04. tbl. 105. árg. 2019

Percutaneous cholecystostomy as treatment for acute cholecystitis at Landspitali University Hospital 2010 – 2016

Ísetning á kera við gallblöðrubólgu á Landspítala 2010-2016

Introduction: Acute cholecystitis is one of the most common reasons for acute admission in abdominal surgery. The recom­mended therapy is cholecystectomy but occasionally that is not possible and a conservative treatment with intravenous antibiotics is used. Should the patient not respond to conservative treatment a percutaneous catheter can be placed in the gallbladder (cholecystostomy). The aim of the study was to look at the frequency of which cholecystostomies were used and the complication rates at Landspitali, The National University Hospital of Iceland.

Materials and methods: A retrospective study where patient charts of those with ICD – diagnosis numbers K80 – 85 at Landspitali University Hospital looked at and patients who received cholecystostomies were identified in the period from 2010 – 2016. Clinical information was registered in Excel. Descriptive statistics were used.

Results: A total of 4423 patients were diagnosed with biliary disease during the study period. 1255 (28%) of them had acute cholecystitis with mean age of 58 years (range: 18 – 99). A cholecystostomy was put in 88 patients (14%), mean age 71 years (range: 28 – 92). A transhepatic route was used for 62 (70%) and the drain was in place for an average of 12 days (range: 0 – 87). A secondary cholangiography was performed in 71 cases. Seventeen patients were discharged home with the cholecystostomy in place. Half of the patients underwent a laparoscopic cholecystectomy 101 days from drain insertion (range: 30 – 258). A total of 28 complications were noted in 27 patients (31%) and the most common complication was dislodgement of the catheter (n=20). Five patients (6%) died within thirty days of the intervention, three from septic shock and two from reasons unrelated to the treatment.

Conclusions: Cholecystostomy is not a common choice of treatment for acute cholecystitis at Landspitali, The National University Hospital of Iceland. Few serious complications arise from the treatment and no patients died in relation to the intervention.

Table I . Overview of comorbidities. Most patients had more than one comorbidity.

Figure I . Flow chart showing number of patients and their management during the study period.

Figure II . Results from secondary cholangiography (n=71).

Þetta vefsvæði byggir á Eplica