Percutaneous cholecystostomy vs. laparoscopic cholecystectomy in the treatment of acute cholecystitis in high-risk patients: a systematic review

Abstract

Acute cholecystitis is an inflammation of the gallbladder, usually caused by obstruction of the cystic duct by gallstones, and is considered one of the main abdominal surgical emergencies. The standard treatment is early laparoscopic cholecystectomy, regarded as definitive and safe in most patients. However, in high-risk surgical patients, such as frail elderly individuals or those with multiple comorbidities, management becomes more challenging. In these cases, percutaneous cholecystostomy emerges as a minimally invasive alternative for the initial control of the infectious process and clinical stabilization. Although effective in the acute phase, drainage alone is associated with a higher risk of recurrence and hospital readmissions. Objective: To synthesize the available information regarding the benefits and risks attributed to each surgical technique involved in the treatment of this disease. The development of the project and the review is based on the methodological principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), aiming to ensure transparency, scientific rigor, and reproducibility in the process of study selection and database searching. Results: The laparoscopic technique, by modulating the systemic inflammatory response (IL-6) in a less aggressive manner and preserving intestinal motility, promotes a more robust recovery in frail patients compared to simple drainage, which leaves the diseased organ and gallstones in place as potential triggers for recurrence.