Impact of percutaneous cholecystostomy on National Health Service (NHS) service provision and subsequent clinical as well as surgical outcomes.
Li Cheng Chong, Jignesh Jatania, Kamil Wynne- Surgery
Abstract
Aims
To evaluate the impact of percutaneous cholecystostomy on the NHS and clinical/surgical outcomes.
Methods
Retrospective analysis of patients who underwent percutaneous cholecystostomy between 01/01/2020 to 31/12/2022. Data collected included patient demographics, procedure (indications, mean time for insertion/removal), microbiology (bile aspirate, blood culture), imaging (endoscopic retrograde cholangio-pancreatography (ERCP) / tubogram) performed, clinical outcome, number of planned/unplanned follow-ups and difficulty of cholecystectomy.
Results
The cohort included 33 patients (20 male, 13 female) with mean age of 74 years. Top indications were (1) gallbladder empyema identified on computed tomographic imaging (76%) and (2) being unfit for surgery i.e., significant comorbidities (55%) / septic (30%). Mean time of insertion and removal was 5 and 59 days, respectively. Escherichia coli (67%) was the most common microorganism from bile aspirate. Most (52%) blood cultures showed no growth. Within the initial admission, majority (82%) did not have ERCP and one-third (36%) had a tubogram. In terms of outcome, 14 (42%) subsequently had cholecystectomy, 12 (36%) were discharged, 6 (18%) died and 1 (3%) is awaiting cholecystectomy. There was a mean of 2 follow-ups before patients were discharged from service. Of those who underwent cholecystectomy, 12/14 were done electively, 12/14 were total cholecystectomy and 13/14 were laparoscopic. Mean surgical time was 116 minutes.
Conclusions
Percutaneous cholecystostomy is an effective treatment/bridging therapy for patients unsuitable for emergency cholecystectomy. It does not reduce time/difficulty of subsequent cholecystectomy. However, it does put a strain on the NHS with regards to length of stay and planned/unplanned follow-ups.