Kolokotronis T, Pantelis D. Interventional management of acute perforated cholecystitis: When is percutaneous transhepatic cholecystostomy a reasonable therapeutic option? World J Gastrointest Surg 2026; 18(1): 114059 [DOI: 10.4240/wjgs.v18.i1.114059]
Corresponding Author of This Article
Theodoros Kolokotronis, MD, PhD, Department of Surgery and Centre of Minimal Invasive Surgery, GFO Kliniken Bonn, Street Josef Hospital Bonn-Beuel, Hermann Street 37, Bonn 53225, North Rhine-Westphalia, Germany. fernado13984@yahoo.gr
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Surgery
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Editorial
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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/
Jan 27, 2026 (publication date) through Jan 28, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Kolokotronis T, Pantelis D. Interventional management of acute perforated cholecystitis: When is percutaneous transhepatic cholecystostomy a reasonable therapeutic option? World J Gastrointest Surg 2026; 18(1): 114059 [DOI: 10.4240/wjgs.v18.i1.114059]
World J Gastrointest Surg. Jan 27, 2026; 18(1): 114059 Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.114059
Interventional management of acute perforated cholecystitis: When is percutaneous transhepatic cholecystostomy a reasonable therapeutic option?
Theodoros Kolokotronis, Dimitrios Pantelis
Theodoros Kolokotronis, Department of Surgery and Centre of Minimal Invasive Surgery, GFO Kliniken Bonn, Bonn 53225, North Rhine-Westphalia, Germany
Dimitrios Pantelis, Department of General and Visceral Surgery, GFO Kliniken Bonn, Bonn 53225, North Rhine-Westphalia, Germany
Author contributions: Kolokotronis T performed the literature review, analyzed the data and wrote the manuscript; Pantelis D critically revised the manuscript. All authors approve the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Theodoros Kolokotronis, MD, PhD, Department of Surgery and Centre of Minimal Invasive Surgery, GFO Kliniken Bonn, Street Josef Hospital Bonn-Beuel, Hermann Street 37, Bonn 53225, North Rhine-Westphalia, Germany. fernado13984@yahoo.gr
Received: September 16, 2025 Revised: October 2, 2025 Accepted: November 3, 2025 Published online: January 27, 2026 Processing time: 133 Days and 2.9 Hours
Abstract
In the case of acute perforated cholecystitis, rapid control of the infection site is important for patient outcomes. For free perforation with generalized peritonitis, emergency laparoscopic cholecystectomy remains the gold standard therapy. Percutaneous transhepatic cholecystostomy (PTC) is an alternative damage-control option, particularly for frail, septic, or profoundly comorbid patients, either as a bridge to (early or interval) cholecystectomy or, in truly inoperable patients, as definitive palliation. Gallbladder perforations are categorized on the basis of the Niemeier classification. The therapeutic modality depends on the type of perforation. In this editorial, we present the actual guidelines and the findings from trials related to this issue. Moreover, we propose a pragmatic pathway that is based on clinical evidence. The following research gaps are identified: Randomized controlled trials aiming to compare emergency laparoscopic cholecystectomy with PTC as a bridge in cases of Niemeier I and Niemeier II disease are lacking; there are no standardized criteria for the use of PTC as a definitive therapy, such as frailty, sarcopenia or other markers; and there are no comparative studies of endoscopic ultrasound-guided gallbladder drainage vs PTC in cases of perforation.
Core Tip: While early laparoscopic cholecystectomy remains the gold standard, critically ill patients with perforated cholecystitis may benefit from minimally invasive strategies such as percutaneous transhepatic cholecystostomy or endoscopic ultrasound-guided gallbladder drainage, as bridging or definitive therapy. However, more evidence is needed concerning which subgroup of patients benefit from those non-surgical modalities.
