endosc Percutan Tech 13(2):71–75CrossRef
9.
Zurück zum Zitat Beliaev AM, Booth M (2016) An association between conversion of laparoscopic cholecystectomy to open surgery and intra‐abdominal organ injury. ANZ J Surg 86(7-8):625 Beliaev AM, Booth M (2016) An association between conversion of laparoscopic cholecystectomy to open surgery and intra‐abdominal organ injury. ANZ J Surg 86(7-8):625
10.
Zurück zum Zitat Papadakis M, Ambe PC, Zirngibl H (2015) Critically ill patients with acute cholecystitis are at increased risk for extensive gallbladder inflammation. World J Emerg Surg 10:59CrossRef Papadakis M, Ambe PC, Zirngibl H (2015) Critically ill patients with acute cholecystitis are at increased risk for extensive gallbladder inflammation. World J Emerg Surg 10:59CrossRef
11.
Zurück zum Zitat Haltmeier T, Benjamin E, Inaba K, Lam L, Demetriades D (2015) Early versus delayed same-admission laparoscopic cholecystectomy for acute cholecystitis in elderly patients with comorbidities. J Trauma Acute Care Surg 78(4):801–807CrossRef Haltmeier T, Benjamin E, Inaba K, Lam L, Demetriades D (2015) Early versus delayed same-admission laparoscopic cholecystectomy for acute cholecystitis in elderly patients with comorbidities. J Trauma Acute Care Surg 78(4):801–807CrossRef
12.
Zurück zum Zitat 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):55–72CrossRef 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):55–72CrossRef
13.
Zurück zum Zitat Akyürek N, Salman B, Yüksel O, Tezcaner T, Irkörücü O, Yücel C et al (2005) Management of acute calculous cholecystitis in high-risk patients: percutaneous cholecystotomy followed by early laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 15(6):315–320CrossRef Akyürek N, Salman B, Yüksel O, Tezcaner T, Irkörücü O, Yücel C et al (2005) Management of acute calculous cholecystitis in high-risk patients: percutaneous cholecystotomy followed by early laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 15(6):315–320CrossRef
14.
Zurück zum Zitat Winbladh A, Gullstrand P, Svanvik J, Sandström P (2009) Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford) 11(3):183–193CrossRef Winbladh A, Gullstrand P, Svanvik J, Sandström P (2009) Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford) 11(3):183–193CrossRef
15.
Zurück zum Zitat Sparkman RS (1967) Bobbs centennial: the first cholecystotomy. Surgery 61(6):965–971PubMed Sparkman RS (1967) Bobbs centennial: the first cholecystotomy. Surgery 61(6):965–971PubMed
16.
Zurück zum Zitat Hardy KJ (1993) Carl Langenbuch and the Lazarus Hospital: events and circumstances surrounding the first cholecystectomy. Aust N Z J Surg 63(1):56–64CrossRef Hardy KJ (1993) Carl Langenbuch and the Lazarus Hospital: events and circumstances surrounding the first cholecystectomy. Aust N Z J Surg 63(1):56–64CrossRef
17.
Zurück zum Zitat Elyaderani M, Gabriele OF (1979) Percutaneous cholecystostomy and cholangiography in patients with obstructive jaundice. Radiology 130(3):601–602CrossRef Elyaderani M, Gabriele OF (1979) Percutaneous cholecystostomy and cholangiography in patients with obstructive jaundice. Radiology 130(3):601–602CrossRef
18.
Zurück zum Zitat Radder RW (1982) Percutaneous cholecystostomy. AJR Am J Roentgenol 139(6):1240–1241CrossRef Radder RW (1982) Percutaneous cholecystostomy. AJR Am J Roentgenol 139(6):1240–1241CrossRef
19.
Zurück zum Zitat Shaver RW, Hawkins IF Jr, Soong J (1982) Percutaneous cholecystostomy. AJR Am J Roentgenol 138(6):1133–1136CrossRef Shaver RW, Hawkins IF Jr, Soong J (1982) Percutaneous cholecystostomy. AJR Am J Roentgenol 138(6):1133–1136CrossRef
20.
Zurück zum Zitat Ren Z, Xu Y, Zhu S (2012) Percutaneous transhepatic cholecystostomy for choledocholithiasis with acute cholangitis in high-risk patients. Hepatogastroenterology 59(114):329–331CrossRef Ren Z, Xu Y, Zhu S (2012) Percutaneous transhepatic cholecystostomy for choledocholithiasis with acute cholangitis in high-risk patients. Hepatogastroenterology 59(114):329–331CrossRef
21.
Zurück zum Zitat Hamy A, Visset J, Likholatnikov D, Lerat F, Gibaud H, Savigny B et al (1997) Percutaneous cholecystostomy for acute cholecystitis in critically ill patients. Surgery 121(4):398–401CrossRef Hamy A, Visset J, Likholatnikov D, Lerat F, Gibaud H, Savigny B et al (1997) Percutaneous cholecystostomy for acute cholecystitis in critically ill patients. Surgery 121(4):398–401CrossRef
22.
Zurück zum Zitat Borzellino G, De Manzoni G, Ricci F, Castaldini G, Guglielmi A, Cordiano C (1999) Emergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly. Br J Surg 86(12):1521–1525CrossRef Borzellino G, De Manzoni G, Ricci F, Castaldini G, Guglielmi A, Cordiano C (1999) Emergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly. Br J Surg 86(12):1521–1525CrossRef
23.
Zurück zum Zitat Sugiyama M, Tokuhara M, Atomi Y (1998) Is percutaneous cholecystostomy the optimal treatment for acute cholecystitis in the very elderly? World J Surg 22(5):459–463CrossRef Sugiyama M, Tokuhara M, Atomi Y (1998) Is percutaneous cholecystostomy the optimal treatment for acute cholecystitis in the very elderly? World J Surg 22(5):459–463CrossRef
24.
Zurück zum Zitat Furtado R, Le Page P, Dunn G, Falk GL (2016) High rate of common bile duct stones and postoperative abscess following percutaneous cholecystostomy. Ann R Coll Surg Engl 98(2):102–106 Furtado R, Le Page P, Dunn G, Falk GL (2016) High rate of common bile duct stones and postoperative abscess following percutaneous cholecystostomy. Ann R Coll Surg Engl 98(2):102–106
25.
Zurück zum Zitat Loftus TJ, Brakenridge SC, Moore FA, Dessaigne CG, Sarosi GA, Zingarelli WJ et al (2017) Routine surveillance cholangiography after percutaneous cholecystostomy delays drain removal and cholecystectomy. J Trauma Acute Care Surg 82(2):351–355CrossRef Loftus TJ, Brakenridge SC, Moore FA, Dessaigne CG, Sarosi GA, Zingarelli WJ et al (2017) Routine surveillance cholangiography after percutaneous cholecystostomy delays drain removal and cholecystectomy. J Trauma Acute Care Surg 82(2):351–355CrossRef
26.
Zurück zum Zitat Kharbutli B, Velanovich V (2008) Management of preoperatively suspected choledocholithiasis: a decision analysis. J Gastrointest Surg 12(11):1973–1980CrossRef Kharbutli B, Velanovich V (2008) Management of preoperatively suspected choledocholithiasis: a decision analysis. J Gastrointest Surg 12(11):1973–1980CrossRef
27.
Zurück zum Zitat Barteau JA, Castro D, Arregui ME, Tetik C (1995) A comparison of intraoperative ultrasound versus cholangiography in the evaluation of the common bile duct during laparoscopic cholecystectomy. Surg Endosc 9(5):490–496CrossRef Barteau JA, Castro D, Arregui ME, Tetik C (1995) A comparison of intraoperative ultrasound versus cholangiography in the evaluation of the common bile duct during laparoscopic cholecystectomy. Surg Endosc 9(5):490–496CrossRef
28.
Zurück zum Zitat Jung G-S, Kim YJ, Yun JH, Park JG, Yun BC, Han BH et al (2019) Percutaneous transcholecystic removal of common bile duct stones: case series in 114 patients. Radiology 290(1):238–243CrossRef Jung G-S, Kim YJ, Yun JH, Park JG, Yun BC, Han BH et al (2019) Percutaneous transcholecystic removal of common bile duct stones: case series in 114 patients. Radiology 290(1):238–243CrossRef
29.
Zurück zum Zitat Li YL, Wong KH, Chiu KWH, Cheng AKC, Cheung RKO, Yam MKH et al (2018) Percutaneous cholecystostomy for high-risk patients with acute cholangitis. Medicine (Baltimore) 97(19):e0735 Li YL, Wong KH, Chiu KWH, Cheng AKC, Cheung RKO, Yam MKH et al (2018) Percutaneous cholecystostomy for high-risk patients with acute cholangitis. Medicine (Baltimore) 97(19):e0735
30.
Zurück zum Zitat Szary NM, Al-Kawas FH (2013) Complications of endoscopic retrograde cholangiopancreatography: how to avoid and manage them. Gastroenterol Hepatol (N Y) 9(8):496–504 Szary NM, Al-Kawas FH (2013) Complications of endoscopic retrograde cholangiopancreatography: how to avoid and manage them. Gastroenterol Hepatol (N Y) 9(8):496–504
31.
Zurück zum Zitat 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:k3965CrossRef 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:k3965CrossRef
32.
Zurück zum Zitat Park JK, Yang J Il, Wi JW, Park JK, Lee KH, Lee KT, et al (2019) Long-term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis. J Gastroenterol Hepatol 34(4):784–90 Park JK, Yang J Il, Wi JW, Park JK, Lee KH, Lee KT, et al (2019) Long-term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis. J Gastroenterol Hepatol 34(4):784–90
33.
Zurück zum Zitat Fukami Y, Kurumiya Y, Mizuno K, Sekoguchi E, Kobayashi S (2014) Cholecystectomy in octogenarians: be careful. Updates Surg 66(4):265–268CrossRef Fukami Y, Kurumiya Y, Mizuno K, Sekoguchi E, Kobayashi S (2014) Cholecystectomy in octogenarians: be careful. Updates Surg 66(4):265–268CrossRef
34.
Zurück zum Zitat Nikfarjam M, Yeo D, Perini M, Fink MA, Muralidharan V, Starkey G et al (2014) Outcomes of cholecystectomy for treatment of acute cholecystitis in octogenarians. ANZ J Surg 84(12):943–948CrossRef Nikfarjam M, Yeo D, Perini M, Fink MA, Muralidharan V, Starkey G et al (2014) Outcomes of cholecystectomy for treatment of acute cholecystitis in octogenarians. ANZ J Surg 84(12):943–948CrossRef
Metadaten
Titel
Retrospective Analysis of Outcomes Following Percutaneous Cholecystostomy for Acute Cholecystitis
verfasst von
L. L. Kuan
T. Oyebola
A. Mavilakandy
A. R. Dennison
G. Garcea
Publikationsdatum
07.04.2020
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 8/2020
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-020-05491-5

Weitere Artikel der Ausgabe 8/2020

World Journal of Surgery 8/2020 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.