Route selection for percutaneous cholecystostomy, concerning complications and catheter related events

The purpose of this article is to compare the complication rates of imaging-guided percutaneous cholecystostomy (PC) between transperitoneal and transhepatic approaches. We performed a database search for patients who underwent imaging-guided percutaneous cholecystostomy from Dec, 2009 to Jun., 2012. Four hundred sixty-five patients were included in our study. These patients were subdivided into two groups by their catheter insertion route; transhepatic approach (group A; n=423) and transperitoneal approach (group B; n=42). Technical success, complications, gender, age, etiology, catheter size, and INR data were compared between the two groups retrospectively. Statistical analysis was performed using independent sample-t test for quantitative variables and chi-square test for qualitative data. The overall technical success rate was 98.49%. There were 7 failure attempts (1.51%), 6 in group A (1.42%) and 1 in group B (2.38%):3 misplaced in the gallbladder (GB) fossa (all in group A), 2 found difficult penetration of gallbladder wall (one in group A and one in group B), and 2 were intolerant to proceed to whole procedure (all in group A). Complications included catheter dislodgement, hemorrhage, secondary infection (abscess along the catheter route), bile leakage induced peritonitis or biloma. Total complication rate of percutaneous cholecystostomy was 13.98% (65/465). The complication rates is 13% (55/423) in group A and 23.8% (10/42) in group B, p=0.054).The most common complication in both groups was catheter dislodgement, followed by bile leakage induced peritonitis or biloma. No procedure related pneumothorax, hollow organ injury, procedure-related death were registered. There was no significant difference in the complication rate between transhepatic and transperitoneal approach of percutaneous cholecystostomy. Percutaneous cholecystostomy is a safe procedure and can be performed with similar complication rates in both groups of transhepatic and transperitoneal approach. Proper secure and aftercare of the drainage catheter is more important than route selection. Therefore, the radiologists should not hesitate to use transperitoneal approach if it is a relatively easy and quick approach route in irritable or uncooperative patients.