Management of high-surgical-risk patients with acute cholecystitis following percutaneous cholecystostomy: results of an international Delphi consensus study

作者：Antonio Pesce, Camilo Ramírez-Giraldo, N. Arkoudis, G. Ramsay, G. Popivanov, K. Gurusamy, Natalia Bejarano, Maria Irene Bellini, M. Allegritti, J. Tesei, A. Gemini, A. Lauro, Matteo Matteucci, A. La Greca, V. Cozza, F. Coccolini, Marco Cannistra', C. Boselli, P. Covarelli, Gianluca Costa, Paolo Bruzzone, G. Tebala, S. Meneghini, V. D’andrea, A. Mingoli, Eugenio Cucinotta, Antonia Rizzuto, M. Zago, P. Prosperi, Massimo Buononato, G. Brachini, R. Cirocchi · 发表于：International Journal of Surgery · 年份：2025 · DOI：10.1097/js9.0000000000002325 · 被引用次数：15 · 研究领域：Medicine

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. Fo...