Tube cholecystostomy as a bridge to cholecystectomy in acute cholecystitis: a retrospective study
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Abstract
Objective: To determine the efficacy and safety of percutaneous cholecystostomy tube placement preceding cholecystectomy in the management of acute cholecystitis.
Methods: This descriptive retrospective study was conducted at Interventional Radiology Department at Shifa International Hospital, Islamabad after obtaining ethical approval (IRB# 0381-23, October 10, 2023). Medical records of patients who underwent ultrasound-guided percutaneous cholecystostomy from January 2016 to December 2023 were reviewed using Radiology Information System. Fifty-eight patients with acute cholecystitis were included. Patients with gallbladder perforation, biliary peritonitis, coagulopathy, contrast allergy, or incomplete records were excluded. Data were collected on a structured proforma and analyzed using SPSS version-25. Outcomes assessed included demographic characteristics, comorbidities, type of cholecystitis, subsequent cholecystectomy, and procedure-related complications.
Results: Fifty-eight patients underwent cholecystostomy tube placement; 31 (53.4%) were males and 27 (46.6%) females, with a mean age of 69.4±10.3 years. Calculous cholecystitis was present in 50 (86.2%) patients, while 8 (13.7%) had acalculous cholecystitis. Hypertension (27.5%) and diabetes mellitus (31.0%) were the common comorbidities. Following stabilization, 23 (39.6%) patients underwent cholecystectomy at an average interval of 32 days, predominantly laparoscopic (82.6%). Among acalculous cases, two patients expired, while three had successful tube removal after tubogram confirmation of biliary patency. The remaining calculous cases were managed conservatively. Major complications included accidental tube slippage (n=2; 3.4%), drain dislodgement into the peritoneum (n=1; 1.7%), and death (n=2; 3.4%).
Conclusion: Percutaneous cholecystostomy is a safe and effective temporizing or definitive management option in high-risk patients with acute cholecystitis, facilitating delayed surgery or conservative treatment with a low complication rate.
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