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Acute cholecystitis in high surgical risk patients: percutaneous cholecystostomy or emergency cholecystectomy?

Juan C Rodríguez-Sanjuán1, Arantxa Arruabarrena, Laura Sánchez-Moreno

  • 1Department of General Surgery, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.

American Journal of Surgery
|October 18, 2011
PubMed

Insights

Percutaneous cholecystostomy (PC) for acute cholecystitis (AC) showed limited benefit, with higher mortality than emergency cholecystectomy. PC is best reserved for elderly patients with surgical contraindications.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Patient Risk Stratification

Background:

  • Acute cholecystitis (AC) management often involves high-risk patients.
  • Percutaneous cholecystostomy (PC) is an alternative to surgery for AC in select populations.
  • The comparative efficacy of PC versus emergency cholecystectomy in high-risk AC patients remains unclear.

Purpose of the Study:

  • To compare the outcomes of PC and emergency cholecystectomy in high-risk patients with AC.
  • To evaluate the effectiveness and safety of PC as a treatment for AC.

Main Methods:

  • Prospective analysis of a database for high-risk AC patients.
  • Comparison between patients treated with PC (n=29) and emergency cholecystectomy (n=32).
  • Surgical risk assessment using POSSUM, Charlson, Apache II, and ASA scores.

Main Results:

  • PC achieved AC resolution in 70.4% of patients, but 29.6% required subsequent emergency surgery.
  • Overall morbidity was 31% for PC and 28.1% for cholecystectomy; no significant difference was found (P = .6).
  • Mortality was significantly higher in the PC group (17.2%) compared to the cholecystectomy group (0%) (P = .02).

Conclusions:

  • Percutaneous cholecystostomy (PC) appears to offer limited advantages for acute cholecystitis (AC) in high-risk patients.
  • PC should be considered primarily for extremely elderly patients with absolute surgical contraindications.
  • Emergency cholecystectomy demonstrated a better safety profile with no mortality in this high-risk cohort.
Abstract

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