Management of high-surgical-risk patients with acute cholecystitis following percutaneous cholecystostomy : results of an international Delphi consensus study
Pesce, A. (University of Ferrara)
Ramírez-Giraldo, C. (Hospital Universitario Mayor - Méderi)
Arkoudis, N.A. (National and Kapodistrian University of Athens)
Ramsay, G. (University of Aberdeen)
Popivanov, G. (Military Medical Academy)
Gurusamy, K. (University College London)
Bejarano, Natalia (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Bellini, M.I. (Università degli Studi di Roma "La Sapienza")
Allegritti, M. (AOSP Santa Maria di Terni)
Tesei, J. (AOSP Santa Maria di Terni)
Gemini, A. ("S.Maria" Hospital)
Lauro, A. (Università degli Studi di Roma "La Sapienza")
Matteucci, M. (University of Milan)
La Greca, A. (Fondazione Policlinico Universitario A. Gemelli IRCCS)
Cozza, V. (Fondazione Policlinico Universitario A. Gemelli IRCCS)
Coccolini, F. (Pisa University)
Cannistra, M. (Ospedale S. Giovanni di Dio)
Boselli, C. (University of Perugia)
Covarelli, P. (University of Perugia)
Costa, G. (Università degli Sudi Link Campus University)
Bruzzone, P. (Università degli Studi di Roma "La Sapienza")
Tebala, G.D. ("S.Maria" Hospital)
Meneghini, S. (Università degli Studi di Roma "La Sapienza")
D'Andrea, V. (Università degli Studi di Roma "La Sapienza")
Mingoli, A. (Università degli Studi di Roma "La Sapienza")
Cucinotta, E. (University of Messina)
Rizzuto, A. (Magna Græcia University)
Zago, M. (Lecco Hospital)
Prosperi, P. (Careggi University Hospital (Florència, Itàlia))
Buononato, M. (S. Maria della Stella Hospital. Località Ciconia)
Brachini, G. (Università degli Studi di Roma "La Sapienza")
Cirocchi, R. (University of Perugia)
Universitat Autònoma de Barcelona

Fecha:	2025
Resumen:	Background: The management of high-surgical-risk patients with moderate to severe acute cholecystitis is challenging in clinical practice. Early laparoscopic cholecystectomy is considered the gold standard for patients who do not respond to conservative treatment. However, for those unfit for surgery due to high risk, alternative treatment options, such as percutaneous cholecystostomy (PC), are available. There are no clear guidelines regarding the management of patients following PC. The primary aim of this study was to propose indications for PC in high-surgical-risk patients with acute cholecystitis and to establish management strategies for gallbladder drainage, either as a bridge to surgery or as a definitive treatment, according to available literature. Materials and methods: After a targeted literature review, International and Italian experts in the field from the Italian Society of Research in Surgery (SIRC) and the Italian Society of Emergency Surgery and Trauma (SICUT) were consulted to provide their evidence-based opinions on the topic. Statements were proposed during subsequent rounds using the Delphi methodology. Ten statements were provided, and the final agreement is presented in this study. Results: Patients with moderate acute cholecystitis, a Charlson Comorbidity Index (CCI) ≥ 6, and American Society of Anesthesiologists-Performance Status (ASA-PS) ≥ 3 who fail conservative treatment should undergo laparoscopic cholecystectomy as the first-line approach. For those with severe acute cholecystitis at high-surgical risk, percutaneous cholecystostomy is recommended to relieve symptoms within 24-48 hours. Once the infection is controlled, we should assess which patients may be candidates for interval laparoscopic cholecystectomy. For patients selected for surgery, laparoscopic cholecystectomy is recommended at least six weeks after PC placement. In patients not suitable for surgery, such as those with CCI ≥ 6 and ASA-PS ≥ 4, percutaneous cholecystostomy should remain in place for at least three weeks, after which, following radiographic confirmation of biliary tree patency, the tube may be removed. Conclusions: This consensus, developed through a multidisciplinary collaboration of interventional radiologists, gastroenterologists, and surgeons, provides a clear and practical guide for managing high-risk surgical patients with acute cholecystitis.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Acute cholecystitis ; Bridge to surgery ; Definitive treatment ; High-surgical risk ; Interval cholecystectomy ; Percutaneous cholecystostomy ; Radiological approach ; Timing ; Trans-tube cholangiography
Publicado en:	International journal of surgery, Vol. 111 Núm. 5 (2025) , p. 3185-3192, ISSN 1743-9159

DOI: 10.1097/JS9.0000000000002325
PMID: 40072363

8 p, 1.3 MB

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