Cholecystostomy Drainage - Current Practices in a Tertiary Hepatobiliary Unit

Abstract

Background
Acute calculous cholecystitis (ACC) is a common general surgical emergency and accounts for 20% of symptomatic gallstone presentations. According to the Tokyo Guidelines, severe ACC necessitates cholecystostomy drainage. Percutaneous Cholecystostomy Drains (PCD) are a temporary intervention in acutely unwell patients with gallbladder-related disease who are unfit to undergo surgery. PCD is used with a therapeutic or palliative intent for the management of gallbladder disease based on the condition and the patient’s fitness. This study aims to assess the current role of PCDs in a tertiary hepatobiliary referral centre.

Methods
This was a retrospective review of PCD patients treated in a tertiary hepatobiliary referral centre between January 2018 and December 2023. Clinical, radiological, and perioperative outcomes were measured. Descriptive analysis was performed using GraphPad Prism.

Results
Sixty-eight patients were identified over six years. The mean age was 71.6 years, with a male majority. The most common diagnosis was severe cholecystitis with septic shock (23, 33.8%), followed by gallbladder perforation (18, 26.4%). The mean duration of PCD placement was 95.78 days. A post-drainage cholecystectomy was performed in 7 (87.1%) of patients with ASA I-II and 24 (40%) with ASA III-IV (p-value<0.05).

Conclusions
PCDs are safe and effective in managing surgically unfit patients with severe, complicated ACC. There is a paucity of literature on specific guidelines for the indications, follow-up, and management of PCDs.