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Percutaneous cholecystostomy using a central venous catheter is effective for treating high-risk patients with acute
Se Ho Park1, Chang Moo Kang, Yoon Seok Chae
1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Insights
Central venous catheter percutaneous cholecystostomy (PC) offers a faster, cheaper alternative to pigtail catheter PC for high-risk acute cholecystitis patients. This method is a viable option when carefully selected.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Surgical Innovation
Background:
- Acute cholecystitis in high-risk patients often necessitates percutaneous cholecystostomy (PC) due to inability to undergo immediate cholecystectomy.
- Standard pigtail catheter PC is effective but time-consuming, costly, and requires specialized resources.
Purpose of the Study:
- To evaluate the viability of using a central venous catheter for PC as an alternative to the standard pigtail catheter.
- To compare waiting times, costs, and clinical outcomes between the two PC methods.
Main Methods:
- A retrospective comparison of 15 patients undergoing PC with a central venous catheter (Group A) versus 29 patients with a pigtail catheter (Group B).
- Analysis of pre-procedure waiting times, procedure costs, complication rates, and outcomes of delayed cholecystectomy.
Main Results:
- Group A had significantly shorter waiting times (1.8 vs. 3.5 days) and lower costs ($254.44 vs. $380.50) compared to Group B.
- Complication rates (4 in Group A, 5 in Group B) and outcomes of delayed cholecystectomy were similar between the groups.
Conclusions:
- Percutaneous cholecystostomy using a central venous catheter is a viable and cost-effective alternative for carefully selected high-risk patients with acute cholecystitis.
- This approach can reduce waiting times and healthcare costs without compromising patient safety or efficacy compared to standard pigtail catheter PC.
Abstract:
Percutaneous cholecystostomy (PC) using a pigtail catheter is performed on high-risk patients with acute cholecystitis as their general condition does not usually allow them to undergo a "definite" cholecystectomy. However, this method of PC is time-consuming and expensive and requires an interventional radiologist and specially designed radiologic equipment. To determine whether another PC approach was viable, we retrospectively compared patients who underwent PC using a central venous catheter (group A, n = 15) with those who underwent standard pigtail catheter PC (group B, n = 29). The waiting time prior to undergoing the PC was 1.8 days in group A and 3.5 days in group B (P < 0.05). The cost per patient was 293,364 won (254.44 dollars) for group A, and 438,719 won (380.50 dollars) for group B (P < 0.05). There were 4 complications in group A and 5 in group B. Following PC, 7 patients in group A and 15 patients in group B underwent delayed definite cholecystectomy, and there were no differences between these groups in terms of complications, mortality, and the delayed definite cholecystectomy surgical method. We conclude that in combination with careful patient selection, PC using a central venous catheter in high-risk patients with acute cholecystitis is a viable alternative to pigtail catheter PC.
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