Percutaneous cholecystostomy and acute cholecystitis: how, when and why.

AIM: Acute cholecystitis (AC) is one of the most frequent pathologies treated in urgency. An immediate surgical intervention for frail patients who are ineligible for surgery as a result of severe co-morbidities is questionable. The aim of this study is to investigate the safety and the management of percutaneous cholecistostomy (PC) in high-risk surgical patients.

MATERIALS AND

METHODS

In the period of time January 2015 - May 2021 we observed 1105 patients admitted with acute cholecystitis in our Department. In the group with severe cholecystitis (160 patients, 14.48%), 137 (12.39%) were submitted to immediate surgery, and 23 (4.8%) were treated with PC. All these patients were non-responding to conservative management. Initially, we used PC as a definitive treatment; from the second half of 2018 PC was implemented as a bridge to surgery.

RESULTS

Clinically, symptoms resolved in all the 23 patients. Mortality was nihil and no complication was recorded. PC was used as definitive treatment in 14 cases, wheres in 9 patients PC was intended as a-bridge-to-surgery treatment, and was followed by cholecystectomy.

DISCUSSION: 2017 guidelines, of World Society of Emergency Surgery recommended PC as a safe and effective management of AC in patients with multiple comorbidities. In this group of patients PC achieves a prompt resolution of clinical symptoms and is superior to conservative management. There are no absolute contraindications to PC.

CONCLUSIONS

PC is a safe and less invasive treatment of AC for patients with prohibitive surgical risk. It may be used as bridge to surgery to switch high-risk for moderate-risk patients, more suitable for a safe and definitive surgical treatment.

KEY WORDS: Acute cholecystitis, High-risk surgical patients, Percutaneous cholecystostomy.