Usman Asad, BS, Amir Aryaie, MD, Eneko Larumbe, PhD, Mark Williams, MD, Edwin Onkendi, MD. Texas Tech University Health Sciences Center
Background: Percutaneous cholecystostomy tube (PCT) has been used as a bridge treatment for grade II-III moderate to severe acute cholecystitis (AC) to “cool” the gallbladder down over several weeks and allow the inflammation to resolve prior to performing interval cholecystectomy (IC) and removal of the PCT, often laparoscopically. The aim of this study was to assess the impact of timing of IC after PCT on operative success and outcomes.
Methods: A retrospective review of electronic medical records of patients who were treated for AC with a PCT, and subsequently underwent IC at our institution between January 2005 to December 2016 was performed. The patients were divided into three groups (n=7 each), based on the duration of the PCT prior to IC, and these groups were comparatively analyzed. A comparative sub-analysis of clinical outcomes between patients who underwent surgery within the first week vs. third week or later after PCT was also performed.
Results: A total of 21 patients met the study criteria. Each group had 7 patients. There were no statistically significant differences between the 3 groups in regards to age, gender, BMI, imaging findings, and indications for cholecystostomy tube placement. Overall, there was no statistically significant difference in outcomes between performing IC within the first 5 weeks, 5-8 weeks and >8 weeks after PCT placement. The length of stay, overall morbidity, Clavien-Dindo grade of complications and mortality were similar between the 3 time intervals. However, a sub-analysis showed that patients who underwent IC within the first week of PCT placement had statistically significant higher mortality rate (p=0.048) compared to those who underwent IC >3 weeks of PCT placement. The two patients who died in our sample had IC within a week after PCT placement. Even though there was a statistically significantly higher morbidity rate in those who had IC >3 weeks after PCT, the Clavien-Dindo grade of these complications was lower than
Conclusion: Delaying IC to >5 weeks after PCT placement for AC is not associated with any improvement in patient morbidity, length of stay or rate of conversion from laparoscopic to open cholecystectomy. Cholecystectomy within the first week of PCT placement is associated with higher mortality rate than after 3 weeks likely due to associated sepsis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87040
Program Number: P081
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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