Importance of Percutaneous Cholecystostomy in the Treatment of High-Risk Acute Cholecystitis Patients

INTRODUCTION: The prevalence of acute calculous cholecystitis (ACC) increases with age, and the majority of these patients have high comorbidities. In high-risk patients with increased comorbidities, conservative treatment or percutaneous cholecystostomy (PC) may be chosen instead of surgical treatment, depending on the center experience and the patient's risk status. Our aim is to investigate the efficacy and safety of PC, ACC recurrence rates, and the surgical need in Tokyo Grade of Severity - Grade 3 patients with high surgical risks.
METHODS: Twenty patients who applied to Haydarpaþa Numune Training and Research Hospital between December 2012 and February 2020, with Grade 3 severity acute cholecystitis (Tokyo guidelines), were included in the study. All were diagnosed with acute cholecystitis using the 2018 Tokyo criteria and treated with percutaneous cholecystostomy. Patient data were obtained through retrospective screening.
RESULTS: Eight (40.0%) of the total patients were female and 12 (60.0%) were male. The mean age of the patients was 78.6±9.9 years. The mean hospital stay was 17.8±11.8 days. The technical success of the PC procedure was 100%. The mean duration of the catheters was 29.0±14.7 days. No procedure-related mortality was observed. 100% of the patients had comorbidities, with all having more than one comorbidity. All patients were grade 3 according to the Tokyo severity rating. All were evaluated as ASA IV due to comorbidities and found to be at high risk for surgery. The follow-up period was 12 months. Mortality was calculated for 90 days, and mortality was observed in 3 (15%) patients.
DISCUSSION AND CONCLUSION: PC can be an effective and safe treatment method that can be applied before cholecystectomy or for permanent treatment to avoid mortality and morbidity in high-risk patients who are not suitable for surgery.