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Management of patients with severe acute cholecystitis (AC) remains controversial. In settings where laparoscopic cholecystectomy (LC) may be technically challenging or medical risks exceedingly high, surgeons may choose between different options including LC conversion to open cholecystectomy or surgical cholecystostomy tube placement (sCCT), or initial percutaneous cholecystostomy (pCCT). We reviewed our experience treating complicated AC with CCT at a tertiary-care academic medical center.
Methods: All adult patients (n=185) with a primary diagnosis of AC that received CCT from 2002-2010 were identified retrospectively through billing / diagnosis codes.
Results: Mean patient age was 71 years, and 80% had at least one comorbidity (mean 2.6). 78% of CCTs were pCCT while 22% were sCCT. Median length of stay from CCT insertion to discharge was 4 days. The majority (57%) of patients eventually underwent a cholecystectomy by 20 surgeons in a median of 63 days post-CCT (range 3-1055 days); of these, 86% underwent laparoscopic cholecystectomy (LC), 13% open conversion or open cholecystectomy. In the radiology and surgical group, 50% and 80% underwent subsequent cholecystectomy, respectively, in a median of 63 and 60 days post-CCT. Whether sCCT or pCCT, approximately the same proportion of patients (85-86%) underwent LC as definitive treatment.
Conclusions: This nine year experience shows that use of CCT in complicated AC may be a desirable alternative to open cholecystectomy that allows most patients to subsequently undergo LC. Further studies are underway to determine the differences in cost, training paradigms and quality of life in this increasingly high-risk surgical population.