HPB SO29 - Outcomes of Percutaneous Image-Guided and Laparoscopic Cholecystostomies in High-Risk Patients With Acute Calculus Cholecystitis: A Five-Year District General Hospital Experience

Abstract Background Acute cholecystitis (AC), inflammation of the gall bladder, is one of the most common emergency surgical presentations. In the UK, approximately 15% of the population is estimated to have gallstones, and approximately 20% of them can develop AC. Laparoscopic cholecystectomy (LC) is considered the definitive management of AC. However, cholecystectomy carries a very high risk of morbidity and mortality in high-risk frail patients with multiple comorbidities who are deemed unfit for surgery. Percutaneous cholecystostomy (PC), both image-guided and laparoscopic, is generally acknowledged as an interim treatment measure before definitive management, which is the LC. Method This retrospective study from the Royal Albert Edward Infirmary in Wigan, UK, analyzed medical records of patients who underwent percutaneous cholecystostomy (PC) between January 2017 and December 2022. Excluded were patients with prior hepato-pancreato-biliary malignancy, those who had open cholecystostomy, or those with abdominal ascites. Data collected included age, gender, American Society of Anaesthesiologists (ASA) grades, procedure success rates (temporary or definitive), hospital stay duration, 30-day and 1-year mortality rates, timing of the procedure, and long-term complications, particularly those related to cholecystostomy tube dislodgment or blockage. Results In this study, 27 patients who underwent percutaneous cholecystostomy (PC) were divided into two groups: Group A (10 patients) had laparoscopic cholecystostomies, and Group B (17 patients) had ultrasound-guided cholecystostomies. The mean ages were 66.7 for Group A and 75.1 for Group B. Most patients were in ASA groups III (14) and IV (10). About 74% had procedures during the day, 26% at night. The mean hospital stay was 13.5 days. Around 55% had elective laparoscopic cholecystectomy (LC) as definitive management. Two patients died within 30 days, and eight within a year. About 40% experienced tube dislodgment or blockage complications. Conclusion This study concludes that PC, using both laparoscopic and US-guided techniques, can serve as an interim as well as a definitive measure, particularly in patients who are at high risk for anesthesia and the procedure itself and have multiple comorbidities.