Internal gallbladder drainage prevents development of acute cholecystitis in a pig model: a randomized study

Twenty pigs were randomized to either internal drainage (drained) or not (undrained). Day 0 acute cholecystitis was induced by ligation of the cystic artery and duct together with inoculation of bacteria. Four days later the pigs were killed and the gallbladders were removed and histologically scored for the presence of cholecystitis. Bile and blood samples were collected for bacterial culturing and biochemical analyses.The histological examination demonstrated statistical significant differences in acute cholecystitis development between groups, the degree of inflammation being highest in undrained pigs. There were no differences in bacterial cultures between the two groups.Internal drainage of the gallbladder protected against the development of acute cholecystitis in the present pig model. These findings support the theory that gallstone impaction of the cystic duct plays a crucial role as a pathogenetic mechanism in the development of acute cholecystitis and suggest that internal drainage may be a way to prevent and treat acute cholecystitis.Gallstones are common in patients throughout the western world and are found in about 10% of the adult population [1]. Gallstone related disease is one of the most frequent medical problems demanding surgical intervention. In Denmark, 130 per 100.000 inhabitants are cholecystectomized each year [2], most often because of biliary attacks of pain. The annual incidence of acute cholecystitis, the second largest group undergoing cholecystectomy, is approximately 20 per 100.000 inhabitants [2]. In a subgroup of patients with acute cholecystitis, surgical intervention is hazardous due to poor performance status. In these patients, the standard treatment options have traditionally been conservative treatment or percutaneous transperitoneal cholecystostomy (PTCS) [3-7]. A significant drawback with both these treatment modalities is a high rate of recurrences, reported to range from 15% to 47% [8,9]. In recent years, an alternative t