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Percutaneous cholecystectomy for patients with acute cholecystitis and an increased surgical risk
H van Overhagen1, H Meyers, H W Tilanus
1Department of Radiology, University Hospital Dijkzigt, Rotterdam, The Netherlands.
Insights
Percutaneous cholecystostomy offers a safe and effective treatment for acute cholecystitis, especially in high-risk surgical patients. This procedure provides clinical improvement for many, serving as definitive therapy for acalculous cases.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Surgical Innovation
Background:
- Acute cholecystitis presents a significant clinical challenge, particularly in patients with elevated surgical risks.
- Percutaneous cholecystostomy is an emerging minimally invasive technique for managing gallbladder inflammation.
Purpose of the Study:
- To assess the efficacy and safety of percutaneous cholecystostomy in managing acute cholecystitis.
- To evaluate outcomes in patients with increased surgical risk undergoing this intervention.
Main Methods:
- Retrospective analysis of 33 patients with acute cholecystitis (22 calculous, 11 acalculous).
- Procedures performed via transhepatic (21) or transperitoneal (12) access routes.
- Clinical and laboratory parameters were monitored to determine treatment benefit.
Main Results:
- All procedures were technically successful, with 67% of patients showing clinical improvement within 48 hours.
- Minor to moderate complications occurred in 18% of patients; no procedure-related deaths were observed.
- Further treatments included cholecystectomy, stone removal, or gallbladder ablation, depending on the type of cholecystitis.
Conclusions:
- Percutaneous cholecystostomy is a safe and effective treatment for acute cholecystitis.
- It can be considered definitive therapy for acalculous cholecystitis.
- For calculous cholecystitis, it often serves as a temporizing measure requiring subsequent definitive treatment.
Purpose:
To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk.
Methods:
Thirty-three patients with acute cholecystitis (calculous, n = 22; acalculous, n = 11) underwent percutaneous cholecystostomy by means of a transhepatic (n = 21) or transperitoneal (n = 12) access route. Clinical and laboratory parameters were retrospectively studied to determine the benefit from cholecystostomy.
Results:
All procedures were technically successful. Twenty-two (67%) patients improved clinically within 48 hr; showing a significant decrease in body temperature (n = 13), normalization of the white blood cell count (n = 3), or both (n = 6). There were 6 (18%) minor-moderate complications (transhepatic access, n = 3; transperitoneal access, n = 3). Further treatment for patients with calculous cholecystitis was cholecystectomy (n = 9) and percutaneous and endoscopic stone removal (n = 3). Further treatment for patients with acalculous cholecystitis was cholecystectomy (n = 2) and gallbladder ablation (n = 2). There were 4 deaths (12%) either in hospital or within 30 days of drainage; none of the deaths was procedure-related.
Conclusions:
Percutaneous cholecystostomy is a safe and effective procedure for patients with acute cholecystitis. For most patients with acalculous cholecystitis percutaneous cholecystostomy may be considered a definitive therapy. In calculous disease this treatment is often only temporizing and a definitive surgical, endoscopic, or radiologic treatment becomes necessary.