Cholecystostomy Drainage; Current Practices in a Tertiary Hepatobiliary Unit

Background Acute calculous cholecystitis is a common general surgical emergency and accounts for 20% of symptomatic gallstone presentations. According to the Tokyo Guidelines, the severity is stratified into mild, moderate, and severe. Percutaneous Cholecystostomy Drains (PCD) are a temporary intervention in acutely unwell patients with gallbladder disease. This study aims to assess the current utility of PCDs in a tertiary hepatobiliary referral centre. Methods This retrospective review of PCD patients treated in a tertiary hepatobiliary referral centre between January 2018 and December 2023. Clinical, radiological, and perioperative outcomes were measured. Descriptive analysis was performed using the GraphPad Prism program. Results Sixty-eight patients were identified over six years. The mean age was 71.6 years, with a male majority. The inpatient referral group had a higher rate of ASA IV score (43%, n=18) compared to the external referral group (39%, n=7) (p-value = 0.775). The most common diagnosis was severe cholecystitis with septic shock (33.8%), followed by gallbladder perforation (26.4%). Complications occurred in 4.4% of cases, and 61.7% of patients had a follow-up cholecystogram. The mean duration of PCT insertion was 95.78 days in our cohort. Completion cholecystectomy was performed in 87.1% of patients with ASA I-II and 40% with ASA III-IV (p value<0.05). Conclusion Percutaneous Cholecystostomy Drainage is a safe and effective procedure for managing acutely calculous cholecystitis. However, the significant heterogeneity in the literature regarding the management and follow-up guidelines of PCT for patients with severe cholecystitis calls for further research. Future studies should focus on establishing best practice guidelines for PCT follow-up, a crucial area that this study has identified for further exploration.