1. Ultrasonographic percutaneous cholecystostomy as a definitive
treatment for acute cholecystitis in the elderly high risk patients
Montserrat Juvany, Mireia Amillo, Núria Rosón*,
Xavier Guirao, Miquel Casal, Esther Nve, Josep
Maria Badia.
Hospital General de Granollers, Barcelona. Spain.
*Radiological Department.
24th European Congress on Surgical Infection, 26th May, Leon.

2. Introduction
• LAPAROSCOPIC CHOLECYSTECTOMY is the gold standard
treatment of acute cholecystitis (mortality rate=0-0.8%)
• However, in the elderly high risk patients the mortality rate of
cholecystectomy is 14-30% and even 77% in ASA IV
• In the elderly high risk patients, ultrasound guided cholecystostomy
(described by Radder, 1980) is likely to be a good option. But, will
this patients require a surgical intervention afterwards?
24th European Congress on Surgical Infection, 26th May, Leon.

3. Objectives
• To evaluate in the elderly high
risk patients with acute
cholecystitis treated by
ultrasound guided
cholecystostomy:
1. Clinical efficacy of the
technique (complications
related)
2. Need of surgery after the
episode of acute
cholecystitis
24th European Congress on Surgical Infection, 26th May, Leon.

4. Material and methods
• Retrospective study from September 2005 until September
2010 (5 years)
• Inclusion of all patients with acute cholecystitis treated by
ultrasound guided cholecystostomy during this period
• Collected data:
– age, gender, ASA
– duration catheter, calculous cholecystitis
– SIRS parameters and blood analysis (diagnosis)
– biliary cultures results
– antibiothic adequacy
• Main variables:
– clinical outcome (first 30 days)
– surgical requirement (medium follow-up of 16 weeks)
• Comparison of patients with good and bad primmary outcomes
24th European Congress on Surgical Infection, 26th May, Leon.

5. Results
Epidemiological data
n 35
Age (y) 81±10
Gender M (17); F (18)
ASA III (15); IV (19); V (1)
Duration 15±14
catheter (d)
Calculous Yes (31); No (4)
cholecystitis
24th European Congress on Surgical Infection, 26th May, Leon.

6. Results
Biliary culture results
Biliary cultures: Positive (25) Negative (8) Not done (2)
Polimicrobial (16) Monomicrobial (9)
24th European Congress on Surgical Infection, 26th May, Leon.

7. Results
Adequacy of treatment
Positivity of biliary culture: 25 Antibiothic treatment
21 antibiogram; 4 mixed flora Piperacillin-Tazobactam 23
Carbapenems 6
Carbapenems+glycopeptids 2
Other 4
Adequacy of treatment: 90%
(19/21)
Reasons for inadequacy: E.coli and enterococcus R to PipTazo
24th European Congress on Surgical Infection, 26th May, Leon.

8. Results
Clinical outcome
n=35
26 9
Good Bad
8 exitus 1 alive
(1surg)
2 technique 6 non-technique
related related (1 surg)
•Clinical efficacy: 74% (26/35)
 Major complications related to technique : 5.7% (2/35)
1 gallbladder perforation; 1 bleeding hepatic surface
24th European Congress on Surgical Infection, 26th May, Leon.

9. Results
Surgical requirements
26
Good
19 5
no recurrence recurrence
17 alive 2 exitus 3 alive 2 exitus
(2 surg) (non-biliary) (3 surg) (2 ab’s)
• Surgical requirements : 19 % (5/26)
 Recurrence of acute cholecystitis: 19% (5/26)
24th European Congress on Surgical Infection, 26th May, Leon.

10. Results
Comparison of good and bad primmary outcome
Good Bad p
(n=26) (n=9)
Age (y) 7810 857 0.08
Epidemiologics Vital signs
(N.S.)
ASA III (14) III (1) 0.07
IV (12) IV (7)
V (1) (N.S.)
SBP (Hg mm) 12321 11928 Patients with bad outcome
N.S.
showed a tendency of being
Heart rate (BPM) 88.614.9 87.224.5 older and having a more
N.S.
advanced ASA classification
Temperature (ºC) 37.00.7 37.01.2 N.S.
24th European Congress on Surgical Infection, 26th May, Leon.

11. Results
Comparison of good and bad primmary outcome
Good Bad p
(n=26) (n=9)
WCC (/mL) 163886987 156335811 N.S.
Blood analysis
C-reactive protein 20789 26898 0.09
(mg/L) (N.S.)
Total bilirrubine 1.61.8 5.18.2 0.04*
(mg/dL)
They showed a tendency of having higher
levels of CRP
Total bilirrubine was higher (suggesting
associated cholangitis as a marker of worst
prognosis)
24th European Congress on Surgical Infection, 26th May, Leon.

12. Conclusions
• Ultrasonographic percutaneous cholecystostomy is the technique of
choice for acute cholecystitis in the elderly high risk patients (74%
of clinical efficacy)
• It is a definitive treatment in 81% of the patients with good
primary outcome
• High levels of total bilirrubine at the moment of diagnosis are
associated with bad primmary outcome
24th European Congress on Surgical Infection, 26th May, Leon.

13. 24th European Congress on Surgical Infection, 26th May, Leon.