Percutaneous cholecystostomy in the management of acute cholecystitis - 10 years of experience

Acalculous Cholecystitis in COVID-19 Patients: A Narrative Review

Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5-10% of all cases of acute cholecystitis in adults. Several risk factors have been recognized, while infectious diseases can be a cause of cholecystitis in otherwise healthy people. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has spread worldwide, leading to an unprecedented pandemic. The virus enters cells through the binding of the spike protein to angiotensin-converting enzyme 2 (ACE2) receptors expressed in many human tissues, including the epithelial cells of the gastrointestinal (GI) tract, and this explains the symptoms emanating from the digestive system. Acute cholecystitis has been reported in patients with COVID-19. The purpose of this review is to provide a detailed analysis of the current literature on the pathogenesis, diagnosis, management, and outcomes of AAC in patients with COVID-19.

[Percutaneous cholecystostomy in multi-field hospital]

OBJECTIVE

To analyze the indications, technical features and results of percutaneous cholecystostomy.

MATERIAL AND METHODS

A retrospective single-center study of the results of percutaneous cholecystostomy over 13-year period was carried out. The indications for surgery, technical features and outcomes were studied.

RESULTS

The indications for percutaneous cholecystostomy were acute cholecystitis in 40 (63.5%) cases and obstructive jaundice in 23 (36.5%) cases. In acute cholecystitis, cholecystectomy was denied due to severe acute and decompensated chronic diseases. In case of obstructive jaundice, cholecystostomy was preferred if other methods of biliary decompression were impossible. Drainage with locking thread was used in 44 (69.8%) patients. A total of 13 (21.3%) cases of drainage migration were noted. Incidence of migration of catheters with locking threads was 13.6%, without locking threads - 41.2% (p=0.033). Subsequent cholecystectomy was performed in 10 (15.9%) patients. In case of obstructive jaundice, cholecystostomy did not lead to destructive cholecystitis in any case. Six patients with acute cholecystitis had progressive gallbladder destruction. Overall postoperative in-hospital mortality was 36.5% (n=23). Mortality in the group of acute cholecystitis was 32.5% (n=13), in the group of obstructive jaundice - 43.5% (n=10). Mortality was higher in acute cholecystitis Grade III (75.0%) compared to Grade II (21.9%; p=0.008).

CONCLUSION

Cholecystostomy is a rare (reserve) intervention. Locking thread significantly reduces the incidence of migration of cholecystostomy catheter. Progressive gallbladder destruction required cholecystectomy in 15% of cases. Treatment of patients with acute cholecystitis depends on physical status and comorbidities.

Computed tomography-guided percutaneous cholecystostomy: a single institution's 6-year experience

BACKGROUND

Acute cholecystitis (AC) is an emergency commonly managed by a surgical department. The interventional part of the standard treatment algorithm includes laparoscopic or open cholecystectomy. Percutaneous cholecystostomy (PC) under imaging guidance is recommended as the first-line approach in the subset of high-risk patients for perioperative complications, as a bridging therapy to elective surgery or as a definitive solution. The aim of the present study was to evaluate the mortality and morbidity of PC performed under computed tomographic (CT) guidance in patients at high surgical risk.

METHODS

Medical and imaging records from all consecutive patients who underwent a CTPC between 2015 and 2020 were reviewed. Adult patients with a definite indication for CTPC were recruited and mortality 7 and 30 days post-procedure was recorded. Variables potentially affecting those outcomes were retrieved and included in our analysis.

RESULTS

Eighty-six consecutive patients at high risk for surgical management were identified and included in the present study. Most patients (58.1%) were diagnosed with AC, while 14 (16.3%) had concurrent AC and cholangitis, 13 (15.2%) gallbladder empyema, and 9 (10.4%) hydrops. The 7- and 30-day mortality rates were 16.3% (14/86) and 22.1% (19/86), respectively, and were significantly associated with patients' hospitalization in the intensive care unit (P<0.05). Other parameters investigated, such as age, sex, diagnosis, catheter diameter, and duration of hospital stay were not significantly associated with our primary outcome.

CONCLUSION

PC is a safe alternative to surgery in patients with high perioperative risk, thus providing acceptable mortality rates.

Use of percutaneous cholecystostomy for complicated acute lithiasic cholecystitis: solving or deferring the problem?

<b>Introduction:</b> Percutaneous cholecystostomies are not infrequently used as an adjunct in the treatment of severe lithiasic cholecystitis, particularly in unstable and comorbid patients. However, their out of proportion liberal use tends to substitute the performance of emergency cholecystectomy, which the definitive treatment. </br></br> <b>Aim:</b> Our aim was to assess the short and long-term outcomes of patients who had percutaneous cholecystostomy insertion due to severe lithiasic cholecystitis, aiming to define areas for improvement of our institutional practice. </br></br> <b>Materials and Methods:</b> Retrospective review of our institutional practice including all patients who had a percutaneous cholecystostomy for complex lithiasic cholecystitis, over a 5-year period, allowing for an additional 1-year follow up. </br></br> <b>Results:</b> A total of 34 patients were included in our final analysis. Percutaneous cholecystostomy insertion enabled quick and efficient control of the source of biliary sepsis without major procedural complications in all cases. In 14 (41.2%) patients, cholecystostomy alone served as definitive treatment, while in 20 (58.9%) cases it was used as bridging strategy for delayed elective cholecystectomy. In the delayed cholecystectomy group of patients, we noted a high conversion rate from laparoscopic to open surgery rate of 70%, with an overall subtotal cholecystectomy rate of 60%. </br></br> <b>Conclusion:</b> Percutaneous cholecystostomies should be reserved only for complex lithiasic cholecystitis patients who are unwilling and/or unfit for surgery. We advocate the performance of upfront emergency cholecystectomy in any other case with liberal use of operative bail-out strategies, as a delayed elective operation is anyway likely to be converted to open and/or subtotal cholecystectomy.

Advances in the Study of Acute Acalculous Cholecystitis: A Comprehensive Review

BACKGROUND

Acute acalculous cholecystitis (AAC) is characterized by acute necrotizing inflammation with no calculi and is diagnosed based on imaging, intraoperative, and pathological examinations.

KEY MESSAGE

Although AAC has been studied clinically for a long time, it remains difficult to diagnose and treat. The pathogenesis of AAC is still not fully understood, and it is often regarded as a relatively independent clinical disease that is different from acute calculous cholecystitis (ACC). Pathological studies suggest that AAC is the manifestation of a critical systemic disease, while ACC is a local disease of the gallbladder.

SUMMARY

Concerning the pathogenesis, diagnosis, and treatment of AAC, we reviewed the research progress of AAC, which will enhance the understanding of the early diagnosis and treatment of AAC.