Cholecystostomy: a Review of Recent Experience

Background: Operative (OC) and percutaneous cholecystostomy (PC) are rarely undertaken for severe acute cholecystitis in patients in whom cholecystectomy is technically difficult or those with significant comorbidity.

Methods: A retrospective review was undertaken of the clinical, radiological and audit records of patients who were treated by cholecystostomy between 1988 and 1997 at Auckland Hospital.

Results: During the 10-year period 19 patients (eight male, 11 female; median age: 70 years, range: 35-90 years) had a cholecystostomy (OC: n = 8; PC: n = 11). The main indication for PC was high anaesthetic risk (10 cases). The main indication for OC was failed cholecystectomy (six cases). The patients undergoing PC tended to have a higher American Society of Anesthesiologists (ASA) grade than patients undergoing OC. The median delay from presentation to cholecystostomy was 3 days. More than half (11/19) were done during the 3 years (1992-94) after the introduction of laparoscopic cholecystectomy. The number of tube-related complications was significantly higher in PC patients (10/11 vs 3/8; P = 0.04), and the number of systemic complications was higher in the OC patients (4/8 vs 0/11; P = 0.018). The median duration of tube drainage was 17 days (range: 0-82 days) for OC and 24 days (range: 5-93 days) for PC. Four patients had stone extraction at the time of OC, including two who also had a partial cholecystectomy. One OC patient had stone extraction via the cholecystostomy tract. A cholecystectomy was performed in four patients.

Conclusion: The data indicate that PC is a safe approach for high-risk patients. Operative cholecystostomy had a role following failed cholecystectomy. But PC might be safer in these patients if they could be identified pre-operatively.