Published online Mar 26, 2020. doi: 10.12998/wjcc.v8.i6.1033
Peer-review started: December 19, 2019
First decision: January 12, 2020
Revised: March 11, 2020
Accepted: March 19, 2020
Article in press: March 19, 2020
Published online: March 26, 2020
In this retrospective study, the clinical course of percutaneous cholecystostomy (PC) was evaluated in 82 patients who had comorbidities and had high mortality risk after surgery. The benefits and success rate of PC were revealed in the selected patient population.
In the literature, the significance of PC was not identified in patients who had Grade 2 and 3 acute cholecystitis (AC) (Tokyo Guidelines 2018) and comorbidities. This study confirms that PC is a safe and adequate treatment option.
In this study, we emphasized that PC alone is an adequate treatment in patients with AC based on our finding that only nine of the 66 patients discharged from the hospital required cholecystectomy. In patients that died, mortality usually occurred for non-biliary reasons during the follow-up without recurrent episodes. PC without general anesthesia may be an adequate treatment option in these patients.
The study was planned retrospectively. In the follow-up of patients undergoing PC, the causes of death and duration of survival after the procedure were obtained from the electronic medical records.
Our findings support that PC is an effective alternative method that can be safely applied to patients with a high comorbidity load, and it can regress clinical symptoms in this patient group. During the retrospective acquisition of the study data by screening the electronic medical records, the number of patients was reduced due to the exclusion of those with incomplete records. Therefore, a future prospective study can be planned to obtain the records of all patients in detail to further emphasize the individual adequacy of PC.
Except for nine cases, PC alone was an adequate and safe treatment alternative in all the remaining evaluated patients with AC. PC is an alternative effective treatment option in AC cases with a high comorbidity load. This study revealed that in the long-term follow-up of patients who had undergone PC and had been discharged, mortality occurred mostly due to non-biliary causes, except for a limited number of cases with a history of episodes, confirming that the procedure was successful, which is a finding that contributes to the literature. PC can be safely used as an alternative treatment in patients with high risk of surgery and provides adequate clinical improvement. We consider that PC presents as a good alternative with a high success rate in patients with AC who have a comorbidity load, those at high risk of anesthesia-related complications, and those that do not agree to undergo surgery after clinical recovery is achieved.
Despite performing PC in the patient population with AC and high comorbidity, approximately 20% of the patients developed mortality. However, the considerable success rate of the procedure presents it as a good treatment option.