Abstract
Objectives: A higher conversion rate from laparoscopic to open cholecystectomy in the setting of acute cholecystitis was reported, with an increased risk for morbidity and longer hospital stay. In critically ill patients with gallbladder stones and cholecystitis, percutaneous gallbladder drainage serves as a temporizing procedure, palliating the gallbladder-related sepsis. Compared with surgery in critically ill patients, percutaneous drainage has a relatively low complication rate and is rapidly effective. We report our institution's experience in using percutaneous cholecystostomy tube (PCT) insertion as a temporizing measure prior to laparoscopic cholecystectomy.
Design: A retrospective study on prospectively collected data
Settings: Tertiary care center in Riyadh, Saudi Arabia
Subjects: Patients who underwent PCT insertion for acute cholecystitis
Intervention: PCT insertion
Main outcome measure(s): Clinical picture of the patient, hospital stay and sepsis indicators
Results: A total of 25 patients underwent a PCT insertion for acute cholecystitis. Clinical improvement of the patients' symptoms (right upper quadrant pain and fever) and normalization of white blood cells following the insertion of the PCT was achieved in 66 hours approximate to 2.75 days (range : 1 - 7 days). The mean hospitalization time was 15.44 days and the median was 15 (3 - 42) days. All 24 patients subsequently underwent laparoscopic cholecystectomy without conversion nor common bile duct injury in our series.
Conclusion: PCT insertion followed by laparoscopic cholecystectomy is an effective and safe treatment in patients with acute cholecystitis and concomitant comorbidities.