Yu-Liang Hung1, Huan-Wu Chen2, Chih-Yuan Fu3, Chun-Yi Tsai4, Sio-Wai Chong4, Shang-Yu Wang4,5,6, Jun-Te Hsu4, Ta-Sen Yeh4, Chun-Nan Yeh4, Yi-Yin Jan4. 1. School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan. 2. Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan. 3. Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. 4. Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. 5. Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan. 6. School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Abstract
BACKGROUND: Percutaneous cholecystostomy (PC) followed by definitive cholecystectomy is an alternative treatment for acute cholecystitis (AC). We retrospectively investigated the impact of PC tube removal before definitive cholecystectomy on surgical outcomes. METHODS: From 2012 to 2017, 942 AC patients underwent PC at a single institute. Eligible patients were selected according to inclusion criteria. Demographic data, clinical and laboratory parameters, and treatment outcomes were extracted from medical records. Categorization of patients and subsequent subgroup analysis were based on cholangiography. RESULTS: The rate of emergent cholecystectomy in the PC tube removal group was higher than that in the PC tube preserved group (OR = 2.969, 95% CI 1.334-6.612, P = 0.008). In subgroup analysis of patients with patent bile flow under cholangiography, the rate of emergent cholecystectomy was higher in the PC tube removal group (OR = 3.173, 95% CI 1.182-8.523, P = 0.022), though the incidence of complications was higher in the PC tube preserved group (P = 0.012). In addition, routine preoperative cholangiography had no clinical impact on surgical outcome. CONCLUSION: Percutaneous cholecystostomy tube can be removed before subsequent LC to avoid postoperative complications, though removal of the PC tube is associated with an increased likelihood of emergent cholecystectomy.
BACKGROUND: Percutaneous cholecystostomy (PC) followed by definitive cholecystectomy is an alternative treatment for acute cholecystitis (AC). We retrospectively investigated the impact of PC tube removal before definitive cholecystectomy on surgical outcomes. METHODS: From 2012 to 2017, 942 ACpatients underwent PC at a single institute. Eligible patients were selected according to inclusion criteria. Demographic data, clinical and laboratory parameters, and treatment outcomes were extracted from medical records. Categorization of patients and subsequent subgroup analysis were based on cholangiography. RESULTS: The rate of emergent cholecystectomy in the PC tube removal group was higher than that in the PC tube preserved group (OR = 2.969, 95% CI 1.334-6.612, P = 0.008). In subgroup analysis of patients with patent bile flow under cholangiography, the rate of emergent cholecystectomy was higher in the PC tube removal group (OR = 3.173, 95% CI 1.182-8.523, P = 0.022), though the incidence of complications was higher in the PC tube preserved group (P = 0.012). In addition, routine preoperative cholangiography had no clinical impact on surgical outcome. CONCLUSION: Percutaneous cholecystostomy tube can be removed before subsequent LC to avoid postoperative complications, though removal of the PC tube is associated with an increased likelihood of emergent cholecystectomy.
Authors: Stephanie Y Chen; Raymond Huang; Joseph Kallini; Ashley M Wachsman; Richard J Van Allan; Daniel R Margulies; Edward H Phillips; Galinos Barmparas Journal: World J Surg Date: 2022-04-16 Impact factor: 3.282