HPB P56 Outcomes of laparoscopic versus percutaneous cholecystostomy in high-risk patients with acute calculus cholecystitis
Authors: Khawaja Zeeshan 
Published: December 2022

Abstract

Background
Around 10–15% population in the UK have gallstones. (1) Gall stone related disease account for 1/3rd of the emergency surgical admissions and referrals. (2) Acute cholecystitis, which is the inflammation of the gall bladder can develop in 1–3% of these patients. (3) Without treatment, acute cholecystitis may resolve spontaneously within 1–7 days. However, 25–30% of people will require surgery or develop complications. (4)
Laparoscopic cholecystectomy is the standard technique for management of acute cholecystitis. However, in the patients who are high risk, LC can result in significant mortality and morbidity. According to the Dutch guidelines for management of Gall Bladder stones disease, high risk patients such as those with multiple comorbidities or those who present with sepsis, LC is not the best management option. (5) In such patients percutaneous cholecystostomy (PC) is sometimes accepted as a bridge to the definitive management. (6) (7) Percutaneous image guided cholecystostomy is a safe and important in such scenarios. However, in those patients who present to the hospital at occasions during which interventional radiology service is not available, laparoscopic cholecystostomy would remain a safe and efficient temporary alternative for management of acute cholecystitis not responding to medical treatment. (8)

Methods
A retrospective analysis of the 29 patients who were admitted in our hospital and had cholecystostomy between 2015–2021 was done. Eleven (11) patients had Laparoscopic cholecystostomy were allocated to Group A and ten 18 patients who underwent US guided cholecystostomy were assigned to Group B.
The data was collected regarding the timing of procedure (Day/Night), 30 days and 1 year mortality, duration of hospital stay, Rate of dislodgement/blockage of cholecystostomy tube and outcome after procedure (definitive management, planned cholecystectomy).
Inclusion criteria: High risk patients with multiple comorbidities (ASA 2–4) who presented with acute cholecystitis and underwent laparoscopic cholecystostomy after failed conservative management were included in this study.
Exclusion criteria: Those patients who had either hepato-pancreatic-biliary malignancy (HPB) or ascites, and those who underwent open cholecystostomy were excluded from the study.

Results
In group A, 7 patients were females and 4 were males while in Group B, 9 patients were females and 9 were males.
8 patients in group A had the procedure over night while only 3 patients had the procedure during day while in group B, only 1 patient had procedure during the night and the rest of them had procedure during the day.
All the patients in group A had their cholecystectomy except one who died within 30 days of the cholecystostomy. In group B, only 6 patients had further LC while 12 patients did not require further operation.
Out of all the patients, only 1 patient in each group died within 30 days after the procedure. None of the patients experienced one year mortality after the procedure in group A whereas, in group B, 7/18 patients died within 1 year after the procedure.
Dislodgment of drain occurred in 2/11 patients in the group A and 4/18 patients in the group B. None of the patients in both the groups A & B had any post cholecystostomy complications.

Conclusions
This study concludes that Laparoscopic cholecystostomy can be as a viable alternative to open cholecystectomy in technically difficult cases and alternative to percutaneous cholecystostomy in hospitals without interventional radiology services or during the times when IR services are not available.