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Persistent acute cholecystitis after cholecystostomy - increased mortality due to treatment approach?

Gabriel F Hess1, Philipp Sedlaczek2, Fabian Haak1

  • 1Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland.

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
|December 6, 2021
PubMed

Insights

Percutaneous cholecystostomy (PC) for acute cholecystitis (AC) has high mortality when performed alone. Subsequent cholecystectomy (CCY) significantly reduces mortality, suggesting CCY should be prioritized over PC alone.

Area of Science:

  • Medical research
  • Surgical outcomes
  • Gastroenterology

Background:

  • Percutaneous cholecystostomy (PC) is an alternative for acute cholecystitis (AC) when cholecystectomy (CCY) is not feasible.
  • The efficacy and role of PC as a definitive treatment for AC remain debated.

Purpose of the Study:

  • To retrospectively analyze the outcomes of patients treated with PC for AC.
  • To evaluate the impact of subsequent cholecystectomy (CCY) on mortality rates after PC.

Main Methods:

  • Retrospective analysis of 158 patients undergoing PC for AC over 10 years.
  • Comparison of mortality rates between PC alone and PC followed by CCY.
  • Multivariable logistic regression and landmark sensitivity analysis to control for confounders and bias.

Main Results:

  • Mortality was significantly higher in patients treated with PC alone (48%) compared to those who underwent subsequent CCY (9%).
  • Subsequent CCY was associated with an 85% lower risk of mortality.
  • Direct PC complications occurred in 17% of patients, with most AC specimens showing persistent inflammation.

Conclusions:

  • PC alone is associated with high mortality and is not a definitive treatment for AC.
  • Performing upfront cholecystectomy (CCY) is recommended due to the high mortality associated with PC alone.
  • PC should be considered a short-term measure due to persistent inflammation in AC specimens.
Abstract

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