Use of cholecystostomy tubes in the management of patients with primary diagnosis of acute cholecystitis
Department of Surgery, Surgical Outcomes Analysis and Research (SOAR); Senior Scholars Program
Aged; Cholecystitis, Acute; Cholecystography; Cholecystostomy; Critical Illness; Decompression, Surgical; Digestive System Surgical Procedures; Female; Humans; Male; Middle Aged; Quality of Life; Retrospective Studies; *Stents; Treatment Outcome
Life Sciences | Medicine and Health Sciences
BACKGROUND: Management of patients with severe acute cholecystitis (AC) remains controversial. In settings where laparoscopic cholecystectomy (LC) can be technically challenging or medical risks are exceedingly high, surgeons can choose between different options, including LC conversion to open cholecystectomy or surgical cholecystostomy tube (CCT) placement, or initial percutaneous CCT. We reviewed our experience treating complicated AC with CCT at a tertiary-care academic medical center.
STUDY DESIGN: All adult patients (n = 185) admitted with a primary diagnosis of AC and who received CCT from 2002 to 2010 were identified retrospectively through billing and diagnosis codes.
RESULTS: Mean patient age was 71 years and 80% had >/=1 comorbidity (mean 2.6). Seventy-eight percent of CCTs were percutaneous CCT placement and 22% were surgical CCT placement. Median length of stay from CCT insertion to discharge was 4 days. The majority (57%) of patients eventually underwent cholecystectomy performed by 20 different surgeons in a median of 63 days post-CCT (range 3 to 1,055 days); of these, 86% underwent LC and 13% underwent open conversion or open cholecystectomy. In the radiology and surgical group, 50% and 80% underwent subsequent cholecystectomy, respectively, at a median of 63 and 60 days post-CCT. Whether surgical or percutaneous CCT placement, approximately the same proportion of patients (85% to 86%) underwent LC as definitive treatment.
CONCLUSIONS: This 9-year experience shows that use of CCT in complicated AC can be a desirable alternative to open cholecystectomy that allows most patients to subsequently undergo LC. Additional studies are underway to determine the differences in cost, training paradigms, and quality of life in this increasingly high-risk surgical population. rights reserved.
DOI of Published Version
J Am Coll Surg. 2012 Feb;214(2):196-201. Epub 2011 Dec 21. Link to article on publisher's site
Journal of the American College of Surgeons
Cherng, Nicole; Witkowski, Elan R.; Sneider, Erica B.; Wiseman, Jason T.; Lewis, Joanne; Litwin, Demetrius E. M.; Santry, Heena P.; Cahan, Mitchell A.; and Shah, Shimul A., "Use of cholecystostomy tubes in the management of patients with primary diagnosis of acute cholecystitis" (2012). University of Massachusetts Medical School. Senior Scholars Program. Paper 147.