Patient outcomes after treatment with percutaneous cholecystostomy for biliary sepsis

• Published in: Annals of the Royal College of Surgeons of England Vol. 96; no. 3; pp. 229 - 233
• Main Authors: Flexer, S M, Peter, M B, Durham-Hall, A C, Ausobsky, J R
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2014; Royal College of Surgeons
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Algorithms; Antibiotics; Bile; Cardiac arrhythmia; Cholecystectomy; Cholecystectomy, Laparoscopic - methods; Cholecystitis, Acute - surgery; Cholecystostomy - methods; Conversion to Open Surgery - statistics & numerical data; Demographics; Female; Females; Gallbladder; Gallbladder diseases; Gallstones; Hospitals; HPB; Humans; Laparoscopy; Male; Middle Aged; Morbidity; Mortality; Patients; Physiology; Postoperative Complications - etiology; Radiology; Retrospective Studies; Risk Factors; Sepsis; Sepsis - surgery; Severity of Illness Index; Surgical anastomosis; Systematic review; Time-to-Treatment; Treatment Outcome; Ultrasonic imaging; United Kingdom > UK
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/003588414X13814021679799

Acute cholecystitis is among the most common general surgical presentations. There is a cohort of patients who develop systemic sepsis and complications of acute cholecystitis. These patients are often elderly and co-morbid. Conservative management with percutaneous cholecystostomy has been shown to be a safe and effective management option in the acute setting. However, there is currently no consensus for the further management of these patients. In particular, there is a paucity of data on readmission rates and subsequent operative or non-operative management. A retrospective study was carried out of patients treated with a percutaneous cholecystostomy for biliary sepsis over a three-year period in a UK teaching hospital. Outcome measures were subsequent operative or conservative management, conversion rates, operative complications and readmission rates. Twenty-five patients had a percutaneous cholecystostomy for the treatment of acute biliary sepsis. The median follow-up duration was 35 months. Thirteen patients (52%) had operative treatment. In the operative group, 6/13 had a laparoscopic cholecystectomy, 2/13 had a planned open cholecystectomy, 2/13 had abandoned procedures and 3/13 had a converted procedure. Complications in the operative group included: postoperative mortality (1/13), common bile duct injury requiring drainage and endoscopic stenting (1/13) and one patient required readmission with recurrent pain. In the non-operative group, 5/12 patients were readmitted with biliary sepsis, 5/12 had no readmissions, 1/12 died in the community and 1/12 was readmitted with biliary colic. Percutaneous cholecystostomy is a recognised treatment modality for elderly, co-morbid patients with biliary sepsis. Nevertheless, the readmission rate in this group is relatively high at 5/12 (42%). Patients who undergo subsequent operative management have a conversion rate of 3/13 (23%) and a significant complication rate of 2/13 (15%). The further management of patients having undergone percutaneous cholecystostomy requires careful consideration on an individual case basis. The P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) may aid decision making.