Mazarieb M, Parvaiz A, Hawashna U, Romanenko Y, Atar E, Bachar GN. Minimally invasive management of acute perforated cholecystitis: The role of percutaneous transhepatic cholecystostomy. World J Gastrointest Surg 2025; 17(10): 108938 [PMID: 41178883 DOI: 10.4240/wjgs.v17.i10.108938]
Corresponding Author of This Article
Gil N Bachar, MD, Associate Professor, Director, Head, Departments of Radiology (Interventional Radiology Unit), Rabin Medical Center (Beilinson Campus), Golda campus/KKL 7, Petach Tikva 49100, Israel. gilbah@clalit.org.il
Research Domain of This Article
Management
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 27, 2025 (publication date) through Nov 14, 2025
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Mazarieb M, Parvaiz A, Hawashna U, Romanenko Y, Atar E, Bachar GN. Minimally invasive management of acute perforated cholecystitis: The role of percutaneous transhepatic cholecystostomy. World J Gastrointest Surg 2025; 17(10): 108938 [PMID: 41178883 DOI: 10.4240/wjgs.v17.i10.108938]
World J Gastrointest Surg. Oct 27, 2025; 17(10): 108938 Published online Oct 27, 2025. doi: 10.4240/wjgs.v17.i10.108938
Minimally invasive management of acute perforated cholecystitis: The role of percutaneous transhepatic cholecystostomy
Mai Mazarieb, Amjad Parvaiz, Ubaida Hawashna, Yackov Romanenko, Eli Atar, Gil N Bachar
Mai Mazarieb, Department of Surgery, Royal Free Hospital, Barnet Hospital, London NW2 2QG, United Kingdom
Amjad Parvaiz, Surgical Unit, Champalimaud Clinic Center, Champalimaud Foundation, Lisbon 1400-038, Portugal
Ubaida Hawashna, Department of Surgery, Rabin Medical Center, Petach Tikva 49100, Israel
Yackov Romanenko, Eli Atar, Units of Vascular and Interventional Radiology, Department of Diagnostic Radiology, Rabin Medical Center, Hasharon and Beilinson Hospitals, Petach Tikva 49100, Israel
Gil N Bachar, Departments of Radiology (Interventional Radiology Unit), Rabin Medical Center (Beilinson Campus), Petach Tikva 49100, Israel
Co-corresponding authors: Eli Atar and Gil N Bachar.
Author contributions: Mazarieb M, Parvaiz A, Hawashna U, Romanenko Y, Atar E, and Bachar GN designed the research study and performed the research; Mazarieb M, Atar E, and Bachar GN analyzed the data, and wrote the manuscript; Atar E and Bachar GN contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Rabin Medical Center, No. RMC-05010-24.
Informed consent statement: This study is a retrospective analysis of anonymized patient data. Therefore, in accordance with institutional guidelines and national regulations, written informed consent was not required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data supporting the findings of this study are not publicly available due to privacy and ethical restrictions concerning participant confidentiality.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gil N Bachar, MD, Associate Professor, Director, Head, Departments of Radiology (Interventional Radiology Unit), Rabin Medical Center (Beilinson Campus), Golda campus/KKL 7, Petach Tikva 49100, Israel. gilbah@clalit.org.il
Received: April 28, 2025 Revised: May 27, 2025 Accepted: September 1, 2025 Published online: October 27, 2025 Processing time: 181 Days and 16.8 Hours
Abstract
BACKGROUND
Acute perforated cholecystitis (APC) is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality, particularly in elderly or high-risk patients. While emergency cholecystectomy is the standard of care, it may not be feasible in unstable patients. Percutaneous transhepatic cholecystostomy (PTC) offers a minimally invasive alternative.
AIM
To evaluate the safety and effectiveness of PTC as an initial treatment modality for APC.
METHODS
We conducted a retrospective cohort study of patients diagnosed with APC between January 2017 and October 2022 at a single tertiary medical center. All patients underwent PTC as the initial intervention. Data collected included demographics, comorbidities, laboratory and imaging findings, complications, and clinical outcomes over a 24-month follow-up. Patients were stratified into two groups based on whether they subsequently underwent cholecystectomy.
RESULTS
Thirty patients underwent PTC for APC. Half of the patients (n = 15) were stabilized and later underwent cholecystectomy; the remaining 15 were managed non-operatively. Patients in the non-surgical group were significantly older (87.1 ± 6.2 years vs 76.1 ± 7.4 years; P < 0.001). Clinical improvement was observed in 61.4% of non-operated patients, with eventual drain removal or closure. Both groups demonstrated significant reductions in white blood cell count and C-reactive protein levels from admission to discharge. No significant differences were found in hospital stay or complication rates. During follow-up, three deaths occurred due to non-biliary causes. Only one patient required repeat drainage.
CONCLUSION
PTC is a safe and effective initial treatment for APC, particularly in elderly and comorbid patients for whom surgery poses excessive risk. It provides clinical stabilization and may serve either as a bridge to delayed cholecystectomy or as definitive management in selected patients. These findings support the broader use of PTC in the management of APC, although larger prospective studies are warranted.
Core Tip: Percutaneous transhepatic cholecystostomy (PTC) offers a safe, minimally invasive first‐line strategy for acute perforated cholecystitis in patients at high surgical risk. In our retrospective cohort of 30 acute perforated cholecystitis cases, PTC achieved clinical stabilization in 61.4% of non‐operated patients, facilitated elective cholecystectomy in half the cohort, and was associated with low, manageable complication rates. Over a 24-month follow-up, most patients managed with PTC alone maintained durable health improvements, underscoring its potential both as a bridge to surgery and as definitive treatment in select critically ill populations.
