Management of percutaneous cholecystostomy drains: a survey of real-world practices across Ireland and the UK

INTRODUCTION: Acute calculous cholecystitis (ACC) is a common surgical emergency with varying severity. The Tokyo Guidelines stratified ACC into grades I-III based on severity. Patients with grade III ACC and high ASA scores can be managed with percutaneous cholecystostomy drain (PCD) insertion to control sepsis. There are currently no guidelines in the literature concerning PCD management. This questionnaire highlights the current real-life practices of PCD across Ireland and the UK. METHODS: The Irish Surgical Research Collaborative sought to explore PCD practices in Ireland and the UK. This study utilised a 23-item digital questionnaire, which included questions pertaining to indications, follow-up, and scheduling of post-PCD cholecystectomy. The questionnaire was disseminated between August and October 2024 to surgical trainees and consultant surgeons from Ireland and the UK. RESULTS: There were 94 responses from various general surgical subspecialties. Of the respondents, 61% (n = 57) were consultant surgeons, 64% (n = 60) worked in a university hospital, and 66% (n = 61) worked in a hospital without a hepatobiliary department. Forty-three Participants (46%) agreed to perform a laparoscopic cholecystectomy for ACC. However, 40% (n = 38) would insert PCD for ACC with septic shock in surgically unfit patients. Forty-six respondents (49%) chose not to perform a post-PCD cholecystogram during the index admission, and 81% (n = 76) wouldn't remove the PCD during the index admission. Regarding follow-up, forty-six participants (49%) wouldn't perform a clamping test before PCD removal, and fifty-four would schedule an outpatient cholecystogram (57%). The majority agreed that the optimal time for a cholecystectomy is 6-12 (66%) weeks, with the laparoscopic approach (81.3%) being the most commonly chosen. CONCLUSION: While laparoscopic cholecystectomy remains the gold standard for managing ACC, PCDs are safe, effective, and a commonly used tool in the surgical arsenal for managing acutely unwell patients who are poor surgical candidates. Guidelines regarding management and follow-up are necessary to guide the treatment.