Tubogram, A Useful Investigation for Evaluation of Patients Post Cholecystostomy Drain for Acute Cholecystitis, Single Centre Experience

Abstract

Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment for cholecystitis. However, for co-morbid or unstable patients, a less invasive approach can be adopted such as cholecystostomy drain (CD) insertion. CD can be a bridging operation or can be used as a definitive treatment if patient unsuitable for surgery. Methods: Retrospective study of patients who had Tubogram at Cumberland Infirmary, post CD for non-malignant cause between January 2019 and January 2022, comparing their outcome with the patients who did not undergo tubogram investigation. Patient data list collected from information department, Cumberland Infirmary. Results: Cholecystostomy drain placed for 58 patients; 21 patient (36.21%) had tubogram. Of the 58,44 patients (75.86%) had one CD; only 10 patients (22.73%) of them had tubogram. 14 patients had more than one CD (11 patient of them had tubogram). 66.67% patients had tubogram at 3-4 weeks following CD insertion. Outcome of tubogram patients was 47.62% (n=10) had Laparoscopic Cholecystectomy (LC) 6 weeks after cholecystostomy drain removal and 28.57% (n=6) had Endoscopic retrograde cholangiography then Laparoscopic Cholecystectomy. Non-tubogram patients’ group had more visits to same day emergency clinic comparing to tubogram patients’ group. Conclusion: Tubogram is a useful, cheap, non-invasive test linked with lower recurrence rate of cholecystitis symptoms after removal of CD; it is also associated with earlier CD removal. We recommend that tubogram should be a routine investigation for all patients three to four weeks post CD insertion.