Influence of Clinical and Procedural Factors on Rate of Cholecystostomy Tube Dislodgement and Other Complications

Percutaneous cholecystostomy tube (PCCT) placement is commonly performed to manage acute cholecystitis; however, tube displacement is a frequent complication. Previous studies have shown placement by transhepatic (TH) and transperitoneal (TP) routes have similar outcomes, but other factors that influence malposition have not been shown {1,2}. This study looks to identify patient and procedure specific factors that affect complication rate of PCCT.

Materials and Methods:

This is a retrospective review of patients with CT scans from March 2018 to April 2021 at two tertiary care medical centers in a multicenter health system that demonstrated the presence of a PCCT. The CTs were read to confirm TH or TP route and to measure path length: the coordinate in axial, sagittal, and coronal planes was located for the cutaneous entry site and the tube’s radiopaque marker, and the distance was calculated between them. Demographic data, procedure details, outcomes, and complications were recorded. Malposition was defined as when a tube dislodged or required repositioning due to displacement. Categorical results were compared by chi-squared test and odds ratio; continuous results were compared by two-tailed t-test. Multivariate analysis by logistic regression was performed with variables chosen a priori.


Results: The study included 216 patients. The rate of tube leak was significantly greater with the TP route than with the TH route (p = .006); the rate of new sepsis diagnosed after tube placement was greater with the TH route than the TP route (p = .004). The average number of exchanges of TP tubes was significantly greater than for TH tubes (p = 3E-5). Multivariate logistic regression found that age (OR: 1.025 (95% CI [1.001, 1.049])), path length (OR: .978 (95% CI [.963, .993])), and time to outcome (OR: 1.002 (95% CI [1.001, 1.003])) were independent risk factors for malposition and that the TP route (OR: 1.497 (95% CI [.800, 2.801])) was not.

Conclusion: Evidence for a difference in complications was observed for tubes of different internal lengths. By using cross-sectional imaging to calculate the path-length of the tube, we have demonstrated tube length as an independent and significant factor in the rate of malposition and found new trends in the rate of complications between TH and TP placement of PCCT.