Acute cholecystitis in non-surgical candidates is often managed with cholecystostomy tube drainage. After symptom resolution, management options include cholecystectomy, long term tube drainage or tube removal. Percutaneous cholecystolithotomy (PCCL) may offer another therapeutic option for patients who are poor operative candidates.
A retrospective study of PCCL performed between December 2000 and September 2017 was conducted. Demographics, procedure details, gallstone-related complications, procedure-related complications, readmission and mortality data were collected.
Seventy-five patients (52.0% male and 48.0% female) of mean age 75.6 ± 13.9 years were identified. Mean follow-up time was 2.8 ± 3.7 years. 90.7% of patients were American Society of Anesthesia score 3 or 4. Eleven patients (14.7%), had failed prior cholecystectomy. A total of 96 PCCL procedures were performed, and complete gallstone removal was achieved in 68 of 75 patients (90.7%), including all patients with previously aborted cholecystectomy. The 30-day and 90-day readmission rates were 4% and 8% respectively. Three patients (3.9%) subsequently underwent cholecystectomy after PCCL. 10 (10.4%) procedure-related complications (Clavien-Dindo grade I and II) and 17 (22.7%) gallstone-related complications occurred during the follow-up period. Post-procedural choledocholithiasis occurred in 6 patients (8.0%). 5 patients (6.3%) developed recurrent gallstones (3 patients undergoing cholecystectomy and 2 patients treated with cholecystostomy tube).
PCCL is a viable option for management of symptomatic gallbladder stones in high-risk surgical patients. There is a high technical success rate, even in patients with prior failed cholecystectomy. The majority of patients (77.3%) avoided gallstone related complications following the procedure.
Copyright © 2020 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

References

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