Percutaneous cholecystostomy is appropriate as definitive treatment for acute cholecystitis in critically ill patients: a single center, cross-sectional study.
OBJECTIVE
Percutaneous cholecystostomy (PC) is an effective treatment for cholecystitis in high-risk surgical patients. However, there is no definitive agreement on the need for additional cholecystectomy in these patients.


METHODS
All patients who were admitted to Cheju Halla General Hospital (Jeju, Korea) for acute cholecystitis and who underwent ultrasonography-guided PC between 2007 and 2012 were consecutively enrolled in this study. Among 82 total patients enrolled, 35 underwent laparoscopic cholecystectomy after recovery and 47 received the best supportive care (BSC) without additional surgery.


RESULTS
The technical and clinical success rates for PC were 100% and 97.5%, respectively. The overall mean survival was 12.8 months. In the BSC group, mean survival was 5.4 months, and in the cholecystectomy group, mean survival was 22.4 months (p<0.01). However, there was no significant difference between these groups in multivariate analysis (relative risk [RR]=1.92; 95% CI, 0.77-4.77; p=0.16). However, advanced age (RR=1.05; 95% CI, 1.02-1.08; p=0.001) and higher class in the American Society of Anesthesiologists' physical status (RR=3.06; 95% CI, 1.37-6.83, p=0.006) were significantly associated with survival in the multivariate analysis. Among the 47 patients in the BSC group, the cholecystostomy tube was removed in 31 patients per protocol. Recurrent cholecystitis was not observed in either group of patients during the follow-up period.


CONCLUSIONS
In high-risk surgical patients, PC without additional cholecystectomy might be the best definitive management. Furthermore, the cholecystostomy drainage catheter can be safely removed in certain patients.
Digestive Disease Center, Department of Internal Medicine, Cheju Halla General Hospital, Doreongno 65, Jeju 690-766, Korea.
Byung Hyo
BH
Cha
Ha Hun
HH
Song
Young Nam
YN
Kim
Won Jung
WJ
Jeon
Sang Jin
SJ
Lee
Jin Dong
JD
Kim
Hak Hyun
HH
Lee
Ban Seok
BS
Lee
Sang Hyub
SH
Lee
D000368:Aged; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000401:mortality / Q000601:surgery*; D002767:Cholecystostomy; D016638:Critical Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015996:Survival Rate