Management of percutaneous cholecystostomy drains: a survey of real-world practices across Ireland and the UK

TL;DR

This survey explores how percutaneous cholecystostomy drains are managed in real-world surgical practices across Ireland and the UK.

Contribution

The study provides insights into current PCD practices and highlights the need for standardized guidelines.

Findings

Most surgeons prefer laparoscopic cholecystectomy for ACC but use PCDs for unfit patients.

Only 49% perform a cholecystogram during the initial admission, and 81% do not remove PCDs during the same admission.

The majority believe cholecystectomy should be scheduled 6–12 weeks after PCD insertion.

Abstract

Acute calculous cholecystitis (ACC) is a common surgical emergency with varying severity. The Tokyo Guidelines stratified ACC into grades I-III based on severity. Patients with grade III ACC and high ASA scores can be managed with percutaneous cholecystostomy drain (PCD) insertion to control sepsis. There are currently no guidelines in the literature concerning PCD management. This questionnaire highlights the current real-life practices of PCD across Ireland and the UK.

The Irish Surgical Research Collaborative sought to explore PCD practices in Ireland and the UK. This study utilised a 23-item digital questionnaire, which included questions pertaining to indications, follow-up, and scheduling of post-PCD cholecystectomy. The questionnaire was disseminated between August and October 2024 to surgical trainees and consultant surgeons from Ireland and the UK.

There were 94 responses from various general surgical subspecialties. Of the respondents, 61% (n = 57) were consultant surgeons, 64% (n = 60) worked in a university hospital, and 66% (n = 61) worked in a hospital without a hepatobiliary department. Forty-three Participants (46%) agreed to perform a laparoscopic cholecystectomy for ACC. However, 40% (n = 38) would insert PCD for ACC with septic shock in surgically unfit patients. Forty-six respondents (49%) chose not to perform a post-PCD cholecystogram during the index admission, and 81% (n = 76) wouldn't remove the PCD during the index admission. Regarding follow-up, forty-six participants (49%) wouldn’t perform a clamping test before PCD removal, and fifty-four would schedule an outpatient cholecystogram (57%). The majority agreed that the optimal time for a cholecystectomy is 6–12 (66%) weeks, with the laparoscopic approach (81.3%) being the most commonly chosen.

While laparoscopic cholecystectomy remains the gold standard for managing ACC, PCDs are safe, effective, and a commonly used tool in the surgical arsenal for managing acutely unwell patients who are poor surgical candidates. Guidelines regarding management and follow-up are necessary to guide the treatment.

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