Percutaneous Cholecystostomy in a Small Community Hospital

Abstract

Laparoscopic cholecystectomy is the gold standard therapeutic approach for the treatment of acute cholecystitis.  However,  there are times when patient are deemed poor surgical candidates because of  Pre-existing  conditions or a current diagnosis causing hemodynamic instability and/or coagulopathies. In lieu of Laparoscopic or open cholecystectomies because of the high risk the alternative is the placement of  Percutaneous cholecystostomy tube (PCT) via Interventional Radiology(IR) given the lower risk of morbidity. The objective of this study was to take an in depth analysis of the clinical outcomes and the utilization of PCT for patients diagnosed with acute cholecystitis but deemed poor surgical candidates. This was a retrospective clinical study of 121 patients who were unfit to undergo surgery at the time of diagnosis of acute cholecystitis and had PCT placed between November 2012-July 2020.  During this time period there were 4596 cholecystectomies done, which shows that about 2.63% underwent PCT placement.. Patients whom underwent treatment for acute cholecystitis with PCT had drain in place for an average of 54.6 days, and resolution of symptoms secondary to biliary decompression and targeted antibiotic therapy. PCT is an effective and safe initial treatment in patients with acute cholecystitis that are acutely ill and not stable to undergo a cholecystectomy with biliary decompression & targeted antibiotic therapy to alleviate symptoms. At time it may even considered as the definitive treatment in patients who are deemed high risk and/or too frail to undergo cholecystectomy.