High Rate of Common Bile Duct Stones and Postoperative Abscess Following Percutaneous Cholecystostomy

Overview

Journal Ann R Coll Surg Engl

Specialty General Surgery

Date 2016 Jan 8

PMID 26741665

Citations 3

Authors

R Furtado

P Le Page

G Dunn

G L Falk

Affiliations

Soon will be listed here.

Abstract

Introduction: The short and long-term outcomes in patients managed with percutaneous cholecystostomy (PCY) at a single institution are described.

Methods: A retrospective study was conducted for patients treated between February 2000 and November 2012. Patient charts, imaging and biochemical data were reviewed. Patient demographics, presenting clinical features and treatment variables were noted. Outcome variables were length of admission, 30-day mortality, 30-day unplanned readmission, tube dislodgement, abscess formation, subsequent endoscopic retrograde cholangiography and surgery, complications after surgery and median overall survival.

Results: PCY was performed for 55 patients for acute cholecystitis where surgical risk was very high. The 30-day readmission rate was 20% (n=11), the 30-day mortality rate was 9% (n=5) and median survival was 59 months (95% confidence interval: 30-88 months). The median follow-up duration was 68 months. Tubes were dislodged in 15 patients (27%) and an abscess occurred after PCY in 5 patients (9%). Subsequent endoscopic common bile duct stone extraction was required in 20 patients (36%). Cholecystectomy was planned in 22 patients and an abscess occurred following the cholecystectomy in 5 (23%).

Conclusions: Although a PCY is lifesaving, significant morbidity can arise during recovery. This study demonstrates a high rate of choledocholithiasis (44%), tube dislodgement (27%) and postoperative abscess (23%) compared with previous reports.

Citing Articles

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References

Borzellino G, De Manzoni G, Ricci F, Castaldini G, Guglielmi A, Cordiano C . Emergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly. Br J Surg. 1999; 86(12):1521-5. DOI: 10.1046/j.1365-2168.1999.01284.x. View

Schemper M, Smith T . A note on quantifying follow-up in studies of failure time. Control Clin Trials. 1996; 17(4):343-6. DOI: 10.1016/0197-2456(96)00075-x. View

Han I, Jang J, Kang M, Lee K, Lee S, Kim S . Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage. J Hepatobiliary Pancreat Sci. 2011; 19(2):187-93. DOI: 10.1007/s00534-011-0458-6. View

Lo C, Liu C, Fan S, Lai E, Wong J . Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998; 227(4):461-7. PMC: 1191296. DOI: 10.1097/00000658-199804000-00001. View

Morse B, Smith J, Lawdahl R, Roettger R . Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy. Am Surg. 2010; 76(7):708-12. DOI: 10.1177/000313481007600724. View

Byrne M, Suhocki P, Mitchell R, Pappas T, Stiffler H, Jowell P . Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center. J Am Coll Surg. 2003; 197(2):206-11. DOI: 10.1016/S1072-7515(03)00143-1. View

Hsieh Y, Chen C, Su C, Chan C, Huo T, Liu C . Outcome after percutaneous cholecystostomy for acute cholecystitis: a single-center experience. J Gastrointest Surg. 2012; 16(10):1860-8. DOI: 10.1007/s11605-012-1965-8. View

Riall T, Zhang D, Townsend Jr C, Kuo Y, Goodwin J . Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. J Am Coll Surg. 2010; 210(5):668-77, 677-9. PMC: 2866125. DOI: 10.1016/j.jamcollsurg.2009.12.031. View

Macri A, Scuderi G, Saladino E, Trimarchi G, Terranova M, Versaci A . Acute gallstone cholecystitis in the elderly: treatment with emergency ultrasonographic percutaneous cholecystostomy and interval laparoscopic cholecystectomy. Surg Endosc. 2005; 20(1):88-91. DOI: 10.1007/s00464-005-0178-6. View

10.

Nikfarjam M, Yeo D, Perini M, Fink M, Muralidharan V, Starkey G . Outcomes of cholecystectomy for treatment of acute cholecystitis in octogenarians. ANZ J Surg. 2013; 84(12):943-8. DOI: 10.1111/ans.12313. View

11.

Sugiyama M, Tokuhara M, Atomi Y . Is percutaneous cholecystostomy the optimal treatment for acute cholecystitis in the very elderly?. World J Surg. 1998; 22(5):459-63. DOI: 10.1007/s002689900416. View

12.

McGillicuddy E, Schuster K, Barre K, Suarez L, Hall M, Kaml G . Non-operative management of acute cholecystitis in the elderly. Br J Surg. 2012; 99(9):1254-61. DOI: 10.1002/bjs.8836. View

13.

Winbladh A, Gullstrand P, Svanvik J, Sandstrom P . Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford). 2009; 11(3):183-93. PMC: 2697889. DOI: 10.1111/j.1477-2574.2009.00052.x. View

14.

Tambyraja A, Kumar S, Nixon S . Outcome of laparoscopic cholecystectomy in patients 80 years and older. World J Surg. 2004; 28(8):745-8. DOI: 10.1007/s00268-004-7378-4. View

15.

Reiss R, Deutsch A . State of the art in the diagnosis and management of acute cholecystitis. Dig Dis. 1993; 11(1):55-64. DOI: 10.1159/000171401. View

16.

Kim H, Son B, Yoo C, Shin J . Impact of delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis. Surg Laparosc Endosc Percutan Tech. 2009; 19(1):20-4. DOI: 10.1097/SLE.0b013e318188e2fe. View

17.

Kolla S, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R . Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc. 2005; 18(9):1323-7. DOI: 10.1007/s00464-003-9230-6. View

18.

Donkervoort S, van Ruler O, Dijksman L, van Geloven A, Pierik E . Identification of risk factors for an unfavorable laparoscopic cholecystectomy course after endoscopic retrograde cholangiography in the treatment of choledocholithiasis. Surg Endosc. 2009; 24(4):798-804. DOI: 10.1007/s00464-009-0659-0. View

19.

Costi R, DiMauro D, Mazzeo A, Boselli A, Contini S, Violi V . Routine laparoscopic cholecystectomy after endoscopic sphincterotomy for choledocholithiasis in octogenarians: is it worth the risk?. Surg Endosc. 2006; 21(1):41-7. DOI: 10.1007/s00464-006-0169-2. View

20.

Melloul E, Denys A, Demartines N, Calmes J, Schafer M . Percutaneous drainage versus emergency cholecystectomy for the treatment of acute cholecystitis in critically ill patients: does it matter?. World J Surg. 2011; 35(4):826-33. DOI: 10.1007/s00268-011-0985-y. View