Background: Although percutaneous cholecystostomy (PC) is a reasonable treatment alternative for acute cholecystitis in patients with comorbidities or who present late in their course, it is unclear when and how subsequent cholecystectomy (CCK) should be performed. We therefore reviewed our experience with interval CCK, performed by different techniques at varying time intervals, after initial treatment of acute cholecystitis with PC.
Methods: Between October 1989 and August 2000, 73 patients with acute cholecystitis underwent interval CCK >1 week after PC at our institution. CCK was performed by 23 surgeons with varying annual case volumes of laparoscopic cholecystectomy (LC). Outcomes were assessed in 2 groups based on surgeon's annual volume of LC, either high volume (HV >50 cases) or low volume (LV <50 cases).
Results: Of the 73 patients, 31 were in the HV group and 42 were in the LV group. Clinical characteristics of the 2 groups were similar; 40 were female (55%), mean age was 62 years, 12% were acalculous, and mean ASA score was 2.4. LC was attempted in 29 (94%) in the HV group, and in 30 (71%) in the LV group (p<0.05). Mean (±SD) operating times were 129±69 and 195±93 minutes in HV and LV groups, respectively (p<0.01). The LC conversion rates were 17% for HV surgeons and 37% for LV surgeons (p=0.09). Length of stay for HV and LV groups were 3.9±3.7 and 5.3±5.7 days, respectively (p=0.30). The time interval between PC and CCK ranged from 12 to 174 days, mean 64±30 days. There were 2 grade II and III complications in each group (p=0.71), and no mortality. Time interval to CCK after PC, <8 weeks vs. >8 weeks, did not influence operative time, conversion rate, complication rate, or length of stay.
Conclusions: Interval CCK following PC for acute cholecystitis may be performed safely with low morbidity, albeit with high conversion rates when LC is attempted. CCK performed by a HV surgeon is more likely to be completed laparoscopically with a shorter OR time than when performed by a LV surgeon. However, complication rates and length of stay are similar independent of surgeon LV case volume. The duration of time between PC and CCK does not affect outcomes. Patients with acute cholecystitis treated with PC requiring interval CCK may benefit from management by a surgeon who performs a high volume of LC.
