Percutaneous cholecystostomy for acute cholecystitis in high-risk patients: experience of a surgeon-initiated interventional program.

BACKGROUND: The treatment of choice for acute cholecystitis is cholecystectomy. However, percutaneous cholecystostomy (PC) is an alternative treatment in patients who are at high risk for urgent surgery. This study reviews our experience of PC for treatment of acute cholecystitis in a surgeon-initiated interventional program.

METHODS: Clinical records of all high-risk patients who underwent PC placement by surgeons (group A; n = 22) for acute cholecystitis were reviewed. Treatment outcomes were compared with patients who underwent PC by interventional radiologists (group B; n = 26).

RESULTS: Similar technical success, procedural complication, or treatment outcome were noted between the two groups. Seven patients (32%) in group A and 9 patients (35%) in group B underwent delayed elective cholecystectomy surgery. The time elapsed between the diagnosis to PC placement in groups A and B was 6.6 +/- 3.5 hours and 18.5 +/- 4.3 hours, respectively (P < .02).

CONCLUSIONS: Ultrasound-guided PC is a safe and effective treatment for acute cholecystitis in high-risk surgical patients. Surgeons with endovascular skills can obtain clinical competence in this catheter-based procedure, which provides an added armamentarium in surgical biliary disease management.