Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment for acute cholecystitis (AC). In high-risk patients, percutaneous drainage (PD) with delayed cholecystectomy (DC) is an alternative. However, the data on outcomes of patients who underwent DC after PD is scarce. The aim of this study was to compare the outcomes after DC in patients primarily treated either with antibiotics (ATB) or with PD.
Methods: Retrospective analysis of all consecutive patients treated primarily either with ATB or PD followed by DC at our institution between January 2006 and December 2015. Patients’ co-morbidities, Charlson index at the time of acute cholecystitis, and DC outcomes (including complication comprehensive index (CCI) after surgery) were analysed.
Results: Twenty-eight patients were treated with PD [median age = 77 years (range = 73-87)] and 77 with antibiotics [median age = 78 years (range = 73-83)] at the time of AC. Both groups had a similar Charlson’s comorbidity index at admission. Eighteen patients (64%) initially treated with PD underwent DC, while 10 (36%) required an emergency cholecystectomy (EC) for recurrence (n=1) or treatment failure (n=9). In the ATB group, 53 (69%) patients underwent DC, while 24 (31%) had an EC for recurrence (n=13) or treatment failure (n=11). The length of stay after DC was longer for patients initially treated with PD [26 days (range = 15-48) vs 7 days (range = 4-13) in ATB group, p<0.001]. After DC, PD group had more major complications, and higher CCI compared to the ATB group [3 vs 1 (p = 0,048) and mean 16,4 ± 32.0 vs mean 1,8 ± 5,6 (p = 0,006), respectively].
Conclusion: Percutaneous drainage is an effective initial treatment for acute cholecystitis in patients at high risk for surgery, however delayed cholecystectomy in this group is associated with a higher complications and longer hospital stay compared to patients treated primarily with antibiotics.