Management After Percutaneous Cholecystostomy: What Should We do With the Catheter?

Background: Percutaneous cholecystostomy (PC) is an alternative to cholecystectomy for acute calculous cholecystitis (ACC) in patients with high mortality risk, but the catheters' and patients' management remains unclear. This study aimed to determine outcomes after PC and to define surgical strategy. Methods: All patients who underwent PC between 2009 and 2014 for ACC in a single institution were reviewed for outcomes and postdrainage management. Results: Forty-one patients underwent PC with a median age of 77 years. Twenty patients (45%) presented American Society of Anesthesiologists (ASA) score 3-4, and all had cholecystitis grade II or III. The 6-month mortality was 17% (7/41 patients). Twelve patients (29%) presented PC-related complications. Catheters were removed, clamped, left open, and dislodged for 17, 9, 5, and 5 patients, respectively. Three patients died after PC, and data were missing for 2 patients. Twenty-five (61%) patients underwent cholecystectomy after PC, and were significantly younger (median age, 70 vs. 83; P<0.010), and presented with higher ASA score (ASA: 3-4, 36% vs. 68%; P=0.041) and more grade III cholecystitis (16% vs. 44%; P=0.050). Among 16 patients who did not undergo cholecystectomy, none presented recurrent gallstone disease (median survival, 7 mo; range, 0 to 55). Conclusions: The risk of complications associated with the catheter is high. To prevent morbidity related to PC, we suggest removing the catheter when ACC is controlled.