title: Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis.
abstract: BACKGROUND
  The aim of this study was to review a series of consecutive percutaneous cholecystostomies (PC) to analyse the clinical outcomes.
  
  
  METHODS
  All patients who underwent a PC between 2000 and 2010 were reviewed retrospectively for indications, complications, and short- and long-term outcomes.
  
  
  RESULTS
  Fifty-three patients underwent a PC with a median age was 74 years (range 14-93). 92.4% (n = 49) of patients were American Society of Anesthesiologists (ASA) III and IV. 82% (43/53) had ultrasound-guided drainage whereas 18% (10/53) had computed tomography (CT)-guided drainage. 71.6% (n = 38) of PC's employed a transhepatic route and 28.4% (n = 15) transabdominal route. 13% (7/53) of patients developed complications including bile leaks (n = 5), haemorrhage (n = 1) and a duodenal fistula (n = 1). All bile leaks were noted with transabdominal access (5 versus 0, P = 0.001). 18/53 of patients underwent a cholecystectomy of 4/18 was done on the index admission. 6/18 cholecystectomies (33%) underwent a laparoscopic cholecystectomy and the remaining required conversion to an open cholecystectomy (67%). 13/53 (22%) patients were readmitted with recurrent cholecystitis during follow-up of which 7 (54%) had a repeated PC. 12/53 patients died on the index admission. The overall 1-year mortality was 37.7% (20/53).
  
  
  CONCLUSIONS
  Only a small fraction of patients undergoing a PC proceed to a cholecystectomy with a high risk of conversion to an open procedure. A quarter of patients presented with recurrent cholecystitis during follow-up. The mortality rate is high during the index admission from sepsis and within the 1 year of follow-up from other causes.
authors.affiliation: Upper GI & HPB Unit, Ninewells Hospital and Medical School, Dundee, UK. sanjay.pandanaboyana@nhs.net
authors.forename: Pandanaboyana
authors.initials: P
authors.lastname: Sanjay
authors.forename: Devender
authors.initials: D
authors.lastname: Mittapalli
authors.forename: Aseel
authors.initials: A
authors.lastname: Marioud
authors.forename: Richard D
authors.initials: RD
authors.lastname: White
authors.forename: Rishi
authors.initials: R
authors.lastname: Ram
authors.forename: Afshin
authors.initials: A
authors.lastname: Alijani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002767:Cholecystostomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004322:Drainage; D004378:Duodenal Diseases / Q000209:etiology; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010359:Patient Readmission; D019106:Postoperative Hemorrhage / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D012606:Scotland; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult