Factors Affecting Cholecystostomy Tube Removal and Interval Cholecystectomy Timing After Percutaneous Cholecystostomy for Acute Cholecystitis

Öz

Background: Percutaneous cholecystostomy (PC) is widely used. It is used in high-risk patients with acute cholecystitis. These patients are not suitable for immediate surgery. However, the optimal timing for removing the cholecystostomy tube and performing subsequent interval cholecystectomy (IC) remains controversial. This study aimed to evaluate factors affecting PC tube removal time and IC timing, and to identify predictors associated with operative outcomes. Methods: This retrospective, single-centre study included patients who underwent percutaneous cholecystostomy for acute cholecystitis between 2015 and 2025. The following data were analysed: demographic characteristics, comorbidity burden, American Society of Anesthesiologists (ASA) scores, Tokyo 2018 acute cholecystitis grade, gallbladder perforation, operative status, surgical approach and mortality. Factors associated with cholecystostomy tube removal time and IC timing were evaluated using comparative and regression analyses. Results: A total of 102 patients were included in the study, with an average age of 64.4 ± 15.4 years. Interval cholecystectomy was performed in 71 patients (69.6%), while 31 patients (30.4%) were managed non-operatively. Patients who underwent surgery were significantly younger and had lower ASA scores and Charlson Comorbidity Index values compared with those who did not undergo surgery (p<0.05 for all). The mean cholecystostomy tube removal time was 38.1 ± 20.4 days. The timing of tube removal was not significantly associated with sex, calculous cholecystitis, gallbladder perforation, operative approach or conversion to open surgery. Similarly, the timing of the interval cholecystectomy did not have a significant effect on either the operative approach or the conversion rates. Patients with acalculous cholecystitis had a significantly longer interval to surgery (p = 0.034). Mortality was significantly higher in non-operated patients (25.8% vs. 1.4%, p < 0.001). Increased mortality was associated with advanced age, a higher ASA score and gallbladder perforation. No perioperative or postoperative bile duct injury was observed. Conclusion Percutaneous cholecystostomy remains an effective strategy for managing high-risk patients with acute cholecystitis. In this cohort, cholecystostomy tube removal time and interval cholecystectomy timing were not associated with surgical approach or conversion outcomes. Surgical decision-making appears to be driven primarily by patient-related factors such as age, comorbidity burden and clinical status rather than a fixed procedural timeline. Therefore, individualised timing strategies may be more appropriate than strict interval-based approaches following percutaneous cholecystostomy.

Anahtar Kelimeler

• Acute cholecystitis
• Percutaneous cholecystostomy
• Interval cholecystectomy
• Cholecystostomy tube
• Surgical timing

Akut kolesistit nedeniyle perkütan kolesistostomi uygulandıktan sonra kolesistostomi tüpünün çıkarılmasını ve aralıklı kolesistektomi zamanlamasını etkileyen faktörler

Öz

Giriş: Perkütan kolesistostomi (PK) yaygın olarak kullanılmaktadır. Bu yöntem, akut kolesistitli yüksek riskli hastalarda uygulanmaktadır. Bu hastalar acil cerrahiye uygun değildir. Bununla birlikte, kolesistostomi tüpünün çıkarılması ve ardından aralıklı kolesistektomi (AK) yapılmasının en uygun zamanlaması konusunda görüş ayrılıkları devam etmektedir. Bu çalışmanın amacı, PK tüpünün çıkarılma süresini ve AK zamanlamasını etkileyen faktörleri değerlendirmek ve cerrahi sonuçlarla ilişkili öngörücü faktörleri belirlemektir. Yöntemler: Bu retrospektif, tek merkezli çalışmaya, 2015 ile 2025 yılları arasında akut kolesistit nedeniyle perkütan kolesistostomi uygulanan hastalar dahil edilmiştir. Demografik özellikler, komorbidite yükü, Amerikan Anesteziyologlar Derneği (ASA) skorları, Tokyo 2018 akut kolesistit derecesi, safra kesesi perforasyonu, ameliyat durumu, cerrahi yaklaşım ve mortalite verileri analiz edilmiştir. Kolesistostomi tüpünün çıkarılma zamanı ve IC zamanlaması ile ilişkili faktörler, karşılaştırmalı ve regresyon analizleri kullanılarak değerlendirildi. Bulgular: Çalışmaya ortalama yaşı 64,4 ± 15,4 olan toplam 102 hasta dahil edildi. 71 hastaya (%69,6) aralıklı kolesistektomi uygulanırken, 31 hasta (%30,4) cerrahi dışı yöntemlerle tedavi edildi. Ameliyat geçiren hastalar, ameliyat geçirmeyenlere kıyasla anlamlı derecede daha gençti ve daha düşük ASA skorları ile Charlson Komorbidite İndeksi değerlerine sahipti (hepsi için p<0,05). Ortalama kolesistostomi tüpü çıkarma süresi 38,1 ± 20,4 gündü. Tüpün çıkarılma zamanı cinsiyet, taşlı kolesistit, safra kesesi perforasyonu, cerrahi yaklaşım veya açık cerrahiye geçiş ile anlamlı bir ilişki göstermedi. Benzer şekilde, aralıklı kolesistektominin zamanlaması da cerrahi yaklaşım veya konversiyon oranları üzerinde anlamlı bir etkiye sahip değildi. Konakçı olmayan kolesistitli hastaların ameliyata kadar geçen süreleri anlamlı olarak daha uzundu (p = 0,034). Mortalite, ameliyat edilmeyen hastalarda anlamlı olarak daha yüksekti (%25,8'e karşı %1,4, p < 0,001). Artan mortalite, ileri yaş, daha yüksek ASA skoru ve safra kesesi perforasyonu ile ilişkiliydi. Perioperatif veya postoperatif safra kanalı yaralanması gözlenmedi. Sonuç Perkütan kolesistostomi, akut kolesistitli yüksek riskli hastaların tedavisinde etkili bir strateji olmaya devam etmektedir. Bu kohort çalışmasında, kolesistostomi tüpünün çıkarılma zamanı ve aralıklı kolesistektomi zamanlaması, cerrahi yaklaşım veya konversiyon sonuçlarıyla ilişkili bulunmamıştır. Cerrahi karar verme süreci, sabit bir prosedür zaman çizelgesinden ziyade, yaş, komorbidite yükü ve klinik durum gibi hastaya bağlı faktörler tarafından belirleniyor gibi görünmektedir. Bu nedenle, perkütan kolesistostomi sonrası katı aralık temelli yaklaşımlardan ziyade, kişiye özel zamanlama stratejileri daha uygun olabilir.

Anahtar Kelimeler

• Akut Kolesistit
• Perkütan kolesistostomi
• Aralıklı Kolesistektomi
• Kolesistostomi tüpü
• Cerrahi zamanlama

Kaynakça

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