Should cholecystectomy be done by a minimally invasive surgery trained surgeon after the cholecystostomy?

Aaron Lee, DO1, Ryan Pinnell, DO1, Mario Gomez, DO1, Warda Zaman2, Michael Timoney, MD1, George Ferzli, MD1. 1Lutheran Medical Center, 2NYCOM

BACKGROUND: Percutaneous cholecystostomy tube (PCT) placement is a successful method of temporizing patients with acute cholecystitis that are unfit to undergo a cholecystectomy. While the benefits of laparoscopic cholecystectomy versus open cholecystectomy have been previously discussed, the rate of open cholecystectomy is significantly higher after placement of PCT due to operative difficulty.

OBJECTIVE: The purpose of this study is to retrospectively evaluate the rate of laparoscopic and open cholecystectomy between the minimally invasive surgery (MIS) trained surgeons to non-minimally invasive surgery (NMIS) trained surgeons after PCT. We hypothesize that the MIS surgeons are more likely to successfully perform laparoscopic cholecystectomy post PCT placement than NMIS surgeons at our institution.

METHODS: We performed a retrospective chart review of patients from January 2007 until October 2013. We reviewed patients that underwent PCT placement at Department of Interventional Radiology, Lutheran Medical Center (LMC). Only those patients diagnosed with acute cholecystitis secondary to either gallstone or sludge, and underwent PCT placement were included in the study. Exclusion criteria included mortality during the same admission as the PCT, patients not completing treatment, those without a record of follow-up in our system, negative sonogram for gallstone or sludge, or those that underwent a cholecystectomy during the same admission as the PCT placement.

RESULTS: 245 patients underwent PCT placement, and 144 had confirmed gallstone or sludge on the utlrasound. Of these, seventy-seven patients were excluded from the analysis based on the exclusion criteria described above. Of the fifty-nine patients that met our study criteria, thirty-eight were females, and twenty-one were males with a mean age of 76 and 69 years old respectively. Of the fifty-nine patients, thirty-three patients underwent cholecystectomy. Twenty (60.6%) were completed laparoscopically and thirteen (39.3%) were performed using open technique. Six out of eight (75%) cholecystectomies performed by MIS trained surgeons were successfully completed laparoscopically compared to NMIS surgeons completing only 14 out of 25 (56%) laparoscopically. MIS surgeons were more likely to perform laparoscopic cholecystectomy vs NMIS surgeons, OR = 2.36 (95% CI of 0.4 to 14.01, z statistic = 0.942, P=0.35).


Our data showed MIS trained surgeons were more likely than NMIS trained surgeons to successfully complete laparoscopic cholecystectomies after percutaneous cholecystostomy tube placements. Considering the benefit of laparoscopic cholecystectomy and the difficulty of performing cholecystectomy after previous cholecystostomy tube placement, we suggest this population of patients may benefit from cholecystectomy performed by MIS trained surgeons.

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