Minimally Invasive Approaches for High-Risk and Elderly Patients With Acute Cholecystitis: A Systematic Review of Techniques and Outcomes

TL;DR

This review compares minimally invasive treatments for acute cholecystitis in high-risk and elderly patients, finding that combining percutaneous drainage with surgery can improve outcomes.

Contribution

The study provides a systematic comparison of percutaneous drainage and laparoscopic cholecystectomy for high-risk patients.

Findings

Percutaneous drainage combined with LC reduces operative time, hospital stay, and complications in high-risk patients.

Routine post-LC drainage increases hospital stay and pain without reducing morbidity.

Advanced energy devices like harmonic scalpels offer limited benefits in optimizing surgical outcomes.

Abstract

Acute cholecystitis is a prevalent condition marked by gallbladder inflammation, typically due to gallstone obstruction, and poses management challenges, particularly for high-risk and elderly patients. This systematic review compares the efficacy and safety of two minimally invasive approaches: percutaneous drainage methods, such as percutaneous cholecystostomy, and laparoscopic cholecystectomy (LC). A structured search of PubMed, MEDLINE, and Embase was conducted, yielding six randomized controlled trials that met the inclusion criteria. Findings suggest that percutaneous drainage combined with LC offers advantages in reducing operative time, hospital stay, and complication rates, particularly for high-risk patients, compared to LC alone. However, routine postoperative drainage after LC may contribute to prolonged hospital stays and increased postoperative pain without reducing morbidity. Advanced energy devices, such as harmonic scalpels, may further optimize surgical outcomes, though benefits are limited. This review highlights the importance of patient-centered, selective approaches over routine practices, advocating for personalized strategies that prioritize patient safety and recovery. Future research should refine patient selection criteria and evaluate long-term outcomes to establish more precise guidelines for managing acute cholecystitis in vulnerable populations.