From the Guidelines
Cholecystostomy Tube Removal
The tract is expected to mature and become less prone to bile leak after 4-6 weeks of cholecystostomy tube placement, allowing for safe removal.
- The duration of drainage ranges from 3 to 6 weeks, with an average of 1 month, which is the mean interval necessary for tract maturation 1.
- A cholangiography via the drain is recommended before drain withdrawal to ensure the absence of leak or obstructed cystic duct, and to confirm biliary tree patency 1.
- In cases with associated conditions such as diabetes, ascites, long-term steroid therapy, and malnutrition, the drain should be left in place for a longer period to allow for tract maturation 1.
- After removal, bleeding from the liver parenchyma is a possible complication, but bile leakage is less likely if the tract has matured and the cystic duct is patent 1.
From the Research
Outcomes After Cholecystostomy Tube Removal
- Fifty-three patients (50%) had no further biliary intervention after removal of the cholecystostomy catheter 2
- One patient required subsequent drainage of a hepatic abscess, and another developed a biloma 2
- Thirty-two patients (30%) underwent cholecystectomy (66% laparoscopic, 34% open) 2
- Eleven patients (10%) required PCT reinsertion, with a mean time to reinsertion of 38 days 2
Complications After Cholecystostomy Tube Removal
- Bile leaks from the cystic duct stump were reported in some cases 3
- Postoperative common bile duct obstruction requiring endoscopic retrograde cholangiopancreatography was reported in 2 patients 3
- Hemoperitoneum requiring a return to the operating room was reported in 1 patient 3
Timing and Method of Tube Removal
- Cholecystostomy tubes can be removed safely with little risk of bile leak if patients are clinically well, and clean-appearing bile is draining 2
- The mean tube indwelling time was 89 days (range 0-586 days) 4
- Forty-five patients (13.9%) had indwelling tubes at the end of the study period 4
Surgical Outcomes After Cholecystostomy Tube Removal
- The rate of emergent cholecystectomy in the PC tube removal group was higher than that in the PC tube preserved group 5
- Removal of the PC tube is associated with an increased likelihood of emergent cholecystectomy 5
- No cases of biliary leakage or tube dislodgement were reported after cholecystostomy tube removal in a case series of 5 patients 6