International Delphi consensus on the management of percutaneous choleystostomy in acute cholecystitis (E-AHPBA, ANS, WSES societies)
José Manuel Ramia, Mario Serradilla-Martín, C. Villodre, Juan José Álvarez Rubio, Fernando Rotellar, Ajith K. Siriwardena, Go Wakabayashi, Fausto Catena, PERCHODEL Collaborative Study Group, Tomoyuki Abe, Yuta Abe, Fikri Abu-Zidan, Cándido F. Alcázar López, Ryusuke Amemiya, Bodil Andersson, Luca Ansaloni, Anita Balakrishnan, Zsolt J. Balogh, Silvia Carbonell-Morote, Ahmet Coker, Dimitrios Damaskos, Belinda De Simone, Jonh Devar, Isabella Frigerio, Yusuke Fujita, Sigheo Hayatsu, Shutaro Hori, Sho Ibuki, Noriaki Kameyama, Youichi Kawano, Andrew Kirkpatrick, Jorg Kleeff, Yoram Kluger, Rifat Latifi, Santiago Lopez-Ben, Giuseppe Malleo, Yuki Masuda, Takuya Minagawa, Kohei Mishima, Ryohei Miyata, Ernest Moore, Ryo Nishiyama, Yusuke Ome, Junichi Saito, Alejandro Serrablo, Masaya Shito, Kjetil Soreide, Oliver Strobel, Michael Sugrue, Keiichi Suzuki, Yutaka Takigawa, Moriaki Tomikawa, Hidejiro Urakami, Carlo Vallicelli, Taiga Wakawayashi, Dieter Weber
Abstract
BACKGROUND: There has been a progressive increase in the use of percutaneous cholecystostomy (PC) in acute cholecystitis (AC) over the last decades due to population aging, and the support of guidelines (Tokyo Guidelines (TG), World Society of Emergency Surgery (WSES) Guidelines) as a valid therapeutical option. However, there are many unanswered questions about the management of PCs. An international consensus on indications and PC management using Delphi methodology with contributions from experts from three surgical societies (EAHPBA, ANS, WSES) have been performed. METHODS: A two-round Delphi consensus, which included 27 questions, was sent to key opinion leaders in AC. Participants were asked to indicate their 'agreement/disagreement' using a 5-point Likert scale. Survey items with less than 70% consensus were excluded from the second round. For inclusion in the final recommendations, each survey item had to have reached a group consensus (≥ 70% agreement) by the end of the two survey rounds. RESULTS: 54 completed both rounds (82% of invitees). Six questions got > 70% and are included in consensus recommendations: In patients with acute cholecystitis, when there is a clear indication of PC, it is not necessary to wait 48 h to be carried out; Surgery is the first therapeutic option for the TG grade II acute cholecystitis in a patient suitable for surgery; Before PC removal a cholangiography should be done; There is no indication for PC in Tokyo Guidelines (TG) grade I patients; Transhepatic approach is the route of choice for PC; and after PC, laparoscopic cholecystectomy is the preferred approach (93.1%). CONCLUSIONS: Only six statements about PC management after AC got an international consensus. An international guideline about the management of PCs are necessary.