Akut kolesistitli hastalarda perkütan kolesistostominin etkisi nedir? Ýþlem için doðru zaman ne zaman?

AMAÇ: Akut Kolesistit (AK), cerrahi pratikte en sýk görülen acil hastalýklardan biridir. Altýn standart tedavi laparoskopik kolesistektomi olmasýna raðmen, bazý hastalarda yaþ, komorbidite ve baþvurudaki gecikmeler nedeniyle perkütan kolesistostomi (PK) uygulanmaktadýr. PK uygulanan hasta-larda zamanlamanýn klinik sürece etkisini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Þubat 2017 ile Aralýk 2021 tarihleri arasýnda PK uygulanan hastalar çalýþmaya dahil edildi. Ýlk 72 saatte PK uygulananlar erken PK grubu, 72 saat sonra uygulananlar ise geç PK grubu olarak belirlendi. Hastalarýn demografik bilgileri, drenaj öncesi klinik bilgileri, ilk üç gün biyo-kimyasal deðerleri, hastanede kalýþ süreleri, drenaj sonrasý erken ve geç dönemde morbidite ve mortalite, elektif kolesistektomi bilgileri kaydedildi. Bu veriler iki grup arasýnda karþýlaþtýrýldý.
BULGULAR: Çalýþmaya 122 hasta dahil edildi. 98 hastaya (%80.3) erken PK, 24 hastaya (%19.7) geç PK uygulandý. Medyan takip süresi erken PK grubunda 26.6 ay (min: 0.25-maks: 67), geç PK grubunda 26.4 ay (min: 0,6-maks: 66) idi (p=0.408). Tokyo sýnýflamasýna göre ortalama yaþ, erkek ve kadýn daðýlýmý, eþlik eden hastalýk, Charlson komorbidite indeksi (CCI), hepatopankreatolilier patoloji (HPBP), endoskopik retrograd kolanjiyo-pankreatografi (ERCP) ve derece (TG18) açýsýndan istatistiksel olarak anlamlý bir fark yoktu (p>0.05). Biyokimyasal parametreler arasýnda fark yoktu (p>0.05). Çalýþmamýzda erken PK grubunda ortalama hastanede kalýþ süresi 6 (min: 2-maks: 36) gün, geç PK grubunda ortalama 9 gün (min: 5-maks: 20) idi (p< 0.001). PK'den sonra 16'sý akut kolesistit olan toplam 25 hastada HPBP geliþti. Erken ve geç PK gruplarý arasýnda PK sonrasý HPBP ge-liþimi açýsýndan istatistiksel olarak anlamlý fark yoktu (p=0.576). Ameliyat oraný ve ameliyat tipi (acil/elektif, açýk/laparoskopik/konversiyon, total/subtotal, süre) açýsýndan erken ve geç PK grubu arasýnda istatistiksel olarak anlamlý fark yoktu (p>0.05).
SONUÇ: Doðru zamanlamayla ilgili tartýþmalar devam etmektedir. Çalýþmamýzda erken PK uygulanan hastalarýn hastanede kalýþ sürelerinin daha kýsa olduðunu bulduk. Hasta özellikleri ve akut kolesistit þiddeti açýsýndan erken ve geç gruplar arasýnda fark yoktu. Akut kolesistit tedavisinde PK iþlemi, hasta bazlý endikasyonlar yerine, randomize kontrollü çalýþmalarla objektif verilerle belirlenen algoritmalara dayanmalýdýr.

What is the effect of percutaneous cholesistostomy in patients with acute cholecystitis? when is the right time for the procedure?

BACKGROUND: Acute cholecystitis (AC) is one of the most common emergency diseases in surgical practice. Although the gold standard treatment is laparoscopic cholecystectomy, percutaneous cholecystostomy (PC) is performed in some patients due to age, comorbidity, and delays in admission. We aimed to investigate the effect of timing on the clinical process of patients undergoing PC.
METHODS: Patients who underwent PC between February 2017 and December 2021 were included in the study. Those who un-derwent PC in the first 72 h were determined as the early PC group, and those who underwent PC after 72 h were determined as the late PC group. Demographic information of the patients, clinical information before drainage, biochemical values of the first 3 days, length of hospital stay, morbidity and mortality in the early and late period after drainage, and elective cholecystectomy information were recorded. These data were compared between the two groups.
RESULTS: One hundred and twenty-two patients were included in the study. Early PC was performed in 98 patients (80.3%) and late PC was performed in 24 patients (19.7%). The median follow-up period was 26.6 months (min: 0.25-max: 67) in the early PC group and 26.4 months (min: 0.6-max: 66) in the late PC group (P=0.408). There was no statistically significant difference in mean age, distribu-tion of males and women, concomitant disease, Charlson Comorbidity Index, hepatopancreatobiliary pathology (HPBP), endoscopic retrograde cholangiopancreatography in history and grade (TG18) compared to Tokyo classification (P>0.05). There was no difference between the biochemical parameters (P>0.05). In our study, the median length of hospital stay was 6 (min: 2-max: 36) days in the early PC group, and the median was 9 days (min: 5-max: 20) in the late PC group (P<0.001). A total of 25 patients developed HPBP after PC, 16 of which were AC. There was no statistically significant difference between the early and late PC groups in terms of HPBP develop-ment after PC (P=0.576). There was no statistically significant difference between the early and late PC group in terms of the rate of surgery and type of operation (emergency/elective, open/laparoscopic/conversion, total/subtotal, duration) (P>0.05).
CONCLUSION: Discussions about the right timing are ongoing. In our study, we found that patients who underwent early PC had shorter hospital stays. There was no difference between the early and late groups in terms of patient characteristics and severity of AC. PC procedure in AC should be based on algorithms determined by objective data instead of patient-based indications with ran-domized controlled trials.