title: Percutaneous cholecystostomy as an alternative to cholecystectomy in high risk patients with biliary sepsis: a district general hospital experience.
abstract: BACKGROUND
  Cholecystectomy is the standard treatment for patients with acute cholecystitis. However, percutaneous cholecystostomy (PC) is an alternative for patients at high risk for surgery. We present our five-year clinical experience with the aim of evaluating the efficacy  of PC in high risk patients.
  
  
  METHODS
  A retrospective review was performed on 30 consecutive patients who underwent PC at our institution. The indications for cholecystostomy, route of insertion, technical success, clinical improvement, length of hospitalisation, in-hospital or 30-day  mortality, complications, subsequent admissions and performance of interval cholecystectomy were recorded. The median follow-up period was 25 months (range: 1-52 months).
  
  
  RESULTS
  Thirty-two PCs were performed in thirty patients (mean age: 76.1 years; range: 52-90 years).  The indications for PC were acute calculous cholecystitis (29/32), acalculous cholecystitis (1/32) and emphysematous cholecystitis (2/32). The route of insertion was transperitoneal for 22/32 PCs (68.8%) and transhepatic for 10/32 (31.2%). The procedure was technically successful in all patients  although 2/22 transperitoneal drains (9.1%) were dislodged subsequently. Twenty-seven PCs (84.4%) resulted in clinical improvement within five days. The in-hospital or 30-day mortality rate was 16.7% (5/30). Eleven patients (36.7%) had a subsequent cholecystectomy: 6 were laparoscopic and  5 converted to open procedures at a median interval of 58 days (range: 1-124 days).
  
  
  CONCLUSIONS
  PCs are straightforward with few complications. Most patients improve clinically and the procedure can therefore be used as a definitive treatment in unfit patients or as a bridge  to surgery in those who might subsequently prove fit for a definitive operation.
authors.affiliation: Chesterfield Royal Hospital NHS Foundation Trust, UK. waljundi@hotmail.com
authors.forename: W
authors.initials: W
authors.lastname: Al-Jundi
authors.forename: T
authors.initials: T
authors.lastname: Cannon
authors.forename: R
authors.initials: R
authors.lastname: Antakia
authors.forename: U
authors.initials: U
authors.lastname: Anoop
authors.forename: R
authors.initials: R
authors.lastname: Balamurugan
authors.forename: N
authors.initials: N
authors.lastname: Everitt
authors.forename: K
authors.initials: K
authors.lastname: Ravi
mesh_terms: D000208:Acute Disease; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods*; D004322:Drainage / Q000379:methods; D005260:Female; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000601:surgery*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional