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Assessing the necessity of routine control cholecystography for improved clinical outcomes in patients with acute cholecystitis following percutaneous cholecystostomy

Year 2024, Volume: 49 Issue: 4, 1067 - 1074, 30.12.2024
https://doi.org/10.17826/cumj.1551514

Abstract

Purpose: This study evaluated whether routine control cholecystography is necessary after percutaneous cholecystostomy (PC) in patients with acute cholecystitis (AC) to improve patient care and optimize resource utilization.
Materials and Methods: This retrospective study included 202 out of 248 patients treated with PC for AC between 2011 and 2022, excluding cases with malignancy, biliary strictures, insufficient follow-up (<6 months), unrelated mortality, or acalculous cholecystitis. Patients were divided into two groups: Group 1 (no routine cholecystography, n=90) and Group 2 (routine cholecystography, n=112). Data on demographics, hospital stay, readmissions, recurrence, surgical procedures, mortality, and complications were analyzed.
Results: Group 1 included 90 patients (52% male, 48% female; mean age 69.2 years), and Group 2 included 112 patients with similar demographics and comorbidities. The mean hospital stay was 5.4 days in Group 1 and 5.6 days in Group 2. The readmission rate after catheter removal was 30.7%, and the recurrence rate of AC was 19.3%. Secondary interventions were significantly higher in Group 2, with 24 patients (11.9%) requiring additional cholecystostomy catheter placement during follow-up, compared to 11 (5.4%) in Group 1.
Conclusion: Routine control cholecystography does not improve patient outcomes following PC. Performing cholecystography without clinical indications may increase unnecessary interventions and result in inefficient resource utilization.

Project Number

KA19/114

References

  • Strasberg SM. Acute calculous cholecystitis. New England J Med. 2008;358:2804-11.
  • Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, et al The European experience with laparoscopic cholecystectomy. Am J Surg. 1991;161:385-7.
  • Csikesz NG, Tseng JF, Shah SA. Trends in surgical management for acute cholecystitis. Surgery. 2008;144:283-9.
  • Yamashita Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, et al TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20:89-96.
  • Gulaya K, Desai SS, Sato K. Percutaneous cholecystostomy: evidence-based current clinical practice. Semin Intervent Radiol. 2016;33:291-6.
  • Spota A, Shahabi A, Mizdrak E, Englesakis M, Mahbub F, Shlomovitz E, et al Postinsertion management of cholecystostomy tubes for acute cholecystitis: a systematic review. Surg Laparosc Endosc Percutan Tech. 2024:10.1097.
  • D'Agostino H, VanSonnenberg E, Sanchez R, Goodacre B, Casola G. Imaging of the percutaneous cholecystostomy tract: observations and utility. Radiol. 1991;181:675-8.
  • Bakkaloglu H, Yanar H, Guloglu R, Taviloglu K, Tunca F, Aksoy M, et al Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention. World J Gastroenterol. 2006;12:7179.
  • Loftus TJ, Brakenridge SC, Moore FA, Dessaigne CG, Sarosi Jr GA, Zingarelli WJ et al Routine surveillance cholangiography following percutaneous cholecystostomy delays drain removal and cholecystectomy. J Trauma Acute Care Surg. 2017;82:351.
  • Wise JN, Gervais DA, Akman A, Harisinghani M, Hahn PF, Mueller PR. Percutaneous cholecystostomy catheter removal and incidence of clinically significant bile leaks: a clinical approach to catheter management. AJR Am J Roentgenol. 2005;184:1647-51.
  • Yehuda AB, Markov E, Jeroukhimov I, Lavy R, Hershkovitz Y. Should cholangiography be part of the management of every patient with percutaneous cholecystostomy? Am J Surg. 2022;224:987-9.
  • 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). J Hepatobiliary Pancreat Sci. 2018;25:41-54.
  • Doğrul AB. Current state of percutaneous cholecystostomy: indications and management. Egypt J Surg. 2022;41:1447-53.
  • Hung Y-L, Sung C-M, Fu C-Y, Liao C-H, Wang S-Y, Hsu J-T et al Management of patients with acute cholecystitis after percutaneous cholecystostomy: from the acute stage to definitive surgical treatment. Front Surg. 2021;8:616320.

Perkütan kolesistostomi sonrası akut kolesistitli hastalarda klinik sonuçların iyileştirilmesi için rutin kontrol kolesistografisinin gerekliliğinin değerlendirilmesi

Year 2024, Volume: 49 Issue: 4, 1067 - 1074, 30.12.2024
https://doi.org/10.17826/cumj.1551514

Abstract

Amaç: Bu çalışma, akut kolesistit (AK) hastalarında perkütan kolesistostomi (PK) sonrası rutin kontrol kolesistografinin gerekli olup olmadığını değerlendirerek hasta bakımını iyileştirme ve kaynak kullanımını optimize etme üzerindeki etkilerini incelemeyi amaçlamıştır.
Gereç ve Yöntem: Bu retrospektif çalışmada, 2011-2022 yılları arasında AK nedeniyle PK uygulanan 248 hastadan 202’si dahil edildi. Malignite, biliyer darlık, yetersiz takip (<6 ay), AK ile ilişkili olmayan ölümler ve akalküloz kolesistit vakaları çalışma dışı bırakıldı. Hastalar, rutin kontrol kolesistografi yapılmayan (Grup 1, n=90) ve yapılan (Grup 2, n=112) olmak üzere iki gruba ayrıldı. Demografik veriler, hastane yatış süresi, tekrar başvurular, nüks oranları, cerrahi işlemler, mortalite ve komplikasyonlar analiz edildi.
Bulgular: Grup 1’de 90 hasta (%52 erkek, %48 kadın; ortalama yaş 69,2 yıl), Grup 2’de 112 hasta benzer demografik ve ek hastalık özellikleriyle yer aldı. Ortalama hastanede kalış süresi Grup 1’de 5,4 gün, Grup 2’de 5,6 gün olarak belirlendi. Kateter çekimi sonrası tekrar başvuru oranı %30,7, AK nüks oranı %19,3 olarak tespit edildi. Sekonder girişimler Grup 2’de anlamlı olarak daha yüksekti; takip sırasında 24 hasta (%11,9) ek kolesistostomi kateteri gerektirirken, Grup 1’de bu sayı 11 hasta (%5,4) olarak bulundu.
Sonuç: Rutin kontrol kolesistografi, PK sonrası hasta sonuçlarına katkı sağlamamıştır. Klinikten bağımsız kolesistografi kararı, gereksiz girişimlerin ve kaynakların israfında artışa yol açabilir.

Ethical Statement

Etik Beyan: Bu çalışma, Başkent Üniversitesi Tıp ve Sağlık Bilimleri Araştırma Kurulu tarafından onaylanmış olup (Proje No: KA19/114), Başkent Üniversitesi Araştırma Fonunca desteklenmiştir. Çalışma, Helsinki Deklarasyonu prensiplerine uygun olarak yürütülmüştür. Tüm katılımcılardan bilgilendirilmiş onam alınmıştır ve hasta gizliliği titizlikle korunmuştur. Çalışma kapsamında elde edilen veriler, anonimleştirilerek değerlendirilmiştir. Yazar(lar), herhangi bir çıkar çatışması bulunmadığını beyan eder.

Supporting Institution

Bu çalışma Başkent Üniversitesi Tıp ve Sağlık Bilimleri Araştırma Kurulu tarafından onaylanmış ve Başkent Üniversitesi Araştırma Fonunca desteklenmiştir.

Project Number

KA19/114

References

  • Strasberg SM. Acute calculous cholecystitis. New England J Med. 2008;358:2804-11.
  • Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, et al The European experience with laparoscopic cholecystectomy. Am J Surg. 1991;161:385-7.
  • Csikesz NG, Tseng JF, Shah SA. Trends in surgical management for acute cholecystitis. Surgery. 2008;144:283-9.
  • Yamashita Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, et al TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20:89-96.
  • Gulaya K, Desai SS, Sato K. Percutaneous cholecystostomy: evidence-based current clinical practice. Semin Intervent Radiol. 2016;33:291-6.
  • Spota A, Shahabi A, Mizdrak E, Englesakis M, Mahbub F, Shlomovitz E, et al Postinsertion management of cholecystostomy tubes for acute cholecystitis: a systematic review. Surg Laparosc Endosc Percutan Tech. 2024:10.1097.
  • D'Agostino H, VanSonnenberg E, Sanchez R, Goodacre B, Casola G. Imaging of the percutaneous cholecystostomy tract: observations and utility. Radiol. 1991;181:675-8.
  • Bakkaloglu H, Yanar H, Guloglu R, Taviloglu K, Tunca F, Aksoy M, et al Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention. World J Gastroenterol. 2006;12:7179.
  • Loftus TJ, Brakenridge SC, Moore FA, Dessaigne CG, Sarosi Jr GA, Zingarelli WJ et al Routine surveillance cholangiography following percutaneous cholecystostomy delays drain removal and cholecystectomy. J Trauma Acute Care Surg. 2017;82:351.
  • Wise JN, Gervais DA, Akman A, Harisinghani M, Hahn PF, Mueller PR. Percutaneous cholecystostomy catheter removal and incidence of clinically significant bile leaks: a clinical approach to catheter management. AJR Am J Roentgenol. 2005;184:1647-51.
  • Yehuda AB, Markov E, Jeroukhimov I, Lavy R, Hershkovitz Y. Should cholangiography be part of the management of every patient with percutaneous cholecystostomy? Am J Surg. 2022;224:987-9.
  • 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). J Hepatobiliary Pancreat Sci. 2018;25:41-54.
  • Doğrul AB. Current state of percutaneous cholecystostomy: indications and management. Egypt J Surg. 2022;41:1447-53.
  • Hung Y-L, Sung C-M, Fu C-Y, Liao C-H, Wang S-Y, Hsu J-T et al Management of patients with acute cholecystitis after percutaneous cholecystostomy: from the acute stage to definitive surgical treatment. Front Surg. 2021;8:616320.
There are 14 citations in total.

Details

Primary Language English
Subjects General Surgery, Radiology and Organ Imaging
Journal Section Research
Authors

Mustafa Mazıcan 0000-0003-1142-213X

İsmail Karluka 0000-0002-5760-1777

İlker Murat Arer 0000-0001-9880-3570

Project Number KA19/114
Publication Date December 30, 2024
Submission Date September 17, 2024
Acceptance Date December 20, 2024
Published in Issue Year 2024 Volume: 49 Issue: 4

Cite

MLA Mazıcan, Mustafa et al. “Assessing the Necessity of Routine Control Cholecystography for Improved Clinical Outcomes in Patients With Acute Cholecystitis Following Percutaneous Cholecystostomy”. Cukurova Medical Journal, vol. 49, no. 4, 2024, pp. 1067-74, doi:10.17826/cumj.1551514.