Yüksek riskli akut kolesistit hastalarında acil kolesistektomi ile perkütan kolesistostominin mortalite ve klinik sonuçlar açısından karşılaştırılması
Öz
Amaç: Bu çalışma ile yüksek riskli akut kolesistit hastalarında mortalite ve diğer klinik özellikleri açısından acil kolesistektomi(EC) ile perkütan kolesistostomiyi (PC) karşılaştırmayı amaçladık.
Gereç ve Yöntem: Akut kolesistit nedeniyle acil kolesistektomi(EC) veya perkütan kolesistostomi(PC) uygulanan ASA/PS≥3 hastalar retrospektif incelendi. Demografik özellikler, mortalite, komplikasyonlar, readmission, reintervention oranları karşılaştırıldı.
Bulgular: PC grubunda yaş daha yüksektir (78.11±9.76 ve 71.69±12.56 yıl), daha sık komorbid bir durum görülmektedir (99.1% ve 89.7%). Cinsiyet dağılımı, komplikasyon sıklığı, komplikasyonların ciddiyeti (Clavien-Dindo),tekrar yatış sıklığı ve yatış süresi gruplar arasında benzerdir. PC’de daha fazla yeniden müdahaleye ihtiyaç duyuldu(30.2% vs 3.4%). Mortalite, PC grubunda daha fazladır, 40.5% vs 6.9%, Tedavide PC uygulanması (odds ratio:8.756) ve yüksek yaş (odds ratio: 1.133) mortalitenin bağımsız yordayıcı faktörleridir.
Sonuç: Yüksek riskli akut kolesistit hastalarında EC mortalite ve reintervention’u azaltır, PC’ye göre üstündür. Bilier sepsis, yoğun bakım hastaları, erken dönem kolesistektomiye köprüleme gibi alt gruplar için araştırmalara devam edilmelidir.
Anahtar Kelimeler
Akut Kolesistit Acil Kolesistektomi Perkütan kolesistostomi Yüksek Risk Mortalite
Kaynakça
- Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F et al. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Ann Transl Med. 2016;4:362.
- Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:15-26.
- Brewer B, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL. Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. Am J Surg. 1976;131:219-23.
- Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi S, Boerna D et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020;15(1):1-26.
- Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25:55-72.
- Hatzidakis AA, Prassopoulos P, Petinarakis I, Sanidas E, Chrysos E, Chalkiadakis G et al. Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment. Eur Radiol. 2002;12:1778-84.
- Tsuyuguchi T, Itoi T, Takada T, Strasberg SM, Pitt HA, Kim M-H et al. TG13 indications and techniques for gallbladder drainage in acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20:81-8.
- Winbladh A, Gullstrand P, Svanvik J, Sandström P. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford). 2009;11:183-93.
- Radder R. Ultrasonically guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging. 1980;49:330-3.
- Akyürek N, Salman B, Yüksel O, Tezcaner T, Irkörücü O, Yücel C et al. Management of acute calculous cholecystitis in high-risk patients: percutaneous cholecystotomy followed by early laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2005;15:315-20.
- Nve E, Badia JM, Amillo-Zaragueeta M, Juvany M, Mourelo-Farina M, Jorba R. Early management of severe biliary infection in the era of the Tokyo guidelines. J Clin Med. 2023;12:4711.
- Sanjay P, Mittapalli D, Marioud A, White RD, Ram R, Alijani A. Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. HPB (Oxford). 2013;15:511-6.
- Li M, Li N, Ji W, Quan Z, Wan X, Wu X et al. Percutaneous cholecystostomy is a definitive treatment for acute cholecystitis in elderly high-risk patients. Am Surg. 2013;79:524-7.
- Wang C-H, Wu C-Y, Yang JC-T, Lien W-C, Wang H-P, Liu K-L et al. Long-term outcomes of patients with acute cholecystitis after successful percutaneous cholecystostomy treatment and the risk factors for recurrence: a decade experience at a single center. PloS One. 2016;11:e0148017.
- Loozen CS, van Santvoort HC, van Duijvendijk P, Besselink MG, Gouma DJ, Nieuwenhuijzen GA et al. Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial. BMJ. 2018;8:363.
- Garcés-Albir M, Martín-Gorgojo V, Perdomo R, Molina-Rodríguez JL, Muñoz-Forner E, Dorcaratto D et al. Acute cholecystitis in elderly and high-risk surgical patients: is percutaneous cholecystostomy preferable to emergency cholecystectomy? J Gastrointest Surg. 2020;24:2579-86.
- La Greca A, Di Grezia M, Magalini S, Di Giorgio A, Lodoli C, Di Flumeri G et al. Comparison of cholecystectomy and percutaneous cholecystostomy in acute cholecystitis: results of a retrospective study. Eur Rev Med Pharmacol Sci. 2017;21:4668-74.
- Hendrix JM, Garmon EH. American Society of Anesthesiologists Physical Status Classification System. In StatPearls. Treasure Island (FL); StatPearls Publishing, 2025..
- Akhan O, Akıncı D, Özmen MN. Percutaneous cholecystostomy. Eur J Radiol. 2002;43:229-36.
- Huang H, Zhang H, Yang D, Wang W, Zhang X. Percutaneous cholecystostomy versus emergency cholecystectomy for the treatment of acute calculous cholecystitis in high-risk surgical patients: a meta-analysis and systematic review. Updates Surg. 2022;74:55-64.
- Markopoulos G, Mulita F, Kehagias D, Tsochatzis S, Lampropoulos C, Kehagias I. Outcomes of percutaneous cholecystostomy in elderly patients: a systematic review and meta-analysis. Prz Gastroenterol. 2021;16:188-95.
- Abi-Haidar Y, Sanchez V, Williams SA, Itani KM. Revisiting percutaneous cholecystostomy for acute cholecystitis based on a 10-year experience. Arch Surg. 2012;147:416-22.
- Hall BR, Armijo PR, Krause C, Burnett T, Oleynikov D. Emergent cholecystectomy is superior to percutaneous cholecystostomy tube placement in critically ill patients with emergent calculous cholecystitis. Am J Surg. 2018;216:116-9.
- Lin W-C, Chang C-W, Chu C-H. Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients. Kaohsiung J Med Sci. 2016;32:518-25.
- Melloul E, Denys A, Demartines N, Calmes J-M, Schäfer M. Percutaneous drainage versus emergency cholecystectomy for the treatment of acute cholecystitis in critically ill patients: does it matter? World J Surg. 2011;35:826-33.
- Cirocchi R, Amato L, Ungania S, Buononato M, Tebala GD, Cirillo B et al. Management of acute cholecystitis in high-risk patients: Percutaneous gallbladder drainage as a definitive treatment vs. Emergency cholecystectomy-systematic review and meta-analysis. J Clin Med. 2023;12:4903.
- Jang WS, Lim JU, Joo KR, Cha JM, Shin HP, Joo SH. Outcome of conservative percutaneous cholecystostomy in high-risk patients with acute cholecystitis and risk factors leading to surgery. Surg Endosc. 2015;29:2359-64.
- Terrone A, Di Martino M, Saeidi S, Ranucci C, Di Saverio S, Giuliani A. Percutaneous cholecystostomy in elderly patients with acute cholecystitis: a systematic review and meta-analysis. Updates Surg. 2024;76:363-73.
- Fleming MM, Liu F, Luo J, Zhang Y, Pei KY. Predictors of 30 day readmission following percutaneous cholecystostomy. J Surg Res. 2019;233:1-7.
- Anderson JE, Chang DC, Talamini MA. A nationwide examination of outcomes of percutaneous cholecystostomy compared with cholecystectomy for acute cholecystitis, 1998–2010. Surg Endosc. 2013;27:3406-11.
- Zerem E, Omerovic S. Can percutaneous cholecystostomy be a definitive management for acute cholecystitis in high-risk patients? Surg Laparosc Endos Percutan Tech. 2014;24:187-91.
- Lu P, Chan C-L, Yang N-P, Chang N-T, Lin K-B, Lai KR. Outcome comparison between percutaneous cholecystostomy and cholecystectomy: a 10-year population-based analysis. BMC Surg. 2017;17:130.
- Wadhwa V, Trivedi PS, Makary MS, Strain DV, Ahmed O, Chick JFB et al. Utilization and outcomes of cholecystostomy and cholecystectomy in patients admitted with acute cholecystitis: a nationwide analysis. AJR Am J Roentgenol. 2021;216:1558-65.
- Jia B, Liu K, Tan L, Jin Z, Liu Y. Percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy versus emergency laparoscopic cholecystectomy in acute complicated cholecystitis: comparison of curative efficacy. Am Surg. 2018;84:438-42.
- Ullah N, Kannan V, Ahmed O, Geddada S, Ibrahiam AT, Al-Qassab ZM et al. Effectiveness and safety of cholecystectomy versus percutaneous cholecystostomy for acute cholecystitis in older and high-risk surgical patients: a systematic review. Cureus. 2024;16:e70537.
- Pesce A, Ramirez-Giraldo C, Arkoudis N-A, Ramsay G, Popivanov G, Gurusamy K, et al. Management of high-surgical risk patients with acute cholecystitis following percutaneous cholecystostomy. results of an international Delphi consensus study. Int J Surg. 2025;111:3185-92.
- Nirhali R, Bhoir R, Prajapati R. Systematic review of percutaneous cholecystostomy (PC) as definitive vs bridge therapy for acute cholecystitis in high-risk patients. Indian J Surg. 2024;86:884-90.
- Lau J, Sinha S, Srinivas G, Andrews S, Bowling K, Platt T. 192 Percutaneous cholecystostomy as a definitive treatment versus bridging treatment before cholecystectomy for acute cholecystitis: a retrospective observational study. Br J Surg. 2023;110(Suppl 6):znad241-452.
Emergency cholecystectomy vs. percutaneous cholecystostomy for acute cholecystitis in high-risk patients: a comparison of mortality and clinical outcomes
Öz
Purpose: The aim of this study was to compare emergency cholecystectomy (EC) and percutaneous cholecystectomy (PC) in high-risk acute cholecystitis patients in respect of mortality and other clinical characteristics.
Material and Methods: A retrospective examination was made of patients graded as ASA/PS≥3 who underwent EC or PC because of acute cholecystitis. The two groups were compared in terms of demographic characteristics, mortality, complications, re-admission, and re-intervention rates.
Results: Patients in the PC group were older (78.11±9.76 vs 71.69±12.56 years) and had more frequent comorbidities (99.1% ve 89.7%). Both groups were similar in terms of gender distribution, complication rates and severity (Clavien-Dindo), re-admission rates, and length of stay in hospital. The need for re-intervention was greater in the PC group (30.2% vs.3.4%). Mortality rates were higher in the PC group (40.5% vs.6.9%. Independent predictive factors of mortality were determined to be the application of PC in treatment (odds ratio:8.756) and older age (odds ratio: 1.133).
Conclusion: In patients with high-risk acute cholecystitis, EC is superior to PC in terms of lower mortality and reducing the need for re-intervention. Research should be continued for subgroups of patients such as those with biliary sepsis, in intensive care, or with early cholecystectomy bridging.
Anahtar Kelimeler
Acute Cholecystitis Emergency Cholecystectomy Percutaneus Cholecystostomy High Risk Mortality
Etik Beyan
No funds, grants, or other support was received. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. All authors declare that the study was conducted in accordance with the Declaration of Helsinki and followed the ethical standards of Türkiye.
Kaynakça
- Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F et al. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Ann Transl Med. 2016;4:362.
- Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:15-26.
- Brewer B, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL. Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. Am J Surg. 1976;131:219-23.
- Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi S, Boerna D et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020;15(1):1-26.
- Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25:55-72.
- Hatzidakis AA, Prassopoulos P, Petinarakis I, Sanidas E, Chrysos E, Chalkiadakis G et al. Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment. Eur Radiol. 2002;12:1778-84.
- Tsuyuguchi T, Itoi T, Takada T, Strasberg SM, Pitt HA, Kim M-H et al. TG13 indications and techniques for gallbladder drainage in acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20:81-8.
- Winbladh A, Gullstrand P, Svanvik J, Sandström P. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford). 2009;11:183-93.
- Radder R. Ultrasonically guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging. 1980;49:330-3.
- Akyürek N, Salman B, Yüksel O, Tezcaner T, Irkörücü O, Yücel C et al. Management of acute calculous cholecystitis in high-risk patients: percutaneous cholecystotomy followed by early laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2005;15:315-20.
- Nve E, Badia JM, Amillo-Zaragueeta M, Juvany M, Mourelo-Farina M, Jorba R. Early management of severe biliary infection in the era of the Tokyo guidelines. J Clin Med. 2023;12:4711.
- Sanjay P, Mittapalli D, Marioud A, White RD, Ram R, Alijani A. Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. HPB (Oxford). 2013;15:511-6.
- Li M, Li N, Ji W, Quan Z, Wan X, Wu X et al. Percutaneous cholecystostomy is a definitive treatment for acute cholecystitis in elderly high-risk patients. Am Surg. 2013;79:524-7.
- Wang C-H, Wu C-Y, Yang JC-T, Lien W-C, Wang H-P, Liu K-L et al. Long-term outcomes of patients with acute cholecystitis after successful percutaneous cholecystostomy treatment and the risk factors for recurrence: a decade experience at a single center. PloS One. 2016;11:e0148017.
- Loozen CS, van Santvoort HC, van Duijvendijk P, Besselink MG, Gouma DJ, Nieuwenhuijzen GA et al. Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial. BMJ. 2018;8:363.
- Garcés-Albir M, Martín-Gorgojo V, Perdomo R, Molina-Rodríguez JL, Muñoz-Forner E, Dorcaratto D et al. Acute cholecystitis in elderly and high-risk surgical patients: is percutaneous cholecystostomy preferable to emergency cholecystectomy? J Gastrointest Surg. 2020;24:2579-86.
- La Greca A, Di Grezia M, Magalini S, Di Giorgio A, Lodoli C, Di Flumeri G et al. Comparison of cholecystectomy and percutaneous cholecystostomy in acute cholecystitis: results of a retrospective study. Eur Rev Med Pharmacol Sci. 2017;21:4668-74.
- Hendrix JM, Garmon EH. American Society of Anesthesiologists Physical Status Classification System. In StatPearls. Treasure Island (FL); StatPearls Publishing, 2025..
- Akhan O, Akıncı D, Özmen MN. Percutaneous cholecystostomy. Eur J Radiol. 2002;43:229-36.
- Huang H, Zhang H, Yang D, Wang W, Zhang X. Percutaneous cholecystostomy versus emergency cholecystectomy for the treatment of acute calculous cholecystitis in high-risk surgical patients: a meta-analysis and systematic review. Updates Surg. 2022;74:55-64.
- Markopoulos G, Mulita F, Kehagias D, Tsochatzis S, Lampropoulos C, Kehagias I. Outcomes of percutaneous cholecystostomy in elderly patients: a systematic review and meta-analysis. Prz Gastroenterol. 2021;16:188-95.
- Abi-Haidar Y, Sanchez V, Williams SA, Itani KM. Revisiting percutaneous cholecystostomy for acute cholecystitis based on a 10-year experience. Arch Surg. 2012;147:416-22.
- Hall BR, Armijo PR, Krause C, Burnett T, Oleynikov D. Emergent cholecystectomy is superior to percutaneous cholecystostomy tube placement in critically ill patients with emergent calculous cholecystitis. Am J Surg. 2018;216:116-9.
- Lin W-C, Chang C-W, Chu C-H. Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients. Kaohsiung J Med Sci. 2016;32:518-25.
- Melloul E, Denys A, Demartines N, Calmes J-M, Schäfer M. Percutaneous drainage versus emergency cholecystectomy for the treatment of acute cholecystitis in critically ill patients: does it matter? World J Surg. 2011;35:826-33.
- Cirocchi R, Amato L, Ungania S, Buononato M, Tebala GD, Cirillo B et al. Management of acute cholecystitis in high-risk patients: Percutaneous gallbladder drainage as a definitive treatment vs. Emergency cholecystectomy-systematic review and meta-analysis. J Clin Med. 2023;12:4903.
- Jang WS, Lim JU, Joo KR, Cha JM, Shin HP, Joo SH. Outcome of conservative percutaneous cholecystostomy in high-risk patients with acute cholecystitis and risk factors leading to surgery. Surg Endosc. 2015;29:2359-64.
- Terrone A, Di Martino M, Saeidi S, Ranucci C, Di Saverio S, Giuliani A. Percutaneous cholecystostomy in elderly patients with acute cholecystitis: a systematic review and meta-analysis. Updates Surg. 2024;76:363-73.
- Fleming MM, Liu F, Luo J, Zhang Y, Pei KY. Predictors of 30 day readmission following percutaneous cholecystostomy. J Surg Res. 2019;233:1-7.
- Anderson JE, Chang DC, Talamini MA. A nationwide examination of outcomes of percutaneous cholecystostomy compared with cholecystectomy for acute cholecystitis, 1998–2010. Surg Endosc. 2013;27:3406-11.
- Zerem E, Omerovic S. Can percutaneous cholecystostomy be a definitive management for acute cholecystitis in high-risk patients? Surg Laparosc Endos Percutan Tech. 2014;24:187-91.
- Lu P, Chan C-L, Yang N-P, Chang N-T, Lin K-B, Lai KR. Outcome comparison between percutaneous cholecystostomy and cholecystectomy: a 10-year population-based analysis. BMC Surg. 2017;17:130.
- Wadhwa V, Trivedi PS, Makary MS, Strain DV, Ahmed O, Chick JFB et al. Utilization and outcomes of cholecystostomy and cholecystectomy in patients admitted with acute cholecystitis: a nationwide analysis. AJR Am J Roentgenol. 2021;216:1558-65.
- Jia B, Liu K, Tan L, Jin Z, Liu Y. Percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy versus emergency laparoscopic cholecystectomy in acute complicated cholecystitis: comparison of curative efficacy. Am Surg. 2018;84:438-42.
- Ullah N, Kannan V, Ahmed O, Geddada S, Ibrahiam AT, Al-Qassab ZM et al. Effectiveness and safety of cholecystectomy versus percutaneous cholecystostomy for acute cholecystitis in older and high-risk surgical patients: a systematic review. Cureus. 2024;16:e70537.
- Pesce A, Ramirez-Giraldo C, Arkoudis N-A, Ramsay G, Popivanov G, Gurusamy K, et al. Management of high-surgical risk patients with acute cholecystitis following percutaneous cholecystostomy. results of an international Delphi consensus study. Int J Surg. 2025;111:3185-92.
- Nirhali R, Bhoir R, Prajapati R. Systematic review of percutaneous cholecystostomy (PC) as definitive vs bridge therapy for acute cholecystitis in high-risk patients. Indian J Surg. 2024;86:884-90.
- Lau J, Sinha S, Srinivas G, Andrews S, Bowling K, Platt T. 192 Percutaneous cholecystostomy as a definitive treatment versus bridging treatment before cholecystectomy for acute cholecystitis: a retrospective observational study. Br J Surg. 2023;110(Suppl 6):znad241-452.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Gastroenteroloji Cerrahisi, Genel Cerrahi |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2025 |
| Gönderilme Tarihi | 30 Ocak 2025 |
| Kabul Tarihi | 16 Nisan 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 50 Sayı: 2 |
