Tube Management in Percutaneous Cholecystostomy

Indications for percutaneous cholecystostomy include calculous and acalculous cholecystitis, gallbladder perforation, malignant obstruction, percutaneous biliary stone removal, biliary duct drainage, and diagnostic imaging of the gallbladder and biliary ductal system. Evidence-based indications for percutaneous cholecystostomy in elderly and critically ill patients have not been established, however. (Winbladh et al, 2009).

The tube can be removed once 1) the patient has recovered from the contributory underlying illness, 2) a catheter cholangiogram has confirmed cystic and bile duct patency, and 3) the tube has drained for a minimum of 3 weeks (Wise et al, 2005).

The last requirement is to ensure maturation of a tract around the tube in order to reduce risk of bile leakage and associated peritonitis and/or sepsis. To this end, some have advocated tract imaging prior to removal. However, this may not be necessary "in patients with small-bore gallbladder catheters [e.g., 8-French] who have recovered from critical illness, show patent cystic and common ducts, and have had catheters for 3–6 weeks." (Wise et al, 2005).

In patients with calculous cholecystitis, percutaneous gallstone extraction may be performed before tube removal.

References

• Davis CA, Landercasper J, Gundersen LH, Lambert PJ. Effective use of percutaneous cholecystostomy in high-risk surgical patients: techniques, tube management, and results. Arch Surg. 1999 Jul;134(7):727-31;
• Winbladh A, Gullstrand P, Svanvik J, Sandström P. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford). 2009;11(3):183-93.
• Wise JN, Gervais DA, Akman A, Harisinghani M, Hahn PF, Mueller PR. Percutaneous cholecystostomy catheter removal and incidence of clinically significant bile leaks: a clinical approach to catheter management. AJR Am J Roentgenol. 2005 May;184(5):1647-51.