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Effect of Preserving the Percutaneous Gallbladder Drainage Tube Before Laparoscopic Cholecystectomy on Surgical Outcome: Post Hoc Analysis of the CSGO-HBP-017. J Gastrointest Surg 2022; 26:1224-1232. [PMID: 35314945 DOI: 10.1007/s11605-022-05291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/26/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND When percutaneous transhepatic gallbladder drainage (PTGBD) is followed by laparoscopic cholecystectomy (LC), there is no consensus regarding whether the drainage tube should be preserved or removed before LC. We hypothesized that the surgical results of LC might differ between cases with PTGBD tube preservation versus removal. Here, we investigated how drainage tube preservation or removal affected the surgical outcome of LC. METHODS Using data from our previous multicenter study, we compared LC outcomes after PTGBD between patients with PTGBD tube preservation versus removal. This study included 208 patients who underwent LC over 12 days after PTGBD. In 83 cases, the PTGBD tube was preserved until LC, and in 125 cases, the tube was removed before LC. The results were verified by propensity score matching with 50 patients in each group. RESULTS Cases with tube preservation versus removal exhibited significantly longer surgery duration (174 ± 105 min vs 145 ± 61 min, P = .0118) and postoperative hospital stay (14 ± 16 days vs 7 ± 7 days, P < .0001), a significantly higher postoperative complication rate (13.2% vs 3.2%, P = .0061), and a marginally higher incidence of open conversion (12.0% vs 4.8%, P = .0547). Propensity score matching verified the inferior surgical outcomes in cases with tube preservation. CONCLUSIONS These results imply that when LC is performed > 12 days after PTGBD, the surgical outcome may be inferior when the drainage tube is preserved rather than removed before LC.
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2
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Kayaoglu SA, Tilki M. When to remove the drainage catheter in patients with percutaneous cholecystostomy? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2021; 68:77-81. [PMID: 34909967 DOI: 10.1590/1806-9282.20210787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/13/2021] [Indexed: 12/07/2022]
Abstract
OBJECTIVE The treatment for patients with acute calculous cholecystitis who have high surgical risk with percutaneous cholecystostomy instead of surgery is an appropriate alternative choice. The aim of this study was to examine the promising percutaneous cholecystostomy intervention to share our experiences about the duration of catheter that has yet to be determined. METHODS A total of 163 patients diagnosed with acute calculous cholecystitis and treated with percutaneous cholecystostomy between January 2011 and July 2020 were reviewed retrospectively. The Tokyo Guidelines 2018 were used to diagnose and grade patients with acute cholecystitis. RESULTS The mean age was 71.81±12.81 years. According to the Tokyo grading, 143 patients had grade 2 and 20 patients had grade 3 disease. The mean duration of catheter was 39.12±37 (1-270) days. Minimal bile leakage into the peritoneum was noted in 3 (1.8%) patients during the procedure. The rate of complications during follow-up of the patients who underwent percutaneous cholecystostomy was 6.9% (n=11), and the most common complication was catheter dislocation. Cholecystectomy was performed in 33.1% (n=54) of the patients at follow-up. Post-cholecystectomy complication rate was 12.9%. At the follow-up, the rate of recurrent acute cholecystitis episodes was 5.5%, while the mortality rate was 1.8%. The length of follow-up was five years. CONCLUSIONS The rate of recurrence was significantly higher among the patients with catheter for <21 days. We recommend that the duration of catheter should be minimum 21 days in patients undergoing percutaneous cholecystostomy.
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Affiliation(s)
- Sevcan Alkan Kayaoglu
- Haydarpasa Numune Training and Research Hospital, Department of General Surgery - Istanbul, Turkey
| | - Metin Tilki
- Haydarpasa Numune Training and Research Hospital, Department of General Surgery - Istanbul, Turkey
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3
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Aortic infective endocarditis decompensated by alithiasic cholecystitis in a patient on hemodialysis: Case report. Ann Med Surg (Lond) 2021; 67:102522. [PMID: 34257960 PMCID: PMC8253946 DOI: 10.1016/j.amsu.2021.102522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 12/07/2022] Open
Abstract
Infective endocarditis is an uncommon disease, which most often affects elderly subjects at risk or with favorable factors. Its prognosis is guarded with complications or decompensating factors that are often formidable. We report the case of an acute endocarditis decompensated by acute alithiasic cholecystitis in a 52-year-old patient, with a history of diagnosed end-stage renal failure (GFR 7 ml/min according to the MDRD) for 4 weeks, of undetermined etiology, undergoing hemodialysis, followed for aortic disease for 6 years (IAO grade II, RAO loose). After 6 weeks, the evolution was favorable under adapted and early antibiotic treatment and associated hygiene measures including gastric rest. Infective endocarditis remains a serious pathology, due to its high morbi-mortality. The association of acute infective endocarditis and acute alithiasic cholecystitis is of reserved prognosis especially on a ground of immunodepression like the end-stage chronic renal failure. This association requires a rapid and efficient management. Infectious endocarditis most often affects subjects at risk or with favorable factors Alithiasis cholecystitis is an acute and necrotic inflammation of the gallbladder, in the absence of gallstones It can be a decompensating factor of an infective endocarditis The association of acute infective endocarditis and acute alithiasic cholecystitis is of reserved prognosis and requires a fast and effective management
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4
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Hung YL, Sung CM, Fu CY, Liao CH, Wang SY, Hsu JT, Yeh TS, Yeh CN, Jan YY. Management of Patients With Acute Cholecystitis After Percutaneous Cholecystostomy: From the Acute Stage to Definitive Surgical Treatment. Front Surg 2021; 8:616320. [PMID: 33937313 PMCID: PMC8083985 DOI: 10.3389/fsurg.2021.616320] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
Percutaneous cholecystostomy (PC) has become an important procedure for the treatment of acute cholecystitis (AC). PC is currently applied for patients who cannot undergo immediate laparoscopic cholecystectomy. However, the management following PC has not been well-reviewed. The efficacy of PC tubes has already been indicated, and compared to complications of other invasive biliary procedures, complications related to PC are rare. Following the resolution of AC, patients who can tolerate anesthesia and the surgical risk should undergo interval cholecystectomy to reduce the recurrence of biliary events. For patients unfit for surgery, whether owing to comorbidities, anesthesia risks, or surgical risks, expectant management may be applied; however, a high incidence of recurrence has been noted. In addition, several interesting issues, such as the indications for cholangiography via the PC tube, removal or maintenance of the PC catheter before definitive treatment, and timing of elective surgery, are all discussed in this review, and a relevant decision-making flowchart is proposed. PC is an effective and safe intervention, whether as expectant treatment or bridge therapy to definitive surgery. High-level evidence of post-PC care is still necessary to modify current practices.
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Affiliation(s)
- Yu-Liang Hung
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Mu Sung
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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5
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Markopoulos G, Mulita F, Kehagias D, Tsochatzis S, Lampropoulos C, Kehagias I. Outcomes of percutaneous cholecystostomy in elderly patients: a systematic review and meta-analysis. PRZEGLAD GASTROENTEROLOGICZNY 2021; 16:188-195. [PMID: 34584579 PMCID: PMC8456769 DOI: 10.5114/pg.2020.100658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/08/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Percutaneous cholecystostomy (PC) represents a management option to control sepsis in patients with acute cholecystitis, who are unable to tolerate surgery. AIM This review aimed to evaluate the outcomes of elderly patients treated with PC and compare it with emergent cholecystectomy. MATERIAL AND METHODS An electronic search of the Embase, Medline Web of Science, and Cochrane databases was performed. Percutaneous cholecystostomy was used as the reference group, and weighted mean differences (WMD) were calculated for the effect of PC on continuous variables, and pooled odds ratios (POR) were calculated for discrete variables. RESULTS There were 20 trials included in this review. Utilisation of PC was associated with significantly increased mortality (POR = 4.85; 95% CI: 1.02-7.30; p = 0.0001) and increased re-admission rates (POR = 2.95; 95% CI: 2.21-3.87; p < 0.0001). CONCLUSIONS This pooled analysis established that patients treated with PC appear to have increased mortality and readmission rates relative to those managed with cholecystectomy.
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Affiliation(s)
- George Markopoulos
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Dimitris Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | | | - Ioannis Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
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6
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Marziali I, Cicconi S, Marilungo F, Benedetti M, Ciano P, Pagano P, D'Emidio F, Guercioni G, Catarci M. Role of percutaneous cholecystostomy in all-comers with acute cholecystitis according to current guidelines in a general surgical unit. Updates Surg 2020; 73:473-480. [PMID: 33058055 DOI: 10.1007/s13304-020-00897-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022]
Abstract
Acute calculous cholecystitis (ACC) is a very common complication of gallstone-related disease. Its currently recommended management changes according to severity of disease and fitness for surgery. The aim of this observational study is to assess the short- and long-term outcomes in all-comers admitted with diagnosis of ACC, treated according to 2013 Tokyo Guidelines (TG13). A retrospective analysis was conducted on a prospectively maintained database of 125 patients with diagnosis of ACC consecutively admitted between January 2017 and September 2019, subdivided in three groups according to TG13: percutaneous cholecystostomy (PC group), cholecystectomy (CH group), and conservative medical treatment (MT group). The primary end point was a composite of morbidity and/or mortality rates; the secondary end points were ACC recurrence, readmission, need for cholecystectomy rates and overall length of hospital stay (LOS). After a median follow-up of 639 days, overall morbidity rate was 20.8% and mortality rate was 6.4%. Death was directly related to AC during the index admission in two out of eight cases. There were no significant differences in primary end point according to the treatment group. Concerning secondary end points, ACC recurrence rate was not significantly different after PC (10.0%) or MT (9.1%); the readmission rates were significantly higher (p < 0.0001) in the MT group (48.5%) and in the PC group (25.0%) than in the CH group (5.8%); need for cholecystectomy rates was significantly higher (p < 0.0001) in the MT group (42.4%) than in the PC group (20.0%); median overall LOS was significantly higher in the PC (16 days) than in the MT (9 days) and than in the CH group (5 days). PC is an effective and safe rescue procedure in high-risk patients with ACC, representing a definitive treatment in 80% of cases of this specific subgroup.
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Affiliation(s)
- Irene Marziali
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Simone Cicconi
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Fabio Marilungo
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Michele Benedetti
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Paolo Ciano
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Paolo Pagano
- Interventional Radiology Units, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Fabio D'Emidio
- Interventional Radiology Units, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Gianluca Guercioni
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Marco Catarci
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy.
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7
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Jeon HW, Jung KU, Lee MY, Hong HP, Shin JH, Lee SR. Surgical outcomes of percutaneous transhepatic gallbladder drainage in acute cholecystitis grade II patients according to time of surgery. Asian J Surg 2020; 44:334-338. [PMID: 32896466 DOI: 10.1016/j.asjsur.2020.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/18/2020] [Accepted: 08/17/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The objective of this study was to determine the appropriate timing for surgical intervention for Grade II acute cholecystitis patients. The study compares the clinical outcomes of patients in Group A, who were treated with early laparoscopic cholecystectomy (ELC) within the first two weeks of hospitalization, and Group B, treated with delayed laparoscopic cholecystectomy (DLC) after recovering from symptoms and that received conservative treatment and were discharged for more than two weeks. METHODS From November 2011 to June 2019, from a total of 196 acute cholecystitis patients that received percutaneous transhepatic gallbladder drainage (PTGBD) insertion, we conducted a retrospective review of the group that received early laparoscopic cholecystectomy within 2 weeks and the group that received delayed laparoscopic cholecystectomy. The clinical characteristics and post-treatment outcomes were evaluated. RESULTS In all patients treated with PTGBD insertion, Group A, the patients who were treated with ELC, showed a significantly longer mean operative time than Group B, the patients who were treated with DLC (72.46 ± 46.396 vs. 54.08 ± 27.12, P = 0.001). Similarly, Group A showed a significantly longer postoperative hospital stay compared to Group B (5.71 ± 5.062 vs. 4.27 ± 2.931, P = 0.014). CONCLUSION In patients with Grade II acute cholecystitis with PTGBD insertion, DLC produces better outcomes with shorter hospital stay and operative time than ELC. These results suggest that DLC may lead to a better outcome than ELC, specifically when deciding the timing for laparoscopic cholecystectomy in patients diagnosed with acute Grade II cholecystitis.
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Affiliation(s)
- Hye Woen Jeon
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Mi Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun Ho Shin
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Ryol Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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8
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Kaura K, Bazerbachi F, Sawas T, Levy MJ, Martin JA, Storm AC, Wise KB, Reisenauer CJ, Abu Dayyeh BK, D Topazian M, Petersen BT, Schiller HJ, Chandrasekhara V. Surgical outcomes of ERCP-guided transpapillary gallbladder drainage versus percutaneous cholecystostomy as bridging therapies for acute cholecystitis followed by interval cholecystectomy. HPB (Oxford) 2020; 22:996-1003. [PMID: 31685380 DOI: 10.1016/j.hpb.2019.10.1530] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/02/2019] [Accepted: 10/13/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Select patients with acute cholecystitis (AC) are not candidates for index cholecystectomy. We compared the influence of ERCP-guided transpapillary gallbladder drainage (ERGD) versus percutaneous cholecystostomy (PC) on delayed cholecystectomy outcomes. METHODS Consecutive patients undergoing ERGD or PC for AC from January 2007 to October 2018 were included. Primary outcome was the rate of conversion to open cholecystectomy and perioperative complications in groups. RESULTS The study included 52 patients with ERGD and 140 with PC prior to cholecystectomy (median 68 days [IQR: 47-105.5]). Technical success was higher in the PC group (100% vs 91%; P = 0.0004). There was a nonsignificant trend to lower postoperative complications with ERGD (30.7% vs 43.5%; P = 0.07). No difference in conversion to open cholecystectomy OR: 1.5 (95% CI: 0.68-3.65; P = 0.28) or severity of complications (Clavien-Dindo grade >2) OR: 0.60, (95% CI: 0.19-1.87; P = 0.38) was noted between the ERGD and PC groups. PC was associated with higher rates of unplanned repeat intervention (16.4% vs 7.7%; P = 0.02). CONCLUSION ERGD is suitable for patients with AC who is candidates for delayed cholecystectomy and should be considered for gallbladder drainage in patients with concomitant choledocholithiasis or cholangitis who require ERCP.
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Affiliation(s)
- Karan Kaura
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Fateh Bazerbachi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Tarek Sawas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - John A Martin
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Kevin B Wise
- Division of Surgery, Mayo Clinic, Rochester, MN, 55905, United States
| | - Christopher J Reisenauer
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, 55902, United States
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Mark D Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Bret T Petersen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Henry J Schiller
- Division of Surgery, Mayo Clinic, Rochester, MN, 55905, United States
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States.
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9
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Søreide JA, Fjetland A, Desserud KF, Greve OJ, Fjetland L. Percutaneous cholecystostomy - An option in selected patients with acute cholecystitis. Medicine (Baltimore) 2020; 99:e20101. [PMID: 32384483 PMCID: PMC7440289 DOI: 10.1097/md.0000000000020101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
While urgent percutaneous cholecystostomy (PC) was introduced as an alternative to acute surgical treatment for acute cholecystitis (AC), the current place of PC in the treatment algorithm for AC is challenged. We evaluate demographics and outcomes of PC in routine clinical practice in a population-based cohort.Retrospective evaluation of consecutive patients treated with PC for AC between 2000 and 2015. The severity of cholecystitis was graded according to the 2013 Tokyo Guidelines.One hundred forty-nine patients were included (82; 55% males) (median age of 72.5 years; range, 21-92). The Tokyo Guidelines criteria of 2013 (TG13) severity grade distribution was 4%, 61.7%, and 34.2% for grades I, II, and III, respectively. No difference was observed between males and females with regard to age, American Society of Anesthesiologists (ASA) score, comorbidities, or previous history of cholecystitis. PC was successfully performed in all but 1 patient, and complications were few and minor. Less than half (48.3%) of all patients subsequently received definitive surgical treatment, mostly (83.3%) laparoscopy. No or minor complications were encountered in 58 (80.6%) patients. Operated patients were significantly younger (P = <.001) and had lower ASA scores (P = .005), less comorbidities (P < .001), and had more seldomly a severe grade 3 cholecystitis (P < .001) than non-operated patients.PC is useful in selected patients with AC. However, since only a half of the patients eventually received definitive surgical treatment, a better routine decision-making based on proper criteria may enable an improved allocation of the individual patient for tailored treatment according to the disease severity, the patient's comorbidity burden, and also to the treatment options available at the institution to prevent overutilization of a non-definitive treatment approach. Comprehension of this responsibility should be acknowledged by hospitals with an emergency surgical service, although the clinical decision-making remains a challenge of the responsible surgeon on call.
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Affiliation(s)
- Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger
- Department of Clinical Medicine, University of Bergen, Bergen
| | - Anja Fjetland
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger
| | - Kari F. Desserud
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger
| | - Ole Jakob Greve
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Lars Fjetland
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
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10
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Hung YL, Chen HW, Fu CY, Tsai CY, Chong SW, Wang SY, Hsu JT, Yeh TS, Yeh CN, Jan YY. Surgical outcomes of patients with maintained or removed percutaneous cholecystostomy before intended laparoscopic cholecystectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:461-469. [PMID: 32281739 DOI: 10.1002/jhbp.740] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/11/2020] [Accepted: 03/02/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Percutaneous cholecystostomy (PC) followed by definitive cholecystectomy is an alternative treatment for acute cholecystitis (AC). We retrospectively investigated the impact of PC tube removal before definitive cholecystectomy on surgical outcomes. METHODS From 2012 to 2017, 942 AC patients underwent PC at a single institute. Eligible patients were selected according to inclusion criteria. Demographic data, clinical and laboratory parameters, and treatment outcomes were extracted from medical records. Categorization of patients and subsequent subgroup analysis were based on cholangiography. RESULTS The rate of emergent cholecystectomy in the PC tube removal group was higher than that in the PC tube preserved group (OR = 2.969, 95% CI 1.334-6.612, P = 0.008). In subgroup analysis of patients with patent bile flow under cholangiography, the rate of emergent cholecystectomy was higher in the PC tube removal group (OR = 3.173, 95% CI 1.182-8.523, P = 0.022), though the incidence of complications was higher in the PC tube preserved group (P = 0.012). In addition, routine preoperative cholangiography had no clinical impact on surgical outcome. CONCLUSION Percutaneous cholecystostomy tube can be removed before subsequent LC to avoid postoperative complications, though removal of the PC tube is associated with an increased likelihood of emergent cholecystectomy.
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Affiliation(s)
- Yu-Liang Hung
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huan-Wu Chen
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Yi Tsai
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sio-Wai Chong
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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11
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Tyberg A, Jha K, Shah S, Kedia P, Gaidhane M, Kahaleh M. EUS-guided gallbladder drainage: a learning curve modified by technical progress. Endosc Int Open 2020; 8:E92-E96. [PMID: 31921991 PMCID: PMC6949177 DOI: 10.1055/a-1005-6602] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/06/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an efficacious and safe option for patients who cannot undergo cholecystectomy. It is a technically challenging procedure, requiring skills in EUS, and ERCP. The aim of this study was to define the learning curve for EUS-GBD. Patients and methods Consecutive patients undergoing EUS-GBD by a single operator were included from a prospective registry over 5 years. Demographics, procedure information, post-procedure follow-up data, and information on adverse events were collected. Non-linear regression and CUSUM analyses were conducted for the learning curve. Clinical success was defined as resolution of cholecystitis post-procedure. Results Forty-eight patients were included (58 % male, mean age 76 years). Twenty patients (42 %) had malignant cholecystitis. Most patients had lumen-apposing metal stents (LAMS) (15 mm, n = 29, 60 %; 10 mm, n = 8, 7 %). The remaining patients had FCSEMS (n = 9, 19 %) or plastic stents alone (n = 2, 4 %). Clinical success was achieved in 36 (86 %) of patients. Of the remaining 12, 7 were lost to follow-up and 5 had persistent cholecystitis. 9 patients (19 %) had adverse events including bleeding (n = 4), liver abscesses (n = 2), and hypotension. Two patients passed away post-procedure. Median procedure time was 41 minutes (range 16 - 121 min), with the 41-minute time occurring during the 19th procedure. Procedure durations further reduced, with the last 10 procedures being 20 minutes or under (nonlinear regression p value P < 0.0001). Conclusion Endoscopists experienced in EUS-GBD are expected to achieve a reduction in procedure time over successive cases, with efficiency reached at 41 minutes and a learning rate of 19 cases. Continued improvement is demonstrated with additional experience.
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Affiliation(s)
- Amy Tyberg
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Kopal Jha
- Cornell University, Ithaca, New York, United States
| | - Shawn Shah
- Weill Cornell Medicine, New York, New York, United Stats
| | | | - Monica Gaidhane
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Michel Kahaleh
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States,Corresponding author Michel Kahaleh, MD, AGAF, FACG, FASGE Clinical Director of GastroenterologyChief of EndoscopyDirector Pancreas ProgramRutgers, The State University of New JerseyRobert Wood Johnson University Hospital1 RWJ Place, MEB 464New Brunswick, NJ 08901+1-732-235-5537
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12
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Degroote T, Chhor V, Tran M, Philippart F, Bruel C. Cholécystite aiguë de réanimation. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
La cholécystite aiguë de réanimation (0,2 à 1 % des patients) est liée à des facteurs de risque spécifiques (jeûne, nutrition parentérale, ventilation mécanique) et systémiques (instabilité, brûlures graves, catécholamines) conduisant à des phénomènes d’ischémie-reperfusion de la paroi vésiculaire, à l’origine d’une cholécystite classiquement alithiasique. Toutefois, les données récentes retrouvent une participation lithiasique dans 50%des cas environ. Il s’agit d’une maladie grave dont le diagnostic est difficile et la mortalité élevée (40 %). Chez ces patients graves, aucun critère clinicobiologique ne permet un diagnostic de certitude. L’imagerie du patient de réanimation peut être prise à défaut par les anomalies fréquemment retrouvées en réanimation ; les signes les plus évocateurs sont un épaississement pariétal vésiculaire supérieur à 4 mm, un hydrocholécyste ou un défaut de rehaussement de la paroi au scanner. Le traitement en urgence repose sur une antibiothérapie à large spectre ciblée sur les germes digestifs et nosocomiaux ainsi que sur une optimisation hémodynamique. La cholécystectomie (laparoscopique, voire sous-costale) représente le traitement de référence en empêchant la récidive. Mais la gravité des patients amène souvent à envisager une solution moins lourde que la chirurgie avec un drainage de la vésicule. Le drainage par voie percutanée est l’alternative de choix en raison de sa disponibilité et de son efficacité, il existe toutefois un risque théorique de récidive à l’ablation du drain, surtout en cas de cholécystite lithiasique. Le drainage interne par voie endoscopique (transpapillaire ou transdigestif) est une possibilité prometteuse, mais réservée à l’heure actuelle aux centres experts.
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13
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Kostrzewa M, Zener R, Swanström LL, Shlomovitz E. An alternative percutaneous technique for gallbladder drainage using lumen-apposing metal stents. Surg Endosc 2019; 34:2512-2518. [PMID: 31392512 DOI: 10.1007/s00464-019-07060-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cholecystostomy is commonly performed in high-risk patients with acute cholecystitis. However, internal drainage may be more desirable in patients as it is associated with lower complication rates. This paper describes an image-guided, percutaneous technique for internal gallbladder drainage using a covered lumen-apposing metal stent (LAMS) and assesses its feasibility and safety in a porcine model. METHODS Procedures were performed on 30-kg pigs. Under ultrasound and fluoroscopic guidance, a percutaneous puncture was performed through-and-through the gallbladder into the stomach. A guidewire was placed and a 12Fr sheath was advanced through which a 10-mm LAMS was deployed. Its distal flange was deployed in the gastric lumen, and its proximal flange in the gallbladder. The cholecystoenteric anastomosis was examined by means of endoscopy, laparoscopy, and necropsy. RESULTS Technical success was 100% (7/7). Procedure times decreased with experience and improvements in technique (median: 22 min). Contrast injection demonstrated free flow through the stent with no leakage. Necropsy confirmed appropriate stent position with good apposition of gallbladder and stomach, and no intraprocedural complications were detected. CONCLUSIONS Image-guided, percutaneous, internal gallbladder drainage using a LAMS is safe and feasible in a porcine model. This technique may be an alternative to endoscopic ultrasound-guided stent placement and external cholecystostomy tube drainage.
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Affiliation(s)
- Michael Kostrzewa
- Division of Vascular and Interventional Radiology, Toronto General Hospital, University Health Network/University of Toronto, 585 University Avenue, Toronto, ON, M5G2N2, Canada. .,Institute of Image Guided Surgery (IHU), 1 Place de l'Hôpital, 67000, Strasbourg, France.
| | - Rebecca Zener
- Division of Vascular and Interventional Radiology, Toronto General Hospital, University Health Network/University of Toronto, 585 University Avenue, Toronto, ON, M5G2N2, Canada
| | - Lee L Swanström
- Institute of Image Guided Surgery (IHU), 1 Place de l'Hôpital, 67000, Strasbourg, France.,Gastrointestinal & Minimally Invasive Surgery, The Oregon Clinic, 4805 NE Glisan Street Suite 6N60, Portland, OR, 97213, USA
| | - Eran Shlomovitz
- Division of Vascular and Interventional Radiology, Toronto General Hospital, University Health Network/University of Toronto, 585 University Avenue, Toronto, ON, M5G2N2, Canada.,Institute of Image Guided Surgery (IHU), 1 Place de l'Hôpital, 67000, Strasbourg, France
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14
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Percutaneous cholecystostomy in the management of acute cholecystitis - 10 years of experience. Wideochir Inne Tech Maloinwazyjne 2019; 14:516-525. [PMID: 31908697 PMCID: PMC6939213 DOI: 10.5114/wiitm.2019.84704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/16/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction The preferred treatment for acute cholecystitis is cholecystectomy, but for patients with precluded general anesthesia due to critical illness or multiple medical comorbidities it is not suitable. Cholecystostomy could be a minimally invasive therapeutic alternative. Aim To retrospectively evaluate the indications, technical features, efficacy, complications, patients’ development and relationships among monitored parameters of percutaneous computed tomography (CT)-guided cholecystostomies in cases of acute cholecystitis and find the role of this procedure in appropriate treatment selection. Material and methods Over the course of 10 years, 75 percutaneous cholecystostomy procedures in 69 patients were performed in cases with diagnosed acute cholecystitis, precluded general anesthesia and contraindicated cholecystectomy by an experienced surgeon and anesthesiologist. These interventions were done using only local anesthesia. The patients were men in 39 cases and women in 33 cases, aged 33 to 91 years. Results Technical success was achieved in all cases. The indications were sepsis in 34 (45.3%) cases, bridging acute gallbladder inflammatory status in 15 (20%) interventions, serious medical comorbidities in 8 (10.7%) cases, disseminated malignancy and cardiac failure in 6 cases each (both 8%) and neurological affections in 5 (6.5%) cases. Cholecystostomy was frequently the final solution in acalculous cholecystitis (79.3%). The 30-day mortality rate was determined at 10.7% and the overall complication rate was 21.3%, but all of these complications were managed conservatively or using minimally invasive treatment. Conclusions Percutaneous CT-guided cholecystostomy is reserved for patients with a serious medical status for various reasons that preclude surgical treatment and general anesthesia. Simultaneously, technical success and efficacy are high and the complication rate is acceptable.
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15
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Park JK, Yang JI, Wi JW, Park JK, Lee KH, Lee KT, Lee JK. Long-term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis. J Gastroenterol Hepatol 2019; 34:784-790. [PMID: 30674071 DOI: 10.1111/jgh.14611] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 01/03/2019] [Accepted: 01/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Percutaneous cholecystostomy (PC) has been frequently used as an alternative treatment for acute cholecystitis in seriously ill patients unfit for surgery. The aim of this study was to investigate the recurrence rate and risk factors of recurrence. METHODS Medical records of 102 patients who were followed up for more than 1 year after PC tube removal among 716 patients who underwent PC for acute cholecystitis treatment were retrospectively analyzed. RESULTS The recurrence rate of acute cholecystitis after PC tube removal was 20.6% (21/102), and the mean time to recur was 660 days. Underlying cancer (odds ratio [OR]: 3.369; 95% confidence interval [CI]: 1.006-11.282; P = 0.0489), PC duration shorter than 44 days (OR: 5.596; 95% CI: 1.35-23.201; P = 0.0176), and the presence of common bile duct stone in initial imaging studies (OR: 24.393; 95% CI: 2.696-220.746; P = 0.0045) were positively correlated with recurrence. Tubogram before PC tube removal did not significantly lower the recurrence. However, PC tube clamping for several days significantly lowered the recurrence (OR: 0.108; 95% CI: 0.015-0.794; P = 0.0288). Fifty-nine (57.8%) had acalculous cholecystitis. Calculous cholecystitis was negatively correlated with recurrence (OR: 0.267; 95% CI: 0.074-0.967; P = 0.0444). Receiver operating characteristic curve of the prediction model for recurrence verified its accuracy (area under the curve: 0.8475). CONCLUSION We should try to keep PC more than 6 weeks and clamp for 1-2 weeks before removal. For those with the presence of common bile duct stones, calculous cholecystitis, and underlying malignancy, we should keep PC for longer duration and carefully observe symptoms and signs of recurrence.
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Affiliation(s)
- Jae Keun Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju-Il Yang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Good Gang-an Hospital, Busan, Korea
| | - Jin Woo Wi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Kyung Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Hyuck Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Taek Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Kyun Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Percutaneous cholecystostomy-tube for high-risk patients with acute cholecystitis: current practice and implications for future research. Surg Endosc 2019; 33:3396-3403. [PMID: 30604258 DOI: 10.1007/s00464-018-06634-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/19/2018] [Indexed: 01/11/2023]
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17
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Altieri MS, Bevilacqua L, Yang J, Yin D, Docimo S, Spaniolas K, Talamini M, Pryor A. Cholecystectomy following percutaneous cholecystostomy tube placement leads to higher rate of CBD injuries. Surg Endosc 2018; 33:2686-2690. [PMID: 30478694 DOI: 10.1007/s00464-018-6559-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/19/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Percutaneous cholecystostomy tube (PCT) placement is often the management of severe acute cholecystitis in the unstable patient. PCT can be later reversed and cholecystectomy performed. The purpose of this study is to investigate the incidence of subsequent cholecystectomy and clinical factors associated with subsequent procedure. METHODS The SPARCS, an administrative database, was used to search all patients undergoing PCT placement between 2000 and 2012 in the state of New York. Using a unique identifier, all patients were followed for subsequent cholecystectomy procedures for at least 2 years. Patients were also followed up to 2014 for potential CBD injury during subsequent laparoscopic (LC) or open cholecystectomy (OC). Univariate and multivariable regression analysis were performed when appropriate. RESULTS There were 9738 patients identified who underwent PCT placements. The incidence of patients who had a PCT in 2000-2012, which subsequently underwent cholecystectomy increased from 25.0% in 2000 to 31.7% in 2012. In addition, patients undergoing subsequent LC increased from 11.8% in 2000 to 22.2% in 2012, while the incidence of OC decreased from 13.2% in 2000 to 9.5% in 2012. After accounting for other confounding factors, younger male patients, race as white compared to black, who didn't have any complications during PCT placement were more likely to undergo subsequent cholecystectomy (p < 0.05). Average time to LC was 122.0 days versus 159.6 days for OC (p < 0.0001). From the patients who underwent cholecystectomy following PCT, 47 patients experienced CBD injury (1.6%). CONCLUSIONS Incidence of cholecystectomy following PCT increased during the study period. Surgeons seem to be more comfortable performing LC as rate of LC increased from 11.8 to 22.2%. However, rate of CBD injury is higher during subsequent cholecystectomy compared to that of the general population. Caution should be used when performing subsequent cholecystectomy following PCT, as these procedures may be more technically challenging.
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Affiliation(s)
- Maria S Altieri
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA.
| | - Lisa Bevilacqua
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Donglei Yin
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Salvatore Docimo
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA
| | - Mark Talamini
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA
| | - Aurora Pryor
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA
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18
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Loozen CS, van Santvoort HC, van Duijvendijk P, Besselink MG, Gouma DJ, Nieuwenhuijzen GA, Kelder JC, Donkervoort SC, van Geloven AA, Kruyt PM, Roos D, Kortram K, Kornmann VN, Pronk A, van der Peet DL, Crolla RM, van Ramshorst B, Bollen TL, Boerma D. Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial. BMJ 2018; 363:k3965. [PMID: 30297544 PMCID: PMC6174331 DOI: 10.1136/bmj.k3965] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To assess whether laparoscopic cholecystectomy is superior to percutaneous catheter drainage in high risk patients with acute calculous cholecystitis. DESIGN Multicentre, randomised controlled, superiority trial. SETTING 11 hospitals in the Netherlands, February 2011 to January 2016. PARTICIPANTS 142 high risk patients with acute calculous cholecystitis were randomly allocated to laparoscopic cholecystectomy (n=66) or to percutaneous catheter drainage (n=68). High risk was defined as an acute physiological assessment and chronic health evaluation II (APACHE II) score of 7 or more. MAIN OUTCOME MEASURES The primary endpoints were death within one year and the occurrence of major complications, defined as infectious and cardiopulmonary complications within one month, need for reintervention (surgical, radiological, or endoscopic that had to be related to acute cholecystitis) within one year, or recurrent biliary disease within one year. RESULTS The trial was concluded early after a planned interim analysis. The rate of death did not differ between the laparoscopic cholecystectomy and percutaneous catheter drainage group (3% v 9%, P=0.27), but major complications occurred in eight of 66 patients (12%) assigned to cholecystectomy and in 44 of 68 patients (65%) assigned to percutaneous drainage (risk ratio 0.19, 95% confidence interval 0.10 to 0.37; P<0.001). In the drainage group 45 patients (66%) required a reintervention compared with eight patients (12%) in the cholecystectomy group (P<0.001). Recurrent biliary disease occurred more often in the percutaneous drainage group (53% v 5%, P<0.001), and the median length of hospital stay was longer (9 days v 5 days, P<0.001). CONCLUSION Laparoscopic cholecystectomy compared with percutaneous catheter drainage reduced the rate of major complications in high risk patients with acute cholecystitis. TRIAL REGISTRATION Dutch Trial Register NTR2666.
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Affiliation(s)
- Charlotte S Loozen
- Department of Surgery, St Antonius Hospital, 3435CM, PO box 2500, Nieuwegein, Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St Antonius Hospital, 3435CM, PO box 2500, Nieuwegein, Netherlands
- Department of Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Marc Gh Besselink
- Department of Surgery, Academic Medical Centre, Amsterdam, Netherlands
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Centre, Amsterdam, Netherlands
| | | | - Johannes C Kelder
- Department of Clinical Epidemiology, St Antonius Hospital, Nieuwegein, Netherlands
| | | | | | - Philip M Kruyt
- Department of Surgery, Gelderse Vallei Hospital, Amsterdam, Netherlands
| | - Daphne Roos
- Department of Surgery, Reinier de Graaff Hospital, Delft, Netherlands
| | - Kirsten Kortram
- Department of Surgery, St Antonius Hospital, 3435CM, PO box 2500, Nieuwegein, Netherlands
| | - Verena Nn Kornmann
- Department of Surgery, St Antonius Hospital, 3435CM, PO box 2500, Nieuwegein, Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, Netherlands
| | | | | | - Bert van Ramshorst
- Department of Surgery, St Antonius Hospital, 3435CM, PO box 2500, Nieuwegein, Netherlands
| | - Thomas L Bollen
- Department of Radiology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Djamila Boerma
- Department of Surgery, St Antonius Hospital, 3435CM, PO box 2500, Nieuwegein, Netherlands
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Elsharif M, Forouzanfar A, Oaikhinan K, Khetan N. Percutaneous cholecystostomy… why, when, what next? A systematic review of past decade. Ann R Coll Surg Engl 2018; 100:1-14. [PMID: 30286647 PMCID: PMC6204498 DOI: 10.1308/rcsann.2018.0150] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Percutaneous cholecystostomy tube drainage has played a vital role in management of cholecystitis in patients where surgery is not appropriate. However, management differs from unit to unit and even between different consultants in the same unit. We conducted this systematic review to understand which of these resulted in the best patient outcomes. METHODS We conducted a systematic review using the PubMed database for publication between January 2006 to December 2016. Keyword variants of 'cholecystostomy' and 'cholecystitis' were combined to identify potential relevant papers for inclusion. FINDINGS We identified 46 studies comprising a total of 312,085 patients from 20 different countries. These papers were reviewed, critically appraised and summarised in table format. Percutaneous cholecystostomy tube drainage is an important treatment modality with an excellent safety profile. It has been used successfully both as a definitive procedure and as a bridge to surgery. There continues to be great variation, however, when it comes to the indications, timing and management of these drains. As far as we are aware, this is the only systematic review to cover the past 10 years. It provides a much-needed update, considering all the technological development and new treatment options in laparoscopic surgery and interventional radiology.
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Affiliation(s)
- M Elsharif
- Department of General Surgery, Doncaster Royal Infirmary, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - A Forouzanfar
- Department of General Surgery, Northern General Hospital, Sheffield, UK
| | - K Oaikhinan
- Department of General Surgery, Doncaster Royal Infirmary, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Niraj Khetan
- Department of General Surgery, Doncaster Royal Infirmary, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
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20
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Aroori S, Mangan C, Reza L, Gafoor N. Percutaneous Cholecystostomy for Severe Acute Cholecystitis: A Useful Procedure in High-Risk Patients for Surgery. Scand J Surg 2018; 108:124-129. [PMID: 30227774 DOI: 10.1177/1457496918798209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acute cholecystitis has the potential to cause sepsis and death, particularly in patients with poor physiological reserve. The gold standard treatment of acute cholecystitis (cholecystectomy) is often not safe in high-risk patients and recourse is made to percutaneous cholecystostomy as either definite treatment or temporizing measure. The aim of this study is to evaluate early and late outcomes following percutaneous cholecystostomy in patients with acute cholecystitis treated at our institution. METHODS All patients who underwent percutaneous cholecystostomy for acute cholecystitis (excluding patients with malignancy) between January 2005 and September 2014 were included in the study. RESULTS A total of 53 patients (22 female, median age, 74 years; range, 27-95 years) underwent percutaneous cholecystostomy during the study period. In total, 12 patients (22.6%) had acalculous cholecystitis. The main indications for percutaneous cholecystostomy were significant co-morbidities (n = 28, 52.8%) and patients too unstable for surgery (n = 21, 39.6%). The median time to percutaneous cholecystostomy from diagnosis of acute cholecystitis was 3.6 days (range, 0-45 days). The median length of hospital stay was 27 (range, 4-87) days. The overall 90-day mortality was 9.3% with two further deaths at 12-month follow up. The mortality was significantly higher in patients with American Society of Anesthesiology grade 4-5 (18% vs 0% in American Society of Anesthesiology grade 2-3, p = 0.026) and in patients with acalculous cholecystitis (25% vs 4.5%, p = 0.035). The overall readmission rate was 18%. A total of 24 (45.2%) patients had surgery: laparoscopic cholecystectomy, n = 11; laparoscopic converted to open, n = 5; open total cholecystectomy, n = 5; open cholecystectomy, n = 1; laparotomy and washout, n = 1; laparotomy partial cholecystectomy and closure of perforated small intestine and gastrostomy, n = 1. CONCLUSION Percutaneous cholecystostomy is a useful temporary or permanent procedure in patients with acute cholecystitis of both calculous and acalculous origin, who are unfit for surgery.
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Affiliation(s)
- S Aroori
- 1 Peninsula HPB Unit, Level 7, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - C Mangan
- 1 Peninsula HPB Unit, Level 7, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - L Reza
- 1 Peninsula HPB Unit, Level 7, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - N Gafoor
- 2 Department of Radiology, Derriford Hospital, Plymouth, UK
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Joliat GR, Longchamp G, Du Pasquier C, Denys A, Demartines N, Melloul E. Delayed Cholecystectomy for Acute Cholecystitis in Elderly Patients Treated Primarily with Antibiotics or Percutaneous Drainage of the Gallbladder. J Laparoendosc Adv Surg Tech A 2018; 28:1094-1099. [DOI: 10.1089/lap.2018.0092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Gaëtan-Romain Joliat
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Grégoire Longchamp
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Céline Du Pasquier
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Department of Interventional Radiology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Alban Denys
- Department of Interventional Radiology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Emmanuel Melloul
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
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Management After Percutaneous Cholecystostomy: What Should We do With the Catheter? Surg Laparosc Endosc Percutan Tech 2018; 28:256-260. [DOI: 10.1097/sle.0000000000000559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Billa RD, McGrath E. A Case Report of Acute Abdominal Pain From a Rare Infectious Etiology. Glob Pediatr Health 2018; 5:2333794X18783876. [PMID: 30014007 PMCID: PMC6041995 DOI: 10.1177/2333794x18783876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/20/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Eric McGrath
- Children's Hospital of Michigan, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
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Lee SO, Yim SK. [Management of Acute Cholecystitis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:264-268. [PMID: 29791985 DOI: 10.4166/kjg.2018.71.5.264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Acute cholecystitis is a common serious complication of gallstones. The reported mortality of acute cholecystitis is approximately 3%, but the rate increases with age or comorbidity of the patient. If appropriate treatment is delayed, complications can develop as a consequence with a grave prognosis. The current standard of care in acute cholecystitis is an early laparoscopic cholecystectomy with the appropriate administration of fluid, electrolyte, and antibiotics. On the other hand, the severity of the disease and patient's operational risk must be considered. In those with high operational risks, gall bladder drainage can be performed as an alternative. Currently percutaneous and endoscopic drainage are available and show clinical success in most cases. After recovering from acute cholecystitis, the patients who have undergone drainage should be considered for cholecystectomy as a definitive treatment. However, in elderly patients or patients with significant comorbidity, operational risks may still be high, making cholecystectomy inappropriate. In these patients, gallstone removal using the percutaneous tract or endoscopy may be considered.
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Affiliation(s)
- Seung Ok Lee
- Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung Kyun Yim
- Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
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Kim SJ, Lee SJ, Lee SH, Lee JH, Chang JH, Ryu YJ. Clinical characteristics of patients with newly developed acute cholecystitis after admission to the intensive care unit. Aust Crit Care 2018; 32:223-228. [PMID: 29680327 DOI: 10.1016/j.aucc.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Critical care patients have many risk factors for acute cholecystitis (AC). However, less data are available regarding newly developed AC in critically ill patients. OBJECTIVES To investigate the clinical features of AC occurring in critically ill patients after admission to an intensive care unit (ICU). METHODS We performed a retrospective cohort study from January 2006 to August 2016 at a tertiary care university hospital. We included patients diagnosed with AC with or without gallstones after ICU admission. All cases of AC were confirmed by gastroenterologists or general surgeons. We excluded patients with AC diagnosed before or at the time of ICU admission. RESULTS A total of 38 patients were diagnosed with AC after ICU admission between January 2006 and August 2016. Seventeen (44.7%) had acute acalculous cholecystitis, while 21 (55.3%) had acute calculous cholecystitis. The median age was 73 years (interquartile range = 63-81 years), and 22 (57.9%) patients were male. The most common reason for ICU admission was pneumonia or sepsis. The median interval from ICU admission to diagnosis of AC was 11 days (interquartile range = 4.8-22.8 days). Before AC diagnosis, almost 90% of patients used total parenteral nutrition, 68% used opioids, 76% were mechanically ventilated, and 42% received vasoactive drugs. More than half of patients underwent cholecystectomy, and all surgically resected gallbladders had pathology results for cholecystitis. Gangrenous cholecystitis was observed in five patients with acute calculous cholecystitis. The overall mortality was 42.1%, and 1/3 of these deaths were directly associated with AC. The average length of stay in the ICU and hospital was 26.5 and 44.5 days, respectively. CONCLUSION The development of AC in the ICU should be carefully monitored, especially in patients who have been infected and admitted to the ICU for more than 10 days. Proper diagnosis and treatment at a critical time could be lifesaving.
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Affiliation(s)
- Soo Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Seok Jeong Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jung Hyun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea.
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Hasbahceci M, Cengiz MB, Malya FU, Kunduz E, Memmi N. The impact of a percutaneous cholecystostomy catheter in situ until the time of cholecystectomy on the development of recurrent acute cholecystitis: a historical cohort study. REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS 2018; 110. [DOI: 10.17235/reed.2018.5644/2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abstract
BACKGROUND AND AIMS Endoscopic ultrasound-guided drainage (EUS-GLB) is a minimally invasive option for patients with cholecystitis who are poor surgical candidates. Compared with percutaneous drainage (PC-GLB), earlier studies have demonstrated similar efficacy with improved quality of life. We present a multicenter, international experience comparing PC-GLB and EUS-GLB in nonsurgical patients with cholecystitis. METHODS All patients who underwent either PC-GLB drainage or EUS-GLB drainage from 7 centers between January 2010 and December 2015 were included. Technical success was defined as successful placement of a catheter or stent into the gallbladder. Clinical success was defined as resolution of clinical symptoms after intervention. Adverse events, length of stay, and the need for repeat interventions and/or hospitalizations were recorded for all patients. RESULTS A total of 155 patients were included (mean age 74±14.24 y; range, 31 to 96; 56% male). Forty-two patients underwent EUS-GLB and 113 patients underwent PC-GLB. Technical success was achieved in 40 patients (95%) in the EUS-GLB group and 112 patients (99%) in the PC-GLB group (P=0.179). Clinical success was achieved in 40 patients (95%) in the EUS-GLB group and 97 patients (86%) in the PC-GLB group (P=0.157). There was no difference in hospital readmission rates between the 2 groups (14% vs. 24%; P=0.194). However, there was significantly higher number of patients requiring repeat interventions in the PC-GLB group (n=28, 24%) compared with the EUS-GLB group (n=4, 10%) (P=0.037). There was no difference in adverse events between the 2 groups. CONCLUSIONS EUS-GLB is safe and efficacious, with comparable technical and clinical success rates and no difference in adverse events. In addition, EUS-GLB offers a potential cost-saving benefit and morbidity benefit by demonstrating a decreased number of repeat interventions.
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Noh SY, Gwon DI, Ko GY, Yoon HK, Sung KB. Role of percutaneous cholecystostomy for acute acalculous cholecystitis: clinical outcomes of 271 patients. Eur Radiol 2017; 28:1449-1455. [PMID: 29116391 DOI: 10.1007/s00330-017-5112-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/20/2017] [Accepted: 09/29/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine the outcomes of percutaneous cholecystostomy (PC) in patients with acute acalculous cholecystitis (AAC). METHODS The study population comprised 271 patients (mean age, 72 years; range, 22-97 years, male, n=169) with AAC treated with PC with or without subsequent cholecystectomy. Clinical data from total 271 patients were analysed, and outcomes were assessed according to whether the catheter was removed or remained indwelling. Patient survival and recurrence rates were calculated. RESULTS Symptom resolution and significant improvement of laboratory test values were achieved in 235 patients (86.7%) within 4 days after PC. Complications occurred in six patients (2.2%). Interval elective cholecystectomy was performed in 127 (46.8%) patients. Among the remaining 121 patients, successful removal of the PC catheter was achieved in 88 patients (72.7%) at a mean of 30 days (range, 4-365 days). Of the catheter removal group, 86/88 (97.7%) were successfully treated with the initial PC, whereas two (2.3%) experienced recurrence of cholecystitis. Cumulative recurrence rates were 1.1%, 2.7%, and 2.7% at 1, 2, and 8 years, respectively. CONCLUSIONS The good therapeutic outcomes of PC and low recurrence rate suggest that PC can be a definitive treatment option in the majority of AAC patients. KEY POINTS • Many patients with AAC are too ill to undergo cholecystectomy. • PC in AAC patients shows low complication and recurrence rate. • PC solely can be a definitive treatment option in the majority of AAC patients.
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Affiliation(s)
- Seung Yeon Noh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic Ro, 43-Gil, Songpa-gu, Seoul, 05505, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic Ro, 43-Gil, Songpa-gu, Seoul, 05505, Korea.
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic Ro, 43-Gil, Songpa-gu, Seoul, 05505, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic Ro, 43-Gil, Songpa-gu, Seoul, 05505, Korea
| | - Kyu-Bo Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic Ro, 43-Gil, Songpa-gu, Seoul, 05505, Korea
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Percutaneous cholecystostomy for acute cholecystitis in elderly patients with comorbidities: Long-term outcomes after successful treatment and the risk factors for recurrence. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hybrid Percutaneous-Endoscopic Treatment for Acute Calculous Cholecystitis in a High-Risk Surgical Patient. ACG Case Rep J 2017; 4:e89. [PMID: 28761892 PMCID: PMC5519400 DOI: 10.14309/crj.2017.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/12/2017] [Indexed: 11/24/2022] Open
Abstract
Acute cholecystitis (AC) has long been treated with percutaneous cholecystostomy (PC) in patients who are poor surgical candidates, but it is associated with high recurrence rate. We report our experience with a hybrid percutaneous-endoscopic technique in an elderly patient with AC who had received a PC. In this technique, a pediatric endoscope was introduced through the PC opening to the gallbladder, and the stones were visualized, fragmented, and extracted using a retrieval basket. The patient’s AC resolved, and within 2 weeks the PC tube was removed. The patient remained asymptomatic at the 6-month and 1-year follow-up visits. We believe that if this method is replicated in large scale, it could be an effective alternative to cholecystectomy in nonsurgical candidates.
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Routine surveillance cholangiography after percutaneous cholecystostomy delays drain removal and cholecystectomy. J Trauma Acute Care Surg 2017; 82:351-355. [PMID: 27893641 DOI: 10.1097/ta.0000000000001315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Percutaneous cholecystostomy (PC) is often performed for patients with acute cholecystitis who are at high risk for operative morbidity and mortality. However, the necessity for routine cholangiography after PC remains unclear. We hypothesized that routine surveillance cholangiography (RSC) after PC would provide no benefit compared to on-demand cholangiography (ODC) triggered by signs or symptoms of biliary pathology. METHODS We performed a 3-year retrospective cohort analysis of patients managed with PC for acute cholecystitis at two tertiary care hospitals. Patients who had routine surveillance cholangiography (RSC, n = 43) were compared to patients who had on-demand cholangiography (ODC, n = 41) triggered by recurrent biliary disease. RESULTS RSC and ODC groups were similar by severity of acute cholecystitis, presence of gallstones, systemic inflammatory response syndrome (SIRS) criteria at the time of PC, SIRS criteria 72 hours after PC, and hospital length of stay. Two patients in the ODC group developed clinical indications for cholangiography. All 44 RSC patients had cholangiography, and 67 total cholangiograms were performed in this group. Surveillance cholangiography identified six patients (14%) with cystic duct filling defect and seven patients (16%) with a common bile duct filling defect, all of whom were asymptomatic. Fifteen patients (35%) in the RSC group had 32 ERCP procedures; five patients (12%) in the ODC group had 7 ERCPs (p = 0.021). The ODC group had fewer days to drain removal (35 vs. 61, p < 0.001) and days to cholecystectomy (39 vs. 81, p = 0.005). Rates of recurrent cholecystitis, cholangitis, gallstone pancreatitis, drain removal, and cholecystectomy were similar between groups. CONCLUSION RSC after PC for acute cholecystitis identified biliary pathology in asymptomatic patients and propagated further testing, but did not provide clinical benefit. ODC was associated with earlier drain removal, earlier cholecystectomy, and decreased resource utilization. LEVEL OF EVIDENCE Prognostic study, level III; therapeutic study, level IV.
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Hermiz SJ, Diegidio P, Garimella R, Ortiz-Pujols S, Yu H, Isaacson A, Mauro MA, Cairns BA, Hultman CS. Acalculous Cholecystitis in Burn Patients: Is There a Role for Percutaneous Cholecystostomy? Clin Plast Surg 2017; 44:567-571. [PMID: 28576245 DOI: 10.1016/j.cps.2017.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Although acute acalculous cholecystitis is uncommon in burn patients, this condition can be rapidly fatal due to delays in diagnosis and treatment and should always be considered in the differential diagnosis when burn patients become septic, develop abdominal pain, or have hemodynamic instability. This article reviews the use of percutaneous cholecystostomy in burn patients as both a diagnostic and therapeutic intervention.
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Affiliation(s)
- Steven J Hermiz
- Department of Surgery, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Paul Diegidio
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Roja Garimella
- Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Shiara Ortiz-Pujols
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Hyeon Yu
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Ari Isaacson
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Matthew A Mauro
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Bruce A Cairns
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Charles Scott Hultman
- Division of Plastic Surgery, Department of Surgery, University of North Carolina School of Medicine, Suite 7038, Burnett Womack, CB#7195, Chapel Hill, NC 27599, USA.
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Inoue K, Ueno T, Nishina O, Douchi D, Shima K, Goto S, Takahashi M, Shibata C, Naito H. Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis. BMC Gastroenterol 2017; 17:71. [PMID: 28569137 PMCID: PMC5452332 DOI: 10.1186/s12876-017-0631-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/24/2017] [Indexed: 12/07/2022] Open
Abstract
Background The Tokyo guideline for acute cholecystitis recommended percutaneous transhepatic gallbladder drainage followed by cholecystectomy for severe acute cholecystitis, but the optimal timing for the subsequent cholecystectomy remains controversial. Methods Sixty-seven patients who underwent either laparoscopic or open cholecystectomy after percutaneous transhepatic gallbladder drainage for severe acute cholecystitis were enrolled and divided into difficult cholecystectomy (group A) and non-difficult cholecystectomy (group B). Patients who had one of these conditions were placed in group A: 1) conversion from laparoscopic to open cholecystectomy; 2) subtotal cholecystectomy and/or mucoclasis; 3) necrotizing cholecystitis or pericholecystic abscess formation; 4) tight adhesions around the gallbladder neck; and 5) unsuccessfully treated using PTGBD. Preoperative characteristics and postoperative outcomes were analyzed. Results The interval between percutaneous transhepatic gallbladder drainage and cholecystectomy in Group B was longer than that in Group A (631 h vs. 325 h; p = 0.031). Postoperative complications occurred more frequently when the interval was less than 216 h compared to when it was more than 216 h (35.7 vs. 7.6%; p = 0.006). Conclusions Cholecystectomy for severe acute cholecystitis was technically difficult when performed within 216 h after percutaneous transhepatic gallbladder drainage. Electronic supplementary material The online version of this article (doi:10.1186/s12876-017-0631-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Koetsu Inoue
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan.
| | - Tatsuya Ueno
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Orie Nishina
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Daisuke Douchi
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Kentaro Shima
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Shinji Goto
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Michinaga Takahashi
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Chikashi Shibata
- Division of Gastroenterological Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Hukumuro, Miyagino-ku, Sendai, Miyagi, Japan
| | - Hiroo Naito
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
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Endo I, Takada T, Hwang TL, Akazawa K, Mori R, Miura F, Yokoe M, Itoi T, Gomi H, Chen MF, Jan YY, Ker CG, Wang HP, Kiriyama S, Wada K, Yamaue H, Miyazaki M, Yamamoto M. Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-Taiwan multicenter cohort study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:346-361. [PMID: 28419741 DOI: 10.1002/jhbp.456] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities. METHODS An international multicentric retrospective observational study was conducted over a 2-year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after gallbladder drainage; Group C: gallbladder drainage alone; and Group D: medical treatment alone. RESULTS The subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index (CCI) scores below and above 6 (P < 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0-3 days after admission (P < 0.01). Multiple regression analysis revealed CCI and low body mass index <20 as predictive factors of 30-day mortality in Grade I+II patients. Also, jaundice, neurological dysfunction, and respiratory dysfunction were predictive factors of 30-day mortality in Grade III patients. In Grade III patients without predictive factors, there were no difference in mortality between Group A and Group B (0% vs. 0%), whereas Group A patients had higher mortality rates than that of Group B patients (9.3% vs. 0.0%) in cases with at least one predictive factor. CONCLUSION Even patients with Grade III severity, primary cholecystectomy can be performed safely if they have no predictive factors of mortality. Gallbladder drainage may have a therapeutic role in subgroups with higher CCI or higher disease severity.
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Affiliation(s)
- Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tsann-Long Hwang
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Kohei Akazawa
- Department of Medical Informatics, Niigata University, Niigata, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masamichi Yokoe
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Harumi Gomi
- Center for Global Health Mito Kyodo General Hospital University of Tsukuba, Ibaraki, Japan
| | - Miin-Fu Chen
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Masaru Miyazaki
- Emeritus Professor, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Cholecystostomy Treatment in an ICU Population: Complications and Risks. Surg Laparosc Endosc Percutan Tech 2017; 26:410-416. [PMID: 27661202 DOI: 10.1097/sle.0000000000000319] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Percutaneous cholecystostomy tube placement has widely been used as an alternative treatment to cholecystectomy, especially in advanced disease or critically ill patients. Reported postprocedural complication rates have varied significantly over the last decade. The goal of this study is to evaluate the safety of percutaneous cholecystostomy tube treatment in critically ill patients. STUDY DESIGN We performed a retrospective chart analysis of 96 critically ill patients who underwent cholecystostomy tube placement during an intensive care unit (ICU) stay between 2005 and 2010 in a tertiary care center in central Massachusetts. Complications within 72 hours of cholecystostomy tube placement and any morbidity or mortality relating to presence of cholecystostomy tube were considered. RESULTS A total of 65 male and 31 female patients with a mean age of 67.4 years underwent percutaneous cholecystostomy tube placement during an ICU stay. Sixty-six patients experienced a total of 121 complications, resulting in an overall complication rate of 69%. Fifty-four of these complications resulted from the actual procedure or the presence of the cholecystostomy tube; the other 67 complications occurred within 72 hours of the cholecystostomy procedure. Ten patients died. Tube dislodgment was the most common complication with a total of 34 episodes. CONCLUSIONS Cholecystostomy tube placement is associated with frequent complications, the most common of which is tube dislodgment. Severe complications may contribute to serious morbidity and death in an ICU population. Complication rates may be underreported in the medical literature. The potential impact of cholecystostomy tube placement in critically ill patients should not be underestimated.
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Emergency Versus Delayed Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage in Grade II Acute Cholecystitis Patients. J Gastrointest Surg 2017; 21:284-293. [PMID: 27778253 DOI: 10.1007/s11605-016-3304-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 10/10/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION In grade II acute cholecystitis patients presenting more than 72 h after onset of symptoms, we prospectively compared treatment with emergency (ELC) to delayed laparoscopic cholecystectomy performed 6 weeks after percutaneous transhepatic gallbladder drainage (PTGBD). METHODS Four hundred ninety-five patients with acute cholecystitis were assessed for eligibility; 345 were excluded or declined to participate. One hundred fifty patients were treated after consent with either ELC or PTGBD. RESULTS Both PTGBD and ELC were able to resolve quickly cholecystitis sepsis. ELC patients had a significantly higher conversion rate (24 vs. 2.7 %, P < 0.001), longer mean operative time (87.8 ± 33.06 vs. 38.09 ± 8.23 min, P < 0.001), higher intraoperative blood loss (41.73 ± 51.09 vs. 26.33 ± 23.86, P = 0.008), and longer duration of postoperative hospital stay (51.71 ± 49.39 vs. 10.76 ± 5.75 h, P < 0.001) than those in the PTGBD group. Postoperative complications were significantly more frequent in the ELC group (26.7 vs. 2.7 %, P < 0.001) with a significant increase in incidence (10.7 %) of bile leak (P = 0.006) compared to those in the PTGBD group. CONCLUSION(S) PTGBD and ELC are highly efficient in resolving cholecystitis sepsis. Delayed cholecystectomy after PTGBD produces better outcomes with a lower conversion rate, fewer procedure-related complications, and a shorter hospital stay than emergency cholecystectomy.
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Solaini L, Paro B, Marcianò P, Pennacchio GV, Farfaglia R. Can percutaneous cholecystostomy be a definitive treatment in the elderly? SURGICAL PRACTICE 2016. [DOI: 10.1111/1744-1633.12212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Leonardo Solaini
- General Surgery Unit; Manerbio Hospital; Manerbio Italy
- Department of Experimental and Clinical Sciences; University of Brescia; Brescia Italy
| | - Barbara Paro
- General Surgery Unit; Manerbio Hospital; Manerbio Italy
- Department of Experimental and Clinical Sciences; University of Brescia; Brescia Italy
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Percutaneously drained intra-abdominal infections do not require longer duration of antimicrobial therapy. J Trauma Acute Care Surg 2016; 81:108-13. [DOI: 10.1097/ta.0000000000001019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Surgical management of empyematous cholecystitis: a register study of over 12,000 cases from a regional quality control database in Germany. Surg Endosc 2016; 30:5319-5324. [PMID: 27177953 DOI: 10.1007/s00464-016-4882-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/14/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Acute cholecystitis is a common indication for surgery. Surgical outcomes depend among other factors on the extent of gallbladder inflammation. Data on the outcomes of patients undergoing cholecystectomy due to acute empyematous cholecystitis are rare. METHODS Data from a prospectively maintained quality control database in Germany were analyzed. Cases with empyematous cholecystitis were compared to cases without gallbladder empyema with regard to baseline features, clinical parameters and surgical outcomes. RESULTS A total of 12,069 patients with empyematous cholecystitis (EC) were compared to 33,296 patients without empyema. The male gender, advanced age, ASA score >2, elevated white blood count and fever were confirmed as risk factors for EC. The EC group differed significantly from the control group with regard to fever (28.0 vs. 9.5 %), elevated WBC (82.5 vs. 62.3 %) and positive findings from ultrasound sonography (87.4 vs. 76.9 %), p < 0001. Surgery lasted significantly longer in the EC group (86.1 ± 38.5 vs. 72.2 ± 33.6, p < 0.001). The rates of conversion (15.2 vs. 5.8 %), bile duct injury (0.8 vs. 0.4 %), re-intervention (5.5 vs. 2.6 %) and mortality (2.8 vs. 1.2 %) were significantly higher in the EC group, p < 0.001. Similarly, the length of stay (11.9 ± 10.5 vs. 8.8 ± 8.3, p < 0.001) was significantly longer in the EC group. CONCLUSION Empyematous cholecystitis is a severe form of acute cholecystitis with high rates of morbidity and mortality. Even the experienced laparoscopic surgeon should expect dissection difficulties, therefore the threshold for conversion in order to prevent bile duct injury should be low.
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Horesh N, Gutman M, Rosin D. Laparoscopic cholecystostomy tube-guided hepatotomy and cholecystolithotomy: alternative strategy for treatment of severe chronic cholecystitis. Ann R Coll Surg Engl 2016; 98:e65-7. [PMID: 26985702 DOI: 10.1308/rcsann.2016.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Laparoscopic cholecystectomy can be a challenging procedure in gallbladders with chronic disease. We describe a patient with chronic cholecystitis and difficult visualisation of the gallbladder at surgery who underwent laparoscopic hepatotomy along the drainage tube of the cholecystostomy. In this way, the gallbladder was identified to avoid non-visualisation of ductal anatomy. This exceptional solution should be added to the surgical options if anatomical recognition is difficult and complete removal of the gallbladder is too risky.
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Affiliation(s)
- N Horesh
- Chaim Sheba Medical Center , Tel Aviv , Israel
| | - M Gutman
- Chaim Sheba Medical Center , Tel Aviv , Israel
| | - D Rosin
- Chaim Sheba Medical Center , Tel Aviv , Israel
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Cortázar García R, Sánchez Rodríguez P, Ramos García M. Colecistostomía percutánea como tratamiento de la colecistitis aguda en pacientes con alto riesgo quirúrgico. RADIOLOGIA 2016; 58:136-44. [DOI: 10.1016/j.rx.2015.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/19/2015] [Accepted: 09/27/2015] [Indexed: 11/26/2022]
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Percutaneous cholecystostomy to treat acute cholecystitis in patients with high risk for surgery. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Furtado R, Le Page P, Dunn G, Falk GL. High rate of common bile duct stones and postoperative abscess following percutaneous cholecystostomy. Ann R Coll Surg Engl 2016; 98:102-6. [PMID: 26741665 PMCID: PMC5210469 DOI: 10.1308/rcsann.2016.0004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The short and long-term outcomes in patients managed with percutaneous cholecystostomy (PCY) at a single institution are described. METHODS A retrospective study was conducted for patients treated between February 2000 and November 2012. Patient charts, imaging and biochemical data were reviewed. Patient demographics, presenting clinical features and treatment variables were noted. Outcome variables were length of admission, 30-day mortality, 30-day unplanned readmission, tube dislodgement, abscess formation, subsequent endoscopic retrograde cholangiography and surgery, complications after surgery and median overall survival. RESULTS PCY was performed for 55 patients for acute cholecystitis where surgical risk was very high. The 30-day readmission rate was 20% (n=11), the 30-day mortality rate was 9% (n=5) and median survival was 59 months (95% confidence interval: 30-88 months). The median follow-up duration was 68 months. Tubes were dislodged in 15 patients (27%) and an abscess occurred after PCY in 5 patients (9%). Subsequent endoscopic common bile duct stone extraction was required in 20 patients (36%). Cholecystectomy was planned in 22 patients and an abscess occurred following the cholecystectomy in 5 (23%). CONCLUSIONS Although a PCY is lifesaving, significant morbidity can arise during recovery. This study demonstrates a high rate of choledocholithiasis (44%), tube dislodgement (27%) and postoperative abscess (23%) compared with previous reports.
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Affiliation(s)
- R Furtado
- Concord Repatriation General Hospital , NSW , Australia
| | - P Le Page
- Concord Repatriation General Hospital , NSW , Australia
| | - G Dunn
- Concord Repatriation General Hospital , NSW , Australia
| | - G L Falk
- Concord Repatriation General Hospital , NSW , Australia
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Papadakis M, Ambe PC, Zirngibl H. Critically ill patients with acute cholecystitis are at increased risk for extensive gallbladder inflammation. World J Emerg Surg 2015; 10:59. [PMID: 26628907 PMCID: PMC4666023 DOI: 10.1186/s13017-015-0054-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/24/2015] [Indexed: 02/07/2023] Open
Abstract
Background Acute cholecystitis is a common diagnosis and surgery is the standard of care for young and fit patients. However, due to high risk of postoperative morbidity and mortality, surgical management of critically ill patients remains a controversy. It is not clear, whether the increased risk of perioperative complications associated with the management of critically ill patients with acute cholecystitis is secondary to reduced physiologic reserve per se or to the severity of gallbladder inflammation. Methods A retrospective analysis of prospectively collected data of patients undergoing laparoscopic cholecystectomy for acute cholecystitis in a university hospital over a three-year-period was performed. The ASA scores at the time of presentation were used to categorize patients into two groups. The study group consisted of critically ill patients with ASA 3 and 4, while the control group was made up of fit patients with ASA 1 and 2. Both groups were compared with regard to perioperative data, postoperative outcome and extent of gallbladder inflammation on histopathology. Results Two hundred and seventeen cases of acute cholecystitis with complete charts were available for analysis. The study group included 67 critically ill patients with ASA 3 and 4, while the control group included 150 fit patients with ASA 1 and 2. Both groups were comparable with regard to perioperative data. Histopathology confirmed severe cholecystitis in a significant number of cases in the study group compared to the control group (37 % vs. 18 %, p = 0.03). Significantly higher rates of morbidity and mortality were recorded in the study group (p < 0.05). Equally, significantly more patients from the study group were managed in the ICU (40 % vs. 8 %, p = 0.001). Conclusion Critically ill patients presenting with acute cholecystitis are at increased risk for extensive gallbladder inflammation. The increased risk of morbidity and mortality seen in such patients might partly be secondary to severe acute cholecystitis.
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Affiliation(s)
- Marios Papadakis
- Helios Klinikum Wuppertal, Department of Surgery II, Witten - Herdecke University, Heusner Str. 40, 42283 Wuppertal, Germany
| | - Peter C Ambe
- Helios Klinikum Wuppertal, Department of Surgery II, Witten - Herdecke University, Heusner Str. 40, 42283 Wuppertal, Germany
| | - Hubert Zirngibl
- Helios Klinikum Wuppertal, Department of Surgery II, Witten - Herdecke University, Heusner Str. 40, 42283 Wuppertal, Germany
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Ambe PC, Weber SA, Christ H, Wassenberg D. Primary cholecystectomy is feasible in elderly patients with acute cholecystitis. Aging Clin Exp Res 2015; 27:921-6. [PMID: 25905472 DOI: 10.1007/s40520-015-0361-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 04/01/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND While early cholecystectomy is generally accepted as the standard procedure for young and fit patients with acute cholecystitis, controversy exits on the management of elderly and severely sick patients. We postulated that primary cholecystectomy is feasible in this subgroup. The aim of this study was to compare the outcomes of young and fit patients to those of elderly patients undergoing surgery for acute cholecystitis. METHODS The outcomes of elderly patients (≥70 years) undergoing surgery for acute cholecystitis in a primary care center in Germany were retrospectively compared to those of younger patients (<70 years). RESULTS 152 patients, 74 aged ≥ 70 years (study group) and 78 < 70 years (control) were included for analysis. The study group was significantly older at the time of surgery (78 vs. 68 years, p = 0.02). Severe cholecystitis was seen in a significant number of cases in the study group, p = 0.01. Equally, the mean WBC (19.5 vs. 17, p = 0.02), CRP (26 vs. 22, p = 0.04) and APACHE II score (17 vs. 8, p = 0.01) were significantly higher in the study group. There was no significant difference in the duration of anesthesia (123 vs. 133 min, p = 0.70) and surgery (72 vs. 81 min, p = 0.90) amongst both groups. There was no significant difference in rate of complication amongst both groups (24 vs. 14%, p = 0.11). Two cases of mortality were recorded (1.3%) in the study group. CONCLUSION The age of the patient cannot be the sole factor in deciding whether or not a patient with acute cholecystitis is fit for surgery.
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Bala M, Mizrahi I, Mazeh H, Yuval J, Eid A, Almogy G. Percutaneous cholecystostomy is safe and effective option for acute calculous cholecystitis in select group of high-risk patients. Eur J Trauma Emerg Surg 2015; 42:761-766. [PMID: 26612179 DOI: 10.1007/s00068-015-0601-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 11/16/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE In high-risk patients with acute calculous cholecystitis (ACC), percutaneous cholecystostomy (PC) can serve as a bridging option to cholecystectomy [laparoscopic cholecystectomy (LC)] or as definitive treatment. The purpose of this study was to identify predictors of the need for permanent PC. METHODS Data from 257 PCs performed for ACC (mean age 67.3 ± 14) was collected for a 10-year period. Demographic and clinical characteristics at initial admission, co-morbidities were analyzed. Patients who underwent interval LC were defined as the surgery group (SG; n = 163, 63.4 %) and the remaining patients as the non-SG (NSG; n = 94, 36.6 %). RESULTS Patients in the SG were significantly younger and had a shorter length of hospital stay (p < 0.01). The rate of coronary artery disease (CAD; 63.2 vs. 20.2 %), chronic renal failure (14.9 vs. 6.1 %), and the mean number of co-morbidities (2.2 vs. 1.4) were significantly higher in the NSG. Sepsis at admission was more common in the NSG (19.1 vs. 4.9 %, p < 0.001). 56 patients (34.4 %) in the SG and 24 patients (25.5 %) in the NSG developed tube-related complications. In hospital mortality was similar between the groups. Multivariate analysis showed that age ≥75, increased alkaline phosphatase (ALK-P), history of CAD, were predictors of PC as a definite treatment in this high-risk group of patients with ACC. CONCLUSIONS High operative risk due to older age and CAD preclude LC in more than one-third of patients following PC especially presenting with sepsis and elevated ALK-P. This study suggests that PC could be a safe treatment option in this select group of high-risk patients.
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Affiliation(s)
- M Bala
- Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel.
| | - I Mizrahi
- Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - H Mazeh
- Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - J Yuval
- Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - A Eid
- Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - G Almogy
- Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
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Timing of percutaneous cholecystostomy affects conversion rate of delayed laparoscopic cholecystectomy for severe acute cholecystitis. Surg Endosc 2015; 30:1028-33. [PMID: 26139479 DOI: 10.1007/s00464-015-4290-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Percutaneous cholecystostomy is reserved for very high-operative-risk patients suffering from severe acute cholecystitis, who do not respond to conservative treatment. It is associated with high conversion rate to open surgery, when cholecystectomy is held later on. Our objective was to assess whether early timing of percutaneous cholecystostomy decreases conversion rate of delayed laparoscopic cholecystectomy to open surgery. METHODS The study population included 59 patients who underwent percutaneous cholecystostomy for severe cholecystitis and then proceeded to delayed interval laparoscopic cholecystectomy. The study consisted of a retrospective survey of medical files, based on a prospective enrollment of the data. We assessed conversion rate between two groups based on the time period from onset of symptoms and from admission to hospital until performance of cholecystostomy. RESULTS Regarding the time from onset of pain to drainage, early cholecystostomy (within 2 days, group I) was associated with 8.3% conversion rate, in contrast to 33.3% in group II (3-6 days from onset of symptoms). Regarding the day of admission to hospital, early drainage revealed 16% conversion rate in contrast to 40.7% in later drainage (p = 0.047, Chi-square test). We found correlation between time interval of symptoms and admission to conversion rate, according to Spearman's correlation coefficient. CONCLUSIONS Early percutaneous cholecystostomy does decrease conversion rate of delayed laparoscopic cholecystectomy, possibly by halting the propagation of the inflammatory process and its consequences. When decision regarding the necessity to perform drainage of the severely inflamed gallbladder is established, it is suggested to be done as soon as possible.
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Comments on the Article About the Evaluation of the Results of Percutaneous Cholecystostomy Versus Cholecystectomy. Ann Surg 2015; 261:e114. [DOI: 10.1097/sla.0000000000000397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Successful laparoscopic cholecystectomy after percutaneous cholecystostomy tube placement. J Trauma Acute Care Surg 2015; 78:100-4. [PMID: 25539209 DOI: 10.1097/ta.0000000000000498] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Interval cholecystectomy (IC) after percutaneous cholecystostomy tube (PCT) placement is the definitive treatment for cholecystitis in patients who are operative candidates after optimization of medical comorbidities. It is not clear, however, which patients will be able to have a laparoscopic IC after PCT placement. We aimed to identify factors associated with successful laparoscopic IC in these patients. METHODS This is a retrospective review of patients who had a PCT from 2009 to 2011. Patient's baseline demographics, clinical data, and outcomes were analyzed. Univariable and multivariable comparisons were performed between patients who did and did not undergo IC. A subgroup analysis of patients who had laparoscopic IC and open IC was performed. Data are presented as percentages, medians with interquartile ranges (IQRs), or odds ratios with 95% confidence interval as appropriate. RESULTS A total of 245 patients had PCT placement, with a median age of 71 years (IQR, 59-80 years); 63% were male, of whom 72 (29%) underwent IC. The median time from PCT placement to IC was 55 days (IQR, 42-75 days). IC patients had a lower Charlson Comorbidity Index (5 [4-6] vs. 6 [4-8], p = 0.005) at the time of PCT placement. When controlling for other factors, lower Charlson Comorbidity Index and fewer previous abdominal operations were associated with performance of IC. Laparoscopic surgery was planned for 89% of the patients and completed successfully in 78%. The only factor associated with successful laparoscopic IC was fewer previous abdominal operations. CONCLUSION Patients who have been medically optimized following PCT can undergo laparoscopic IC with a high rate of success. The degree of illness at the time of PCT placement did not seem to influence the rate of success of laparoscopic IC. LEVEL OF EVIDENCE Therapeutic/care management study, level III.
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Lee SI, Na BG, Yoo YS, Mun SP, Choi NK. Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients. Ann Surg Treat Res 2015; 88:145-51. [PMID: 25741494 PMCID: PMC4347039 DOI: 10.4174/astr.2015.88.3.145] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/31/2014] [Accepted: 09/26/2014] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Extremely elderly patients who present with complicated gallstone disease are less likely to undergo definitive treatment. The use of laparoscopic cholecystectomy (LC) in older patients is complicated by comorbid conditions that are concomitant with advanced age and may increase postoperative complications and the frequency of conversion to open surgery. We aimed to evaluate the results of LC in patients (older than 80 years). METHODS We retrospectively analyzed 302 patients who underwent LC for acute cholecystitis between January 2011 and December 2013. Total patients were divided into three groups: group 1 patients were younger than 65 years, group 2 patients were between 65 and 79 years, and group 3 patients were older than 80 years. Patient characteristics were compared between the different groups. RESULTS The conversion rate was significantly higher in group 3 compared to that in the other groups. Hematoma in gallbladder fossa and intraoperative bleeding were higher in group 3, the difference was not significant. Wound infection was not different between the three groups. Operating time and postoperative hospital stay were significantly higher in group 3 compared to those in the other groups. There was no reported bile leakage and operative mortality. Preoperative percutaneous transhepatic gallbladder drainage and endoscopic retrograde cholangiopancreatography were performed more frequently in group 3 than in the other groups. CONCLUSION LC is safe and feasible. It should be the gold-standard approach for extremely elderly patients with acute cholecystitis.
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Affiliation(s)
- Sang-Ill Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Byung-Gon Na
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Young-Sun Yoo
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Seong-Pyo Mun
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Nam-Kyu Choi
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
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