Percutaneous Cholecystostomy as an Alternative Treatment Choice for Acute Cholecystitis in Elderly and High-Risk Surgical Patients

INTRODUCTION: Acute cholecystitis (AC) is a common surgical emergency. Although surgery is a definite solution, (PC) is effective and safe for the decompression of an infected gallbladder in elderly patients with severe comorbidity or high surgical risk. This study aimed to evaluate the results of percutaneous cholecystostomy PC in elderly or high-risk surgical patients. METHODS: A total of 41 patients with AC aged over 65 years with American Society of Anesthesiologists scores of III or IV and high surgical risk that had undergone a PC due to comorbidity between February 2017 and December 2019 were included in this study. RESULTS: Of the 41 patients, 22 (53.66%) were male, and 19 (46.34%) were female. The median age was 76.44 ± 8.46 (range 65–93). The most common comorbidities were cardiovascular diseases (73.17%) and diabetes mellitus (51.22%), and 43.90% of the patients had a multisystem disease. Either the transhepatic or transperitoneal route was used for the PC. No complications or mortality related to the PC procedure were observed. The average time of tube indwelling was 5 (range 0–12) weeks. Surgery was performed on eight patients 4–6 weeks after the procedure. Seven patients (17.1%) died in the intensive care unit after PC. The mean hospitalization time was 7.20 ± 6.31 (range 1–30) days. DISCUSSION AND CONCLUSION: This study found that PC is an inexpensive, easy-to-apply alternative treatment method that can be safely used in the treatment of elderly patients with AC who do not respond to medical therapy and have high surgical risk.

Akut Kolesistit Tanılı Yaşlı ve Yüksek Cerrahi Riskli Hastalarda Alternatif Bir Tedavi Seçeneği: Perkütan Kolesistostomi

GİRİŞ ve AMAÇ: Akut kolesistit yaygın bir cerrahi acildir. Cerrahi tedavi kesin çözüm olmasına rağmen, ciddi komorbiditesi olan veya yüksek cerrahi riski olan yaşlı hastalarda, perkütan kolesistostomi işlemi enfekte safra kesesinin dekompresyonu için etkili ve güvenlidir. Bu çalışmada, yaşlı veya yüksek riskli cerrahi hastalarda perkütan kolesistostomi (PK) sonuçlarımızı değerlendirmeyi amaçladık. YÖNTEM ve GEREÇLER: Bu çalışmaya Şubat 2017 ile Aralık 2019 tarihleri arasında ciddi komorbidite ve yüksek cerrahi risk nedeniyle perkütan kolesistostomi uygulanan, 65 yaş üstü 41 Akut Kolesistit tanılı hasta dahil edildi. BULGULAR: Kırkbir hastanın 22’si (% 53,66) erkek, 19’u (% 46,34) kadındı. Ortanca yaş 76.44 ± 8.46 (65-93 aralığında) idi. En sık eşlik eden hastalıklar kardiyovasküler hastalıklar (%73.17) ve diabetes mellitus (%51.22) idi ve hastaların % 43.90’ında multisistem hastalığı vardı. PK işlemi için ya transhepatik yada transperitoneal yol kullanıldı. PK işlemine bağlı herhangi bir komplikasyon veya mortalite gözlenmedi. Ortalama kateter kalma süresi 5 (0-12 arası) haftaydı. Sekiz hastaya işlemden 4-6 hafta sonra cerrahi uygulandı. Yedi hasta takip ve tedavi edildikleri yoğun bakım ünitesinde diğer nedenlerden ex oldu. Ortalama hastanede kalış süresi 7.20 ± 6.31 (1-30) gündü. TARTIŞMA ve SONUÇ: Perkütan Kolesistostomi’nin medikal tedaviye yanıt vermeyen ve yüksek cerrahi riski olan yaşlı hastalarda Akut Kolesistitin tedavisinde güvenle kullanılabilecek ucuz, uygulaması kolay alternatif bir tedavi yöntemi olduğunu düşünmekteyiz.

___

1. Gandhi K, Du Plessis R, KlopperJ, Kloppers C. Percutaneous Cholecystostomy Placement in Cases of Non-operativ Cholecystitis: A Retrospective Cohort Analysis. World J Surg. 2020. https://doi.org/10.1007/s00268-020-05752-3

2. Tolan HK, Semiz Oysu A, Basak F, Atak I, Ozbagriacik M, Ozpek A, et al. Percutaneous cholecystostomy: A curative treatment modality forelderly and high ASA score acute cholecystitis patients. Ulus Travma Acil Cerrahi Derg. 2017;23(1):34-8. https://doi.org/10.5505/tjtes.2016.26053

3. Bhandari TR, Shahi S, Bhandari R, Poudel R. Laparoscopic Cholecystectomy in the Elderly: An Experience at a Tertiary Care Hospital in Western Nepal. Surg Res Pract. 2017;2017:8204578. https://doi.org/10.1155/2017/8204578

4. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). Journal of Hepato-biliary-pancreatic Sciences. 2018;25(1):41-54. https://doi.org/10.1002/jhbp.515

5. Gulaya K, Desai SS, Sato K. Percutaneous Cholecystostomy: Evidence-Based Current Clinical Practice. Semin Intervent Radiol. 2016;33(4):291-6. https://doi.org/10.1055/s-0036-1592326

6. CartiEB,KutluturkK.Shouldpercutaneouscholecystostomy be used in all cases difficult to manage? Ulus Travma Acil Cerrahi Derg. 2020;26(2):186-90. https://doi.org/10.14744/tjtes.2020.73557

7. Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25(1):55-72. https://doi.org/10.1002/jhbp.516

8. Arslan M, Sözütok S, Akbulut S, Gülek B. Percutaneous gall bladder drainage in ccute cholecystitis patients. Pam Med J. 2019;12(1):127-32.

9. Hurwitz EE, Simon M, Vinta SR, Zehm CF, Shabot SM, Minhajuddin A, et al. Adding Examples to the ASA-Physical Status Classification Improves Correct Assignment to Patients. Anesthesiology. 2017;126(4):614-22. https://doi.org/10.1097/ALN.0000000000001541

10. Aroori S, Mangan C, Reza L, Gafoor N. Percutaneous Cholecystostomy for Severe Acute Cholecystitis: A Useful Procedure in High-Risk Patients for Surgery. Scand J Surg. 2019;108(2):124-9. https://doi.org/10.1177/1457496918798209

11. Rassameehiran S, Tantrachoti P, Nugent K. Percutaneous gallbladder aspiration for acute cholecystitis. Proc (Bayl Univ Med Cent). 2016;29(4):381-4. https://doi.org/10.1080/08998280.2016.11929476

12. Itoi T, Coelho-Prabhu N, Baron TH. Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc. 2010;71(6):1038-45. https://doi.org/10.1016/j.gie.2010.01.026

13. Polistina F, Mazzucco C, Coco D, Frego M. Percutaneous cholecystostomy for severe (Tokyo 2013 stage III) acute cholecystitis. Eur J Trauma Emerg Surg. 2019;45(2):329-36. https://doi.org/10.1007/s00068-018-0912-0

14. Pinto A, Reginelli A, Cagini L, Coppolino F, Stabile Ianora AA, Bracale R, et al. Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature. Crit Ultrasound J. 2013;5 Suppl 1:S11. https://doi.org/10.1186/2036-7902-5-S1-S11

15. Bhatt MN, GhioM, Sadri L, SarkarS, Kasotakis G,NarsuleC, et al. Percutaneous Cholecystostomy in Acute CholecystitisPredictors of Recurrence and Interval Cholecystectomy. J Surg Res. 2018;232:539-46. https://doi.org/10.1016/j.jss.2018.06.051

16. Kao LS, Ball CG, Chaudhury PK, for Members of the Evidence Based Reviews in Surgery G. Evidencebased Reviews in Surgery: Early Cholecystectomy for Cholecystitis. Ann Surg. 2018;268(6):940-2. https://doi.org/10.1097/SLA.0000000000002867

17. Thangavelu A, Rosenbaum S, Thangavelu D. Timing of Cholecystectomy in Acute Cholecystitis. J Emerg Med. 2018;54(6):892-7. https://doi.org/10.1016/j.jemermed.2018.02.045

18. Ozkardes AB, Tokac M, Dumlu EG, Bozkurt B, Ciftci AB, Yetisir F, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective, randomized study. Int Surg. 2014;99(1):56-61. https://doi.org/10.9738/INTSURG-D-13-00068.1

19. Haas I, Lahat E, Griton Y, Shmulevsky P, Shichman S, Elad G, et al. Percutaneous aspiration of the gall bladder for the treatment of acute cholecystitis: a prospective study. Surg Endosc. 2016;30(5):1948-51. https://doi.org/10.1007/s00464-015-4419-z

20. Radder RW. Ultrasonically guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging. 1980;49(6):330-3.

21. Bundy J, Srinivasa RN, Gemmete JJ, Shields JJ, Chick JFB. Percutaneous Cholecystostomy: Long-Term Outcomes in 324 Patients. Cardiovasc Intervent Radiol. 2018;41(6):928- 34. https://doi.org/10.1007/s00270-018-1884-5

22. Yeo CS, Tay VW, Low JK, Woon WW, Punamiya SJ, Shelat VG. Outcomes of percutaneous cholecystostomy and predictors of eventual cholecystectomy. J Hepatobiliary Pancreat Sci. 2016;23(1):65-73. https://doi.org/10.1002/jhbp.304
Kocaeli Tıp Dergisi-Cover
  • ISSN: 2147-0758
  • Başlangıç: 2012
  • Yayıncı: -
Sayıdaki Diğer Makaleler

Bir Eğitim ve Araştırma Hastanesi Denetimli Serbestlik Birimine Başvuran Olguların Madde Kullanım Özellikleri Açısından Değerlendirilmesi

Selim POLAT, Buket KOPARAL, Burak OKUMUŞ, Çiçek HOCAOĞLU

Vücut Kitle İndeksinin Artroskopik Rotator Kılıf Cerrahisi Sonrası Fonksiyonel Sonuçlara Etkisi

Turan Bilge KIZKAPAN, Sinan OĞUZKAYA

Sıçramadan Sonra Yere İniş Hata Puanlama Sistemi’nin Türkçe Uyarlama Çalışması

Ferdi BAŞKURT, Mukadder İnci BASER KOLCU, Giray KOLCU, Zeliha BAŞKURT, Esma ARSLAN, Sabriye ERCAN, Cem ÇETİN

Retrospectıve Evaluatıon of Our Surgıcal Approach and Treatment Results in Subaxıal Cervıcal Spıne Injury

Oğuz KARAKOYUN, Oğuzhan UZLU, Ali YILMAZ, Serdar IŞIK

Percutaneous Cholecystostomy as an Alternative Treatment Choice for Acute Cholecystitis in Elderly and High-Risk Surgical Patients

Ali ÇİFTÇİ, M. Burç YAZICIOĞLU, Samet GENEZ, Ahmet YALNIZ

Gebe Bilgilendirme Sınıfının Doğum Şekline Etkisi

Pakize Özge KARGIN, Gözde SEZER, Selma ŞEN, Müberra DURAN

İntravenöz Trombolitik Tedavi Verilen Akut İskemik İnmeli Hastaların Değerlendirilmesi; Bir İnme Merkezinin Deneyimleri

Pınar BEKDİK ŞİRİNOCAK, Serhan YILDIRIM

Results of Microvascular Decompression Surgery in the Treatment of Trigeminal Neuralgia

Mehmet SEÇER, Aykut GÖKBEL

Malign Plevral Effüzyonlarda Sıvı Miktarı, Histopatoloji, Radyoloji ve Plöredez Durumu Sağkalımı Etkiliyor mu?

Dursun TATAR, Ceyda ANAR, Özgür BATUM, Gülistan KARADENİZ, Günseli BALCI, Berna KÖMÜRCÜOĞLU, Gülru POLAT, Melih BÜYÜKŞİRİN, Seher SUSAM, Nimet AKSEL, Mine GAYAF, Filiz GÜLDAVAL, Aysu AYRANCI, Fatma ÜÇSULAR, Yasemin ÖZDOĞAN, Bilge SALIK, Emel TELLİOĞLU

Yumuşak Doku Kitlelerinde Kontrastlı Dinamik T2 Perfüzyon ve T2 Relaksometrinin Tanısal Performansı

Mesude TOSUN, Gür AKANSEL, Hande USLU, Yonca ANIK, Ercüment ÇİFTÇİ