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Inicio Cirugía Española (English Edition) Is percutaneous cholecystostomy safe and effective in acute cholecystitis? Analy...
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Vol. 100. Issue 5.
Pages 281-287 (May 2022)
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Vol. 100. Issue 5.
Pages 281-287 (May 2022)
Original article
Is percutaneous cholecystostomy safe and effective in acute cholecystitis? Analysis of adverse effects associated with the technique
¿Es segura y eficaz la colecistostomía percutánea en la colecistitis aguda? Análisis de los efectos adversos asociados a la técnica
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Natalia Bejarano Gonzáleza,
Corresponding author
nbejaranog74@gmail.com

Corresponding author.
, Andreu Romaguera Monzonísa, Pere Rebasa Claderab, Neus García Monfortea, Meritxell Labró Ciuransb,c, Jesús Badia Closab, Eva Criado Paredesd, Francisco Javier García Borobiaa
a Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
b Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
c Servicio de Cirugía General y del Aparato Digestivo, Althaia Xarxa Assistencial Universitària, Manresa, Barcelona, Spain
d Unidad de Radiología Vascular Intervencionista, Servicio de Radiología, UDIAT Centro Diagnóstico, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
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Table 1. AE grades presented after PC during hospitalization according to the Dindo–Clavien classification.
Table 2. Motives for re-consultation after the acute episode hospitalization in patients with PC.
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Abstract
Introduction

The main objective of our study is to assess the safety and efficacy of percutaneous cholecystostomy for the treatment of acute cholecystitis, determining the incidence of adverse effects in patients undergoing this procedure.

Material and method

Observational study with consecutive inclusion of all patients diagnosed with acute cholecystitis for 10 years. The main variable studied was morbidity (adverse effects) collected prospectively. Minimum one-year follow-up of patients undergoing percutaneous cholecystostomy.

Results

Of 1223 patients admitted for acute cholecystitis, 66 patients required percutaneous cholecystostomy. 21% of these have presented some adverse effect, with a total of 22 adverse effects. Only 5 of these effects, presented by 5 patients (7.6%), could have been attributed to the gallbladder drainage itself. The mortality associated with the technique is 1.5%. After cholecystostomy, one third of the patients (22 patients) have undergone cholecystectomy. Urgent surgery was performed due to failure of percutaneous treatment in 2 patients, and delayed in another 2 patients due to recurrence of the inflammatory process. The rest of the cholecystectomized patients underwent scheduled surgery, and the procedure could be performed laparoscopically in 16 patients (72.7%).

Conclusion

We consider percutaneous cholecystostomy as a safe and effective technique because it is associated with a low incidence of morbidity and mortality, and it should be considered as a bridge or definitive alternative in those patients who do not receive urgent cholecystectomy after failure of conservative antibiotic treatment.

Keywords:
Acute cholecystitis
Percutaneous cholecystostomy
Gallbladder drainage
Adverse effects
Comorbidity
Resumen
Introducción

El objetivo principal de nuestro estudio es valorar la seguridad y eficacia de la colecistostomía percutánea para el tratamiento de la colecistitis aguda determinando la incidencia de efectos adversos que presentan los pacientes sometidos a este procedimiento.

Material y método

Estudio observacional con inclusión consecutiva de todos los pacientes con diagnóstico de colecistitis aguda durante 10 años. La variable principal estudiada ha sido la morbilidad (efectos adversos) recogida de forma prospectiva. Seguimiento mínimo de un año de los pacientes sometidos a colecistostomía percutánea.

Resultados

De 1223 pacientes ingresados por colecistitis aguda, 66 pacientes han precisado colecistostomía percutánea. El 21% de éstos ha presentado algún efecto adverso, con un total de 22 efectos adversos. Tan sólo 5 de estos efectos, presentados por 5 pacientes (7,6%), han podido ser atribuidos al propio drenaje vesicular. La mortalidad asociada a la técnica es del 1,5%. Tras la colecistostomía un tercio de los pacientes (22 pacientes) han sido sometidos a colecistectomía. Se ha realizado intervención quirúrgica urgente por fracaso del tratamiento percutáneo en 2 pacientes, y diferida en otros 2 pacientes por recidiva del proceso inflamatorio. El resto de los pacientes colecistectomizados han sido intervenidos de forma programada pudiéndose llevar a cabo el procedimiento de forma laparoscópica en 16 pacientes (72,7%).

Conclusión

Consideramos la colecistostomía percutánea como técnica segura y eficaz por relacionarse con una baja incidencia de morbilidad y mortalidad, debiéndose considerar como alternativa puente o definitiva en aquellos pacientes no tributarios de colecistectomía urgente tras fracaso del tratamiento conservador con antibiótico.

Palabras clave:
Colecistitis aguda
Colecistostomía percutánea
Drenaje vesicular
Efectos adversos
Comorbilidad

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