TPT 8.13 Have we Stopped Over-Tubing? A Post-COVID Evaluation of Percutaneous Cholecystostomy Practice and Adherence to Tokyo Guidelines

Abstract

COVID-19–related disruption to emergency surgery led to increased use of percutaneous cholecystostomy (PC) for acute cholecystitis. We evaluated whether a residual “COVID shadow” persists in PC decision-making, assessed adherence to Tokyo Guideline severity criteria, and explored whether these guidelines encompass all clinically relevant factors influencing optimal patient selection. A retrospective cohort study was conducted at a single NHS trust. All patients undergoing percutaneous cholecystostomy (PC) between May 2023 to 2025 were included. Data were obtained from prospectively maintained electronic records. Cholecystitis severity was categorised according to the Tokyo Guidelines using values closest to the time of PC insertion. Procedural complications and subsequent management, including cholecystectomy timing, approach, and outcomes, were recorded. 109 patients underwent PC between April 2023 and May 2025. Tokyo classification included 11 Grade I, 63 Grade II, and 35 Grade III cases. PCs were performed in patients with low-grade disease (Tokyo I), suggesting potential overuse. Key clinical features not fully captured by Tokyo Guidelines included trends in inflammatory markers, immunocompromised status, and severe pain. Complications from drain insertion occurred in over 60% of patients, and 37 patients underwent subsequent cholecystectomy, with up to 85% determined to be difficult procedures. PC use persists beyond the pandemic, including in low-severity disease, suggesting a sustained COVID-related practice shift. While Tokyo Guidelines provide a valuable framework, they may insufficiently reflect clinical complexity influencing PC decisions. High complication rates and operative difficulty following PC support cautious patient selection and re-evaluation of guideline application in post-pandemic surgical practice.