Surgery in practice and science · 2022
What happens after percutaneous cholecystostomy tube for acute calculous cholecystitis?
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Cruz-Centeno Nelimar, Jovet-Toledo Gerardo, Ramirez-Tanchez Carlos
Аннотация
BACKGROUND: Acute cholecystitis is commonly treated with laparoscopic cholecystectomy, if feasible. However, critically ill patients can be managed with a percutaneous cholecystostomy tube (PCT) for biliary drainage. This is a temporizing measure and does not represent a final treatment. We aimed to compare the outcomes of performing an interval cholecystectomy vs. conservative management after PCT placement.
METHODS: We conducted a retrospective study of all patients with a PCT placed for acute calculous cholecystitis (ACC) at a single center from October 2010 to March 2015.
RESULTS: Ninety-five patients (median age 79 years) underwent PCT placement for ACC. Only 26.3% of patients underwent interval cholecystectomy. The mortality rate within 6 weeks of ACC diagnosis was higher in the non-surgical group but this was not statistically significant. The number of re-admissions and complications of biliary disease was higher in the surgical group before undergoing interval cholecystectomy, specifically, choledocholithiasis (44% vs. 21.4%; p = 0.03). Patients who had an ICU admission [OR 0.21; 95% CI 0.07-0.66] or increased age [OR 0.94; 95% CI 0.89-0.98] were less likely to undergo interval cholecystectomy. Nine cholecystectomies were performed laparoscopic, 6 were converted to open and 10 were done in an open fashion. The complication rate in the first 30 days after cholecystectomy was 56%. Most complications occurred when surgery was performed in an open or converted to open technique (11/14=78.6%) vs. laparoscopic (3/14=21.4%).
CONCLUSION: The relatively high incidence of biliary complications in the period between PCT placement and cholecystectomy calls for timely cholecystectomy in patients treated with PCT. When feasible, patients with a history of ACC should undergo interval cholecystectomy.
METHODS: We conducted a retrospective study of all patients with a PCT placed for acute calculous cholecystitis (ACC) at a single center from October 2010 to March 2015.
RESULTS: Ninety-five patients (median age 79 years) underwent PCT placement for ACC. Only 26.3% of patients underwent interval cholecystectomy. The mortality rate within 6 weeks of ACC diagnosis was higher in the non-surgical group but this was not statistically significant. The number of re-admissions and complications of biliary disease was higher in the surgical group before undergoing interval cholecystectomy, specifically, choledocholithiasis (44% vs. 21.4%; p = 0.03). Patients who had an ICU admission [OR 0.21; 95% CI 0.07-0.66] or increased age [OR 0.94; 95% CI 0.89-0.98] were less likely to undergo interval cholecystectomy. Nine cholecystectomies were performed laparoscopic, 6 were converted to open and 10 were done in an open fashion. The complication rate in the first 30 days after cholecystectomy was 56%. Most complications occurred when surgery was performed in an open or converted to open technique (11/14=78.6%) vs. laparoscopic (3/14=21.4%).
CONCLUSION: The relatively high incidence of biliary complications in the period between PCT placement and cholecystectomy calls for timely cholecystectomy in patients treated with PCT. When feasible, patients with a history of ACC should undergo interval cholecystectomy.