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Cholecystectomy following percutaneous cholecystostomy tube placement leads to higher rate of CBD injuries

  • 2018 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Percutaneous cholecystostomy tube (PCT) placement is often the management of severe acute cholecystitis in the unstable patient. PCT can be later reversed and cholecystectomy performed. The purpose of this study is to investigate the incidence of subsequent cholecystectomy and clinical factors associated with subsequent procedure.

Methods

The SPARCS, an administrative database, was used to search all patients undergoing PCT placement between 2000 and 2012 in the state of New York. Using a unique identifier, all patients were followed for subsequent cholecystectomy procedures for at least 2 years. Patients were also followed up to 2014 for potential CBD injury during subsequent laparoscopic (LC) or open cholecystectomy (OC). Univariate and multivariable regression analysis were performed when appropriate.

Results

There were 9738 patients identified who underwent PCT placements. The incidence of patients who had a PCT in 2000–2012, which subsequently underwent cholecystectomy increased from 25.0% in 2000 to 31.7% in 2012. In addition, patients undergoing subsequent LC increased from 11.8% in 2000 to 22.2% in 2012, while the incidence of OC decreased from 13.2% in 2000 to 9.5% in 2012. After accounting for other confounding factors, younger male patients, race as white compared to black, who didn’t have any complications during PCT placement were more likely to undergo subsequent cholecystectomy (p < 0.05). Average time to LC was 122.0 days versus 159.6 days for OC (p < 0.0001). From the patients who underwent cholecystectomy following PCT, 47 patients experienced CBD injury (1.6%).

Conclusions

Incidence of cholecystectomy following PCT increased during the study period. Surgeons seem to be more comfortable performing LC as rate of LC increased from 11.8 to 22.2%. However, rate of CBD injury is higher during subsequent cholecystectomy compared to that of the general population. Caution should be used when performing subsequent cholecystectomy following PCT, as these procedures may be more technically challenging.

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Acknowledgements

We acknowledge the biostatistical consultation and support provided by the Biostatistical Consulting Core at School of Medicine, Stony Brook University.

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Authors and Affiliations

  1. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA

    Maria S. Altieri, Lisa Bevilacqua, Salvatore Docimo, Konstantinos Spaniolas, Mark Talamini & Aurora Pryor

  2. Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

    Jie Yang

  3. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA

    Donglei Yin

Authors
  1. Maria S. Altieri
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  2. Lisa Bevilacqua
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  3. Jie Yang
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  4. Donglei Yin
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  5. Salvatore Docimo
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  6. Konstantinos Spaniolas
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  7. Mark Talamini
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  8. Aurora Pryor
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Corresponding author

Correspondence to Maria S. Altieri.

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Disclosures

Dr. Aurora Pryor receives honoraria for speaking for Ethicon, Medtronic, Stryker, and Gore; is a consultant for Medicines Company, Merck, and Intuitive and had 290 research support from Baronova and Obalon. Drs. Maria S. Altieri, Jie Yang, Lisa Bevilacqua, Konstantinos Spaniolas, Salvatore Docimo, Mark Talamini and Ms. Donglei Yin have no conflicts of interest or financial ties to disclose.

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Altieri, M.S., Bevilacqua, L., Yang, J. et al. Cholecystectomy following percutaneous cholecystostomy tube placement leads to higher rate of CBD injuries. Surg Endosc 33, 2686–2690 (2019). https://doi.org/10.1007/s00464-018-6559-4

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  • DOI: https://doi.org/10.1007/s00464-018-6559-4

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