FTP7.12 Percutaneous Cholecystostomy use at ESHT
Annabelle White, Elmurtada Ahmed, Basim Al-Robaie, Michail Klimovskij- Surgery
Abstract
Aim
Percutaneous Cholecystostomy is a well-recognised adjunct to antibiotic therapy in management of acute calculous cholecystitis – often as a temporising measure to definitive surgery. Multiple guidelines exist advising on patient selection and timing of insertion, however little evidence exists on managing these following insertion, timing of interval cholecystectomy, and investigations prior to removal.
Method
A closed-loop retrospective review of all patients undergoing radiologically guided PC insertion between 01/06/2015-31/05/2017 (Cycle 1) and 01/11/2021-01/12/2022 (Cycle 2) at ESHT. Data collected included patient demographics, time from diagnosis to PC, duration of admission and PC in situ and investigations prior to removal.
Results
43 patients across both cycles, with average age 72, (median 74, range 50-92). Cycle 1 consisted of 26 patients, whereas Cycle 2 had 17 patients. Duration of admission was longer in Cycle 1 (Average: 10 vs 8.5, Median: 9.5 vs 6, Range: 3-21 vs. 1-26 days). Time from admission to PC insertion was similar (Average: 2.7 vs. 3, Median: 2 vs. 1, Range: 0-12 vs 0-25 days). Duration of cholecystostomy in situ was longer in Cycle 2 (Average: 26 vs. 41, Median: 21 vs. 32, Range: 7-95 vs 1-196 days). 53% (n=17) of patients in Cycle 2 underwent a cholecystogram prior to removal vs. 12% (n=3) in Cycle 1.
Conclusions
We identified considerable heterogeneity within practice surrounding the insertion and removal of PC at ESHT. Considering this we are introducing a trust-wide “Cholecystostomy Management” Pathway to standardise our practice, and “Cholecystostomy Passport” for patients outlining this and providing safety netting information and emergency contact details.