From the Guidelines
Percutaneous cholecystostomy is a recommended procedure for high-risk patients with acute cholecystitis who cannot tolerate surgical cholecystectomy, as it can effectively reduce morbidity and mortality by decompressing the gallbladder and draining infected bile. The procedure involves ultrasound or CT-guided placement of a drainage catheter into the gallbladder, and patient preparation includes coagulation profile assessment, antibiotic administration (typically a broad-spectrum agent like Piperacillin-Tazobactam 4.5g IV every 8 hours or Ceftriaxone 2g IV daily plus Metronidazole 500mg IV every 8 hours), and local anesthesia with conscious sedation 1.
Procedure Details
The procedure takes 30-60 minutes, with the catheter typically left in place for 4-6 weeks. Post-procedure management includes:
- Monitoring vital signs for 24 hours
- Continuing antibiotics for 5-7 days
- Flushing the catheter with 5-10ml sterile saline daily
- Pain management with acetaminophen or NSAIDs Complications may include bleeding, bile leakage, or catheter dislodgement 1.
Follow-up and Definitive Management
Follow-up includes clinical assessment, laboratory tests, and imaging at 2-4 weeks. Definitive cholecystectomy should be considered after the patient's condition stabilizes, typically 6-8 weeks later, though some patients with prohibitive surgical risks may have the catheter removed without subsequent surgery if cholangiography shows a patent cystic duct and no stones 1.
Patient Selection
Percutaneous cholecystostomy is particularly recommended for patients with advanced age over 65 years, a history of abdominal surgery, a higher ASA score, elevated white blood cell count, and C-reactive protein levels 1. It can be used as a bridge to cholecystectomy in acutely ill (high-risk) elderly patients deemed unfit for surgery, to convert them into moderate risk patients, more suitable for surgery 1.
From the Research
Procedure and Management of Percutaneous Cholecystectomy
Percutaneous cholecystectomy, also known as percutaneous cholecystostomy (PC), is a minimally invasive procedure used to treat acute cholecystitis, particularly in high-risk patients with serious comorbidity and advanced age 2, 3, 4, 5, 6. The procedure involves the insertion of a catheter into the gallbladder through the skin to drain bile and relieve symptoms.
Indications and Contraindications
The indications for percutaneous cholecystectomy include:
- High-risk patients with acute cholecystitis who are not suitable for immediate surgery due to comorbidities or advanced age 2, 4, 5
- Patients who have failed conservative management 6 There are no absolute contraindications to percutaneous cholecystectomy, as it is a life-saving procedure for patients with severe acute cholecystitis who cannot undergo surgery 3, 6
Procedure Steps
The procedure steps for percutaneous cholecystectomy include:
- Pre-procedural evaluation, including risk assessment and imaging studies to confirm the diagnosis of acute cholecystitis 3
- Insertion of a catheter into the gallbladder under imaging guidance, usually ultrasound or computed tomography (CT) scan 4
- Drainage of bile and relief of symptoms 2, 5
Outcomes and Complications
The outcomes of percutaneous cholecystectomy include:
- Resolution of symptoms in the majority of patients 2, 5, 6
- Low morbidity and mortality rates, particularly in high-risk patients 4, 5 The complications of percutaneous cholecystectomy include:
- Bile leakage from the gallbladder 2
- Infection or sepsis 5
- Recurrence of cholecystitis 5, 6
Role of Percutaneous Cholecystectomy in Treatment
Percutaneous cholecystectomy can be used as a:
- Definitive treatment for acute cholecystitis in elderly high-risk patients 5
- Bridge to surgery to stabilize high-risk patients before undergoing cholecystectomy 3, 6 The decision to use percutaneous cholecystectomy as a definitive treatment or a bridge to surgery depends on the individual patient's condition and risk factors 6