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[Outcomes of percutaneous cholecystostomy in patients with high surgical risk]
Devrim Akinci1, Okan Akhan, Mustafa Ozmen
1Hacettepe Universitesi Tip Fakültesi, Radyoloji Anabilim Dali, Ankara, Turkey.
Insights
Percutaneous cholecystostomy is an effective procedure for acute cholecystitis, with 86% symptom recovery and no procedure-related deaths. This minimally invasive approach offers a reliable solution for critically ill patients.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Hepatology
Background:
- Acute cholecystitis is a common surgical emergency.
- Percutaneous cholecystostomy offers a less invasive alternative to surgery.
- Patient selection is crucial for successful outcomes.
Purpose of the Study:
- To evaluate the effectiveness of percutaneous cholecystostomy.
- To assess the follow-up results in patients undergoing the procedure.
- To determine complication rates and success rates in critically ill patients.
Main Methods:
- Retrospective evaluation of 37 patients (7-88 years old) with acute cholecystitis.
- Procedures performed under fluoroscopic and sonographic guidance.
- Transhepatic or transperitoneal approach using 6-10 F drainage catheters.
Main Results:
- 86% of patients recovered from acute cholecystitis symptoms.
- No procedure-related mortality was observed.
- Six patients (16.7%) eventually underwent cholecystectomy after risk reduction.
Conclusions:
- Percutaneous cholecystostomy is a cost-effective, reliable procedure.
- It demonstrates low complication and high success rates.
- It is a suitable option for critically ill patients with acute cholecystitis.
Purpose:
To evaluate the effectiveness of the percutaneous cholecystostomy with the follow up results of our patients.
Materials And Methods:
We retrospectively evaluated the medical records of 37 patients who underwent percutaneous cholecystostomy. Eighteen female and 19 male patients were included into this study between the ages of 7 and 88 years. All of our patients had acute cholecystitis or eventually developed acute cholecystitis except one. Seven year old male patient with Non-Hodgkin lymphoma underwent percutaneous cholecystostomy due to elevation of liver function tests and direct bilirubin. Since he had dilated intrahepatic biliary ducts due to a lymphadenopathy compression at portal hilus, percutaneous cholecystostomy was performed to decompress the biliary system to decrease the bilirubin and liver function tests to normal levels for initiating appropriate chemotherapy protocol. All the procedures were carried under fluoroscopic and sonographic guidance through transhepatic or transperitoneal approach with 6 to 10 F drainage catheters.
Results:
Recovery from the acute cholecystitis symptoms was achieved in 31 patients (86%) in follow-up. No procedure-related mortality was observed. The only major complication was intraperitoneal bleeding due to underlying coagulopathy which was treated with blood transfusion. Eight patients (21.6%) died in 30 days after the percutaneous intervention procedure. In the patient with Non-Hodgkin lymphoma at the age of 7, however, the procedure to decrease the bilirubin levels was successful and chemotherapy was given subsequently; he had died after 31 days due to his aggressive primary disease. Catheterization times were between 2 days and 60 days due to accompanied diseases. Six patients (16.7%) were finally undergone to cholecystectomy after the risks for surgery had been reduced. ERCP was performed in 2 patients (5.6%) for stone extraction from common bile duct. Eighteen patients (50%) were recovered from the acute illness and following the control cholangiograms, catheters were taken out consequently.
Conclusion:
Percutaneous cholecystostomy under ultrasonographic and fluoroscopic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis.
