Upper GI Session
AB044. SOH25_AB_224. Management of percutaneous cholecystostomy drains: a survey of real-world practices across the UK and Ireland
Mohammed Al Azzawi1,2,3, Carolyn Cullinane1,3, Nicola Raftery1,3, Michael Devine1,3, Stephen O’Brien1,3, Czara Kennedy1,3, Conor Toale1,3, Noel Donlon1,3, Jessie Elliott1,3, Jarlath Bolger2,3
1Irish Surgical Research Collaborative, Royal College of Surgeons Ireland, Dublin, Ireland;
2Department of Upper GI Surgery, Beaumont Hospital, Dublin, Ireland;
3Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
Background: Acute calculous cholecystitis (AC) is a common surgical emergency with varying degrees of severity. The Tokyo guidelines 2018 stratified AC into grades I–III based on severity. Patients with grade III AC and high American Society of Anaesthesiologists (ASA) score may be managed with percutaneous cholecystostomy tube (PCT) insertion for sepsis control. There are no guidelines concerning PCT management. This questionnaire highlights the current real-world practices of PCT management across the United Kingdom (UK) and Ireland.
Methods: A 28-item digital questionnaire was distributed to surgeons in the UK and Ireland with questions pertaining to indications, follow-up, management and scheduling of post-PCT cholecystectomy. The questionnaire was disseminated between August and October 2024.
Results: There were 92 respondents across a range of general surgical specialities, 59.8% of which were consultants. Almost half of respondents (47.8%) worked in a Model 4 hospital (district general hospital) and 67% worked in a hospital without a Hepatobiliary department. Early laparoscopic cholecystectomy for AC was supported by 45.7% and 40.2% recommended insertion of PCT for AC with septic shock and patients with high ASA score. The majority do not perform post-PCT cholecystogram or remove the PCT during index admission. Nearly half of the respondents (48.9%) do not perform a clamping test prior to PCT removal and 56.6% schedule an outpatient cholecystogram. Most agreed that the optimal timing for cholecystectomy is 6–12 (66.3%) weeks with a laparoscopic approach (81.3%) and would abandon in difficult procedures and refer to HPB service (33.7%).
Conclusions: There is significant heterogeneity when it comes to indications, follow-up and management of PCT. Future studies should focus on consolidating guidelines to optimise PCT management and improve patient care.
Keywords: Acute cholecystitis (AC); cholecystograms; laparoscopic cholecystectomy; open cholecystectomy; percutaneous cholecystostomy drains
Acknowledgments
None.
Funding: None.
Conflicts of Interest: The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/map-25-ab044
Cite this abstract as: Al Azzawi M, Cullinane C, Raftery N, Devine M, O’Brien S, Kennedy C, Toale C, Donlon N, Elliott J, Bolger J. AB044. SOH25_AB_224. Management of percutaneous cholecystostomy drains: a survey of real-world practices across the UK and Ireland. Mesentery Peritoneum 2025;9:AB044.
