26 Management of Percutaneous Cholecystostomy Drains: A Delphi Consensus from Ireland and the UK

Abstract Introduction Acute calculous cholecystitis (AC) is a common surgical emergency with varying severity. The Tokyo Guidelines 2018 indicate that patients with grade III AC and high ASA scores are managed with a Percutaneous Cholecystostomy Drainage (PCD) to control sepsis. Currently, there are no guidelines regarding the indications, management, and follow-up of PCDs. This is a Delphi Consensus project aimed at generating guidelines for managing PCDs. Method The Irish Surgical Research Collaborative sought to generate guidelines for PCD management through a Delphi Consensus process involving a panel of experts from Ireland and the UK. The panel comprised 44 consultants specialising in general surgery and interventional radiology. Following a thorough literature review, the steering committee generated thirty-four statements shared digitally with the expert panel using Google Forms (Google LLC, Mountain View, CA, USA). Results Following three rounds, consensus was reached on nineteen statements on PCD management. PCD is an appropriate alternative strategy to cholecystectomy for surgically unfit patients with severe AC. Transhepatic drains are preferred to transperitoneal drains and should be kept for six weeks post-insertion. An outpatient cholecystogram should be performed before PCD removal. A completion cholecystectomy is feasible with low perioperative complications. Endoscopic drainage is a novel technique that should be used where available. There was no consensus on the management of AC during pregnancy, acalculous cholecystitis management, or clamping tests. Conclusions PCD is a suitable alternative to laparoscopic cholecystectomy for surgically unfit patients with severe cholecystitis. This study presents guidelines for the indications, follow-up and management of PCDs.