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World Journal of Surgery

, Volume 35, Issue 4, pp 826–833 | Cite as

Percutaneous Drainage versus Emergency Cholecystectomy for the Treatment of Acute Cholecystitis in Critically Ill Patients: Does it Matter?

  • E. Melloul
  • A. Denys
  • N. DemartinesEmail author
  • J.-M. Calmes
  • M. Schäfer
Article

Abstract

Background

The aim if this study was to compare percutaneous drainage (PD) of the gallbladder to emergency cholecystectomy (EC) in a well-defined patient group with sepsis related to acute calculous/acalculous cholecystitis (ACC/AAC).

Methods

Between 2001 and 2007, all consecutive patients of our ICU treated by either PD or EC were retrospectively analyzed. Cases were collected from a prospective database. Percutaneous drainage was performed by a transhepatic route and EC by open or laparoscopic approach. Patients’ general condition and organ dysfunction were assessed by two validated scoring systems (SAPS II and SOFA, respectively). Morbidity, mortality, and long-term outcome were systematically reviewed and analyzed in both groups.

Results

Forty-two patients [median age = 65.5 years (range = 32–94)] were included; 45% underwent EC (ten laparoscopic, nine open) and 55% PD (n = 23). Both patient groups had similar preoperative characteristics. Percutaneous drainage and EC were successful in 91 and 100% of patients, respectively. Organ dysfunctions were similarly improved by the third postoperative/postdrainage days. Despite undergoing PD, two patients required EC due to gangrenous cholecystitis. The conversion rate after laparoscopy was 20%. Overall morbidity was 8.7% after PD and 47% after EC (P = 0.011). Major morbidity was 0% after PD and 21% after EC (P = 0.034). The mortality rate was not different (13% after PD and 16% after EC, P = 1.0) and the deaths were all related to the patients’ preexisting disease. Hospital and ICU stays were not different. Recurrent symptoms (17%) occurred only after ACC in the PD group.

Conclusions

In high-risk patients, PD and EC are both efficient in the resolution of acute cholecystitis sepsis. However, EC is associated with a higher procedure-related morbidity and the laparoscopic approach is not always possible. Percutaneous drainage represents a valuable intervention, but secondary cholecystectomy is mandatory in cases of acute calculous cholecystitis.

Keywords

Laparoscopic Cholecystectomy Cholecystitis Sequential Organ Failure Assessment Acute Cholecystitis Percutaneous Drainage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • E. Melloul
    • 1
  • A. Denys
    • 2
  • N. Demartines
    • 1
    Email author
  • J.-M. Calmes
    • 1
  • M. Schäfer
    • 1
  1. 1.Department of Visceral Surgery and TransplantationUniversity Hospital of Lausanne (CHUV)LausanneSwitzerland
  2. 2.Department of Imaging and Interventional RadiologyUniversity Hospital of LausanneLausanneSwitzerland

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