Efficacy of short term percutaneous cholecystostomy for acute cholecystitis in critically ill patients

Aims: Percutaneous cholecystostomy (PC) is a safe and effective procedure in high-risk patients affected by moderate-severe acute cholecystitis (AC). Previous literature describes a success rate of 85% and a readmission rate for biliary sepsis of about 42%, with a mean catheter maintenance of at least 4 weeks. The aim of this study is to assess the success rate of PC for AC in high-risk patients when the catheter is left in place for a shorter period. Methods: We retrospectively analyzed all patients undergoing PC as definitive treatment for moderate-severe AC in our surgical department from 2011 to 2014, in order to establish the temporal length of catheter maintenance and the success rate. Results: 25 patients were included in the study with a mean follow-up of 12 months. The mean age was 7910 years. Patients were mostly ASA III (48%) and IV (44%). Mean estimated P-Possum morbidity and mortality were respectively 7019% and 1815%. PC catheter was left in place for a mean of 94 days with a success rate of 100% (defined as clinical improvement within 48–72h after insertion of the PC). 30-day overall mortality was 13% (comparable to 15.4% reported in literature). 12% of the patients needed further hospital readmission for recurrent biliary disease within 6 months. Conclusions: In high-risk patients affected by moderate-severe AC, PC results to be an effective procedure to improve the outcome, even if the maintenance of the PC catheter is limited to a short term period of less than 2 weeks.