J Korean Soc Radiol.  2017 Dec;77(6):372-381. 10.3348/jksr.2017.77.6.372.

The Efficacy of Preoperative Percutaneous Cholecystostomy for Acute Cholecystitis with Gallbladder Perforation

Affiliations
  • 1Department of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea. bhpark@dau.ac.kr

Abstract

PURPOSE
Treatment of acute cholecystitis with gallbladder perforation remains controversial. We aimed to determine the feasibility of percutaneous cholecystostomy (PC) in these patients.
MATERIALS AND METHODS
We retrospectively reviewed patients who had acute cholecystitis with gallbladder perforation at a single institution. Group 1 (n = 27; M:F = 18:9; mean age, 69.9 years) consisted of patients who received PC followed by cholecystectomy, and group 2 (n = 16; M:F = 8:8; mean age 57.1 years) consisted of patients who were treated with cholecystectomy only. Preoperative details, including sex, age, underlying medical history, signs of systemic inflammatory response syndrome (SIRS), laboratory findings, body mass index, presence of gallstone, and type of perforation; treatment-related variables, including laparoscopic or open cholecystectomy, conversion to laparotomy, blood loss, surgical time and anesthesia time; and outcome, including postoperative complications and hospital stay were analyzed.
RESULTS
There was no significant difference in preoperative details, treatment-related variables, postoperative complications, and postoperative hospital stay. However, preoperative hospital stay (median, 14 days vs. 8 days; p < 0.05) and total hospital stay (median, 22 days vs. 14.5 days; p < 0.05) were significantly longer in group 1 than in group 2.
CONCLUSION
The preferred treatment of acute cholecystitis with gallbladder perforation might be cholecystectomy without preoperative PC; however, preoperative PC can be a safe, optional treatment in elderly patients with signs of SIRS.


MeSH Terms

Aged
Anesthesia
Blood Loss, Surgical
Body Mass Index
Cholecystectomy
Cholecystitis, Acute*
Cholecystostomy*
Gallbladder*
Gallstones
Humans
Laparotomy
Length of Stay
Postoperative Complications
Retrospective Studies
Systemic Inflammatory Response Syndrome

Figure

  • Fig. 1. Algorithm for treatment decision in the patients having acute cholecystitis with gallbladder perforation in this study.


Reference

1.Derici H., Kara C., Bozdag AD., Nazli O., Tansug T., Akca E. Diag-nosis and treatment of gallbladder perforation. World J Gas-troenterol. 2006. 12:7832–7836.
2.Date RS., Thrumurthy SG., Whiteside S., Umer MA., Pursnani KG., Ward JB, et al. Gallbladder perforation: case series and systematic review. Int J Surg. 2012. 10:63–68.
Article
3.Niemeier OW. Acute Free Perforation of the Gall-Bladder. Ann Surg. 1934. 99:922–924.
Article
4.Roslyn J., Busuttil RW. Perforation of the gallbladder: a fre-quently mismanaged condition. Am J Surg. 1979. 137:307–312.
Article
5.Donati M., Biondi A., Basile F., Gruttadauria S. An atypical pre-sentation of intrahepatic perforated cholecystitis: a modern indication to open cholecystectomy. Report of a case. BMC Surg. 2014. 14:6.
Article
6.Zafar SN., Obirieze A., Adesibikan B., Cornwell EE 3rd., Fullum TM., Tran DD. Optimal time for early laparoscopic cholecys-tectomy for acute cholecystitis. JAMA Surg. 2015. 150:129–136.
Article
7.Nagata T., Nakase Y., Nakamura K., Mochiduki S., Fujino M., Kitai S, et al. Impact of percutaneous transhepatic gallbladder drainage on the outcome of laparoscopic cholecystectomy. J Gastroenterol Hepatol Res. 2016. 5:1899–1902.
Article
8.Suzuki K., Bower M., Cassaro S., Patel RI., Karpeh MS., Leitman IM. Tube cholecystostomy before cholecystectomy for the treatment of acute cholecystitis. JSLS. 2015. 19:e2014. .00200.
Article
9.Cull JD., Velasco JM., Czubak A., Rice D., Brown EC. Manage-ment of acute cholecystitis: prevalence of percutaneous cho-lecystostomy and delayed cholecystectomy in the elderly. J Gastrointest Surg. 2014. 18:328–333.
Article
10.Na BG., Yoo YS., Mun SP., Kim SH., Lee HY., Choi NK. The safe-ty and efficacy of percutaneous transhepatic gallbladder drainage in elderly patients with acute cholecystitis before laparoscopic cholecystectomy. Ann Surg Treat Res. 2015. 89:68–73.
Article
11.McKay A., Abulfaraj M., Lipschitz J. Short- and long-term out-comes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients. Surg Endosc. 2012. 26:1343–1351.
Article
12.American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative ther-apies in sepsis. Crit Care Med. 1992. 20:864–874.
13.Guidelines for the clinical application of laparoscopic biliary tract surgery. Society of American Gastrointestinal and Endoscopic Surgeons. Available at:. http://www.sages.org/publications/guidelines/guidelines-for-the-clinical-appli-cation-of-laparoscopic-biliary-tract-surgery. Published 2010. Assessed September 16,. 2016.
14.SSAT patient care guidelines, treatment of gallstones and gallbladder disease. Society for Surgery of the Alimentary Tract. Available at:. http://ssat.com/guidelines/Gallstone-and-Gallbladder-Disease.cgi. Published 2014. Assessed Sep-tember 16,. 2016.
15.Welschbillig-Meunier K., Pessaux P., Lebigot J., Lermite E., Aube Ch., Brehant O, et al. Percutaneous cholecystostomy for high-risk patients with acute cholecystitis. Surg Endosc. 2005. 19:1256–1259.
Article
16.Sugiyama M., Tokuhara M., Atomi Y. Is percutaneous cholecys-tostomy the optimal treatment for acute cholecystitis in the very elderly? World J Surg. 1998. 22:459–463.
Article
17.Kim SW., Kim SY., Hong SK., Park SB., Rho HR., Chae GB. Clini-cal benefits of preoperative percutaneous transhepatic gall-bladder drainage in patients older than sixty with acute cho-lecystitis. Korean J Hepatobiliary Pancreat Surg. 2010. 14:184–190.
18.Winbladh A., Gullstrand P., Svanvik J., Sandström P. System-atic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford). 2009. 11:183–193.
Article
19.Kim KH., Sung CK., Park BK., Kim WK., Oh CW., Kim KS. Percutaneous gallbladder drainage for delayed laparoscopic cho-lecystectomy in patients with acute cholecystitis. Am J Surg. 2000. 179:111–113.
Article
20.Khan SA., Gulfam ., Anwer AW., Arshad Z., Hameed K., Shoaib M. Gallbladder perforation: a rare complication of acute chole-cystitis. J Pak Med Assoc. 2010. 60:228–229.
21.Kim HO., Ho Son B., Yoo CH., Ho Shin J. Impact of delayed lap-aroscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis. Surg Laparosc Endosc Percutan Tech. 2009. 19:20–24.
Article
22.Han IW., Jang JY., Kang MJ., Lee KB., Lee SE., Kim SW. Early ver-sus delayed laparoscopic cholecystectomy after percutane-ous transhepatic gallbladder drainage. J Hepatobiliary Pan-creat Sci. 2012. 19:187–193.
Article
Full Text Links
  • JKSR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr