Objectives: This study aimed to evaluate the feasibility and outcome of ultrasound (US)-
guided percutaneous cholecystostomy (PC) in high-risk patients for surgical intervention, as a
preparatory procedure for assigned laparoscopic choiccystectoniy (LC).
Patients & Methods: The study included 22 patients; 17 females and 5 males with mean age
of 64.8±8.4 years and presented with a picture of acute cholecystitis (AC). All patients had
co-morbidities; 13 were ASA grade III, 5 were ASA grade II, and 4 were ASA grade IV, with
a median at admission APACH1 11 score of 10; range: 6-13. All patients underwent physical
examination. laboratory investigations and abdominal US. US-guided PC was conducted
through percutaneous transhepatic route, under fluoroscopic guidance an Accustick
Introducer System was introduced into the gallbladder (GB) over a 0.018" guide wire and a
7F pigtail catheter was introduced for drainage. After subsidence of inflammation and
improvement of general condition, LC was conducted.
Results: All patients had successful drainage and showed significant decrease of body
temperature and total leucocytic count (TLC) and estimated serum C-reactive protein (CRP)
levels at 24 and 72 hours after PC compared to at admission measures. The mean hospital stay
for the PC procedure was 9.1±4.4 days, 2 patients died at ICU for unrelated causes and
catheter dislodgement occurred in 3 patients (13.6%); one patient had successful catheter
reinsertion. in the 2'ffi patient catheter reinsertion was not required and the patient was
admitted for LC, while the 3"I patient presented with picture of localized perotinitis and was
admitted to urgent LC that was converted to open cholecystectomy (OC) due to gall bladder
perforation and pericholecystic abscess. One patient was readmitted after home discharge for
intermittent recurrent symptoms, and after conservative treatment for 5 days, the
inflammation subsided and the patient was prepared for LC. Eighteen patients underwent
interval LC after a mean duration of 42.5±13.3 days. One patient required conversion to OC
for the presence of severe inflammatory adhesions masking important structures and was
discharged 5 days after surgery, 16 patients passed smooth postoperative course and returned
home after a mean duration of 41.5±I4.9 hours and one patient had successful LC but
developed anginal attack and admitted for ICU for 4 days and was discharged uneventfully.
Conclusion: PC is an appropriate preparatory procedure for interval LC for elderly high-risk
patients with AC with 100% success rate of application and relief of acute manifestations and
catheter-related complication rates of 18.2%. Also, LC 'vas feasible, safe surgical procedure
in such high-risk patients |
