Emergency Cholecystectomy Versus Percutaneous Cholecystostomy for The Treatment of Acute Cholecystitis in High-Risk Surgical Patients
DOI:
https://doi.org/10.51253/pafmj.v75i6.11642Keywords:
Acute Cholecystitis, Emergency Cholecystectomy, Percutaneous CholecystostomyAbstract
Objective: To compare the outcomes of emergency cholecystectomy versus percutaneous cholecystostomy for treatment of acute cholecystitis in high-risk surgical patients.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Surgery, Combined Military Hospital Quetta, Pakistan from Apr 2022 to Sep 2023.
Methodology: After taking written informed consent, eighty-eight patients who fulfilled the inclusion criteria were enrolled in the study. The patients were divided into two groups of 44 each by odd and even number. Patients in Group-A underwent percutaneous cholecystostomy and in Group-B emergency cholecystectomy was performed. The outcome measures were assessed till the patients were discharged and then on the 30th postoperative day.
Results: The mean age of the patients was 51.0±7.41 years in Group-A and 53.00±8.53 years in Group-B. In-hospital mortality occurred in 6(13.6%) patients in Group-A compared to 1(2.3%) patient in Group-B (p=0.049). Thirty days mortality occurred in 7(15.9%) patients in Group-A and 1(2.3%) patient in Group-B (p=0.026). Complications occurred in 4(9.1%) patients in Group-A compared to 14(31.8%) patients in Group-B (p=0.008).
Conclusion: In high-risk surgical patients with acute cholecystitis, emergency cholecystectomy was significantly associated with lower rates of in-hospital and 30 days’ mortality, but higher rates of complications compared to percutaneous cholecystostomy.
Downloads
References
1. Gallaher JR, Charles A. Acute cholecystitis: a review. J Am Med Assoc 2022; 327(10): 965-975.
https://doi.org/10.1001/jama.2022.2350
2. Musbahi A, Abdulhannan P, Bhatti J, Dhar R, Rao M, Gopinath B. Outcomes and risk factors of cholecystectomy in high risk patients: A case series. Ann Med Surg 2020; 50: 35-40.
https://doi.org/10.1016/j.amsu.2019.12.003
3. Pavurala RB, Li D, Porter K, Mansfield SA, Conwell DL, Krishna SG et al. Percutaneous cholecystostomy-tube for high-risk patients with acute cholecystitis: current practice and implications for future research. Surg Endosc 2019; 33(10): 3396-3403.
https://doi.org/10.1007/s00464-018-06634-5
4. Maruta A, Iwashita T, Iwata K, Yoshida K, Uemura S, Mukai T, et al. Permanent endoscopic gallbladder stenting versus removal of gallbladder drainage, long‐term outcomes after management of acute cholecystitis in high‐risk surgical patients for cholecystectomy: multi‐center retrospective cohort study. J Hepatobiliary Pancreat Sci 2021; 28(12): 1138-1146.
https://doi.org/10.1002/jhbp.967
5. Teoh AY, Kitano M, Itoi T, Pérez-Miranda M, Ogura T, Chan SM, et al. Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1). Gut 2020; 69(6): 1085-1091. https://doi.org/10.1136/gutjnl-2019-319996
6. Rerknimitr R, Pham KC. Practical approaches for high-risk surgical patients with acute cholecystitis: the percutaneous approach versus endoscopic alternatives. Clin Endosc 2020; 53(6): 678-685. https://doi.org/10.5946/ce.2019.186
7. Krishnamoorthi R, Jayaraj M, Thoguluva V, Singh D, Law J, Ross A et al. EUS-guided versus endoscopic transpapillary gallbladder drainage in high-risk surgical patients with acute cholecystitis: a systematic review and meta-analysis. Surg Endosc 2020; 34(5): 1904-1913.
https://doi.org/10.1007/s00464-020-07409-7
8. Tufo A, Pisano M, Ansaloni L, de Reuver P, van Laarhoven K, Davidson B, et al. Risk prediction in acute calculous cholecystitis: a systematic review and meta-analysis of prognostic factors and predictive models. J Laparoendosc Adv Surg Tech 2021; 31(1): 41-53.
https://doi.org/10.1089/lap.2020.0151
9. Luk SW, Irani S, Krishnamoorthi R, Lau JY, Ng EK, Teoh AY et al. Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis. Endosc 2019; 51(8): 722-732.
https://doi.org/10.1055/a-0929-6603
10. Mou D, Tesfasilassie T, Hirji S, Ashley SW. Advances in the management of acute cholecystitis. Ann Gastroenterol Surg 2019; 3(3): 247-253. https://doi.org/10.1002/ags3.12240
11. Ahmed Z, Khan NU, Ahmad J, Saeed S, Batool SF, Sami A, et al. Incidence, Risk Factors and Outcome of Gallbladder Perforation during Laparoscopic Cholecystectomy. Pak J Med Health Sci 2022; 16(12): 798-800.https://doi.org/10.53350/pjmhs20221612798
12. Atar E, Khasminsky V, Friehmann T, Choen A, Bachar GN. Cystic duct embolization with chemical gallbladder ablation for the treatment of acute calculous cholecystitis in high-risk patients: a prospective single-center study. J Vasc Interv Radiol 2020; 31(4): 644-648.https://doi.org/10.1016/j.jvir.2019.12.806
13. Rodríguez-Sanjuán JC, Arruabarrena A, Sánchez-Moreno L, González-Sánchez F, Herrera LA, Gómez-Fleitas M et al. Acute cholecystitis in high surgical risk patients: percutaneous cholecystostomy or emergency cholecystectomy?. Am J Surg 2012; 204(1): 54-59.
https://doi.org/10.1016/j.amjsurg.2011.05.013
14. Cirocchi R, Amato L, Ungania S, Buononato M, Tebala GD, Cirillo B, et al. Management of Acute Cholecystitis in High-Risk Patients: Percutaneous Gallbladder Drainage as a Definitive Treatment vs. Emergency Cholecystectomy—Systematic Review and Meta-Analysis. J Clin Med 2023; 12(15): 4903. https://doi.org/10.3390/jcm12154903
15. Aroori S, Mangan C, Reza L, Gafoor N. Percutaneous cholecystostomy for severe acute cholecystitis: a useful procedure in high-risk patients for surgery. Scand J Surg 2019; 108(2): 124-129.
https://doi.org/10.1177/1457496918798209
16. Karakayali FY, Akdur A, Kirnap M, Harman A, Ekici Y, Moray G et al. Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis. Hepatobiliary Pancreat Dis Int 2014; 13(3): 316-322. https://doi.org/10.1016/s1499-3872(14)60045-x
17. Coelho JC, COSTA MA, Enne M, Torres OJ, Andraus W, Campos AC et al. Acute cholecystitis in high-risk patients. Surgical, radiological, or endoscopic treatment? Brazilian College of Digestive Surgery position paper. ABCD. Arq Bras Cir Dig 2023; 36: e1749.
https://doi.org/10.1590/0102-672020230031e1749
18. Huang H, Zhang H, Yang D, Wang W, Zhang X. Percutaneous cholecystostomy versus emergency cholecystectomy for the treatment of acute calculous cholecystitis in high-risk surgical patients: a meta-analysis and systematic review. Updates Surg 2022; 74(1): 55-64. https://doi.org/10.1007/s13304-021-01081-9
19. Akarsu C, Dural AC, Salik AE, Unsal MG, Kones O, Gok I, et al. Emergency cholecystectomy versus percutaneous cholecystostomy for treatment of acute cholecystitis in high-risk surgical patients. Int Surg 2018; 103(11-12): 534-541.
https://doi.org/ 10.9738/INTSURG-D-16-00076.1
20. Garcés-Albir M, Martín-Gorgojo V, Perdomo R, Molina-Rodríguez JL, Muñoz-Forner E, Dorcaratto D, et al. Acute cholecystitis in elderly and high-risk surgical patients: is percutaneous cholecystostomy preferable to emergency cholecystectomy? J Gastrointest Surg 2020; 24: 2579-2586.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Naveed Akhtar, Muhammad Omar Farooq, Sohail Ilyas, Tariq Mukhtar Farani, Falak Siyar; Hassan Mehmood
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
