Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis Kenneth S. H. Chok,* Ferdinand S. K. Chu,† Tan To Cheung,* Vincent W. T. Lam,* Wai Key Yuen,*‡ Kelvin K. C. Ng,* See Ching Chan,* Ronnie T. P. Poon,* Chun Yeung,* Chung Mau Lo* and Sheung Tat Fan* *Centre for the Study of Liver Disease and Department of Surgery, The University of Hong Kong †Department of Radiology, Queen Mary Hospital and ‡Department of Surgery, Tung Wah Hospital, Pokfulam, Hong Kong, China Key words American Society of Anaesthesiologists (ASA), percutaneous transhepatic cholecystostomy (PTC), USG-guided. Abbreviations ASA, American Society of Anaesthesiologists; PTC, percutaneous transhepatic cholecystostomy; USG-guided, ultrasound-guided. Correspondence Dr Chok Siu Ho Kenneth, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China. Email: kennethchok@yahoo.com.hk K. S. H. Chok FRCS; F. S. K. Chu FRCR; T. T. Cheung FRCS; V. W. T. Lam MS, FRACS; W. K. Yuen FRACS; K. K. C. Ng PhD; S. C. Chan Ms; R. T. P. Poon PhD, MS; C. Yeung FRCS; C. M. Lo Ms; S. T. Fan MD, PhD, MS. Accepted for publication 23 July 2008. doi: 10.1111/j.1445-2197.2009.05105.x Abstract Aim: To assess the efficacy and safety of percutaneous transhepatic cholecystostomy (PTC) in treatment for acute cholecystitis in high surgical risk patients. Patients and methods: A retrospective review was carried out from January 1999 to June 2007 on 23 patients, 11 males and 12 females, who underwent PTC for the management of acute cholecystitis at the Department of Surgery, Queen Mary Hos- pital, Hong Kong, China. The mean age of the patients was 83. They all had either clinical or radiological evidence of acute cholecystitis and had significant pre-morbid diseases. The median follow-up period on them was 35 months. Results: All the PTCs performed were technically successful. One patient died from procedure-related haemoperitoneum, while 87% (n = 20) of all the patients had clinical resolution of sepsis by 20 h after PTC. Eight patients underwent elective cholecystec- tomy afterwards (62.5% with the laparoscopic approach). Eight patients had dislodge- ment of the PTC catheter and one of them developed recurrent acute cholecystitis 3 months after PTC. That patient was treated conservatively. Four patients died from their pre-morbid conditions during the follow-up period. Conclusion: PTC was a safe and effective alternative for treating acute cholecystitis in this group of patients. Thirteen of them without elective cholecystectomy performed did not have recurrent acute cholecystitis after a single session of PTC. It may be considered as a definitive treatment for this group of patients. Introduction Cholecystectomy, either open or laparoscopic, is the established treatment for patients with acute cholecystitis. The reported mortal- ity of this operation is well accepted to be below 1%. However, aged patients having other life-threatening co-morbidities constitute a high-risk group for which the mortality rate can be as high as 30%. 1 Percutaneous transhepatic cholecystostomy (PTC) is an alternative method to treat acute cholecystitis in patients with significant co-morbid diseases. 2–5 It can be done under ultrasound (USG) or computed tomography guidance. PTC was introduced in the early 1980s and has been shown to be a safe alternative for treating acute cholecystitis in high surgical risk patients. 6 There is controversy over PTC being done after acute cholecys- titis. Some people advocate early elective cholecystectomy after an acute infection. However, life-threatening co-morbid diseases linger even after the acute episode has settled. Our study was carried out with the aim of evaluating the safety and efficacy of PTC and determining the outcomes of those who were not fit for elective cholecystectomy. Patients and methods For the background information, we have been managing around 30–40 patients with acute cholecystitis in our department yearly. On average, PTC was done on two to three patients annually. Most of them had their cholecystectomy done (~70%) and the rest had intra- venous antibiotics and subsequent interval cholecystectomy. It is because most of our patients do not prefer interval cholecystectomy. ORIGINAL ARTICLE ANZJSurg.com © 2010 The Authors Journal compilation © 2010 Royal Australasian College of Surgeons ANZ J Surg 80 (2010) 280–283