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Introduction:
Abdominal surgical intervention in cirrhotic patients is correlated with high mortality due to coagulopathy, bleeding, and sepsis from ascitic breach.1 Although percutaneous cholecystostomy has been advocated as a safer alternative to cholecystectomy in high-risk critically ill patients with concurrent gallbladder disease, no study has focused exclusively on the outcomes of cholecystostomy in patients with cirrhosis. As a result, it is unknown whether the outcomes of cholecystostomy in cirrhotics are as encouraging as those of their non-cirrhotic counterparts. Physicians thus often face a predicament in treating cirrhotic patients with gallbladder disease refractory to medical management. The purpose of this investigation was to determine whether cholecystostomy is a safe and viable option in the treatment of gallbladder disease in patients with cirrhosis.


Methods
A retrospective chart review was performed which identified 16 cirrhotic and 49 non-cirrhotic patients treated with cholecystostomy tubes between 2000 and 2011. Information investigated included demographics, common comorbidities, markers of disease severity (relevant labs and ASA scores), type of gallbladder and liver disease, post-operative complications, and post-operative survival time. Differences in survival time was assessed with Kaplan-Meier survival analysis. Qualitative and quantitative variables were compared with Chi-square and two independent sample t-tests respectively.


Results
No significant difference in gender, age, race, ASA score, LFTs, duration of tube placement, gallbladder disease, ultrasound findings or CT findings was found between cirrhotic and non-cirrhotic patients. Cirrhotic patients were found to be more likely to have HCV (p = 0.001), ascites (p =0 .004), jaundice (p = 0.045), and encephalopathy (p = 0.012). While cirrhotic patients had a significantly greater amount of post-operative complications (p<0.001), e.g. bleeding (p =0 .041), no significant difference was found in post-operative survival between cirrhotic and non-cirrhotic patients.


Conclusion
Although cirrhotic patients have a greater number of complications than their non-cirrhotic counterparts after cholecystostomy, there is no significant difference in survival between the two types of patient. Cirrhosis does not appear to be a contraindication to performing cholecystostomy, which is an appropriate temporizing procedure for cirrhotic patients with gallbladder disease.


1. Mansour A, Watson W, Shayani V, Pickleman J. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997;122(4):730-735; discussion 735-736.