Minimally invasive management of acute perforated cholecystitis: The role of percutaneous transhepatic cholecystostomy
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Acute perforated cholecystitis (APC) is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality, particularly in elderly or high-risk patients. While emergency cholecystectomy is the standard of care, it may not be feasible in unstable patients. Percutaneous transhepatic cholecystostomy (PTC) offers a minimally invasive alternative. AIM: To evaluate the safety and effectiveness of PTC as an initial treatment modality for APC. METHODS: We conducted a retrospective cohort study of patients diagnosed with APC between January 2017 and October 2022 at a single tertiary medical center. All patients underwent PTC as the initial intervention. Data collected included demographics, comorbidities, laboratory and imaging findings, complications, and clinical outcomes over a 24-month follow-up. Patients were stratified into two groups based on whether they subsequently underwent cholecystectomy. RESULTS: < 0.001). Clinical improvement was observed in 61.4% of non-operated patients, with eventual drain removal or closure. Both groups demonstrated significant reductions in white blood cell count and C-reactive protein levels from admission to discharge. No significant differences were found in hospital stay or complication rates. During follow-up, three deaths occurred due to non-biliary causes. Only one patient required repeat drainage. CONCLUSION: PTC is a safe and effective initial treatment for APC, particularly in elderly and comorbid patients for whom surgery poses excessive risk. It provides clinical stabilization and may serve either as a bridge to delayed cholecystectomy or as definitive management in selected patients. These findings support the broader use of PTC in the management of APC, although larger prospective studies are warranted.
Authors: Mai Mazarieb, Amjad Parvaiz, Ubaida Hawashna, Yackov Romanenko, Eli Atar, Gil N Bachar
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4415465266