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Surgical Endoscopy And Other Interventional Techniques

, Volume 19, Issue 9, pp 1256–1259 | Cite as

Percutaneous cholecystostomy for high-risk patients with acute cholecystitis

  • K. Welschbillig-Meunier
  • P. Pessaux
  • J. Lebigot
  • E. Lermite
  • Ch. Aube
  • O. Brehant
  • A. Hamy
  • J. P. Arnaud
Original article

Abstract

Background

Cholecystectomy remains the best treatment for acute cholecystitis but may cause high morbidity and mortality in critically ill or elderly patients.

Methods

From October 1995 to March 2004, percutaneous cholecystostomy was performed in 65 patients with acute cholecystitis. The mean age was 78 years (range, 45–95). All patients were American Society of Anesthesiologists (ASA) class III (n = 51) or ASA IV (n = 14).

Results

Percutaneous cholecystostomy was technically successful in 63 patients (97%) with no attributable mortality or major complications. In two patients, bile drainage was inefficient, requiring emergency laparoscopic cholecystectomy. One patient developed necrotic cholecystitis and died. The 30-day mortality rate was 13.8% (n = 9); eight patients died of respiratory or cardiac complications related to comorbidities. Mean drainage time was 18 days (range, 9–60). Postoperative length of hospital stay was 15 days (range, 7–30). Early and delayed cholecystitis occurred in six and five patients, respectively. During follow-up (mean, 20.4 months), five patients died of their underlying medical condition at 5, 6, 8, 12, and 14 months, respectively. In this study, delayed elective cholecystectomy was performed in 10 patients (15.3%).

Conclusions

Percutaneous cholecystostomy is a valuable and effective procedure without mortality and with a low morbidity. Whenever possible, percutaneous cholecystostomy should be followed by laparoscopic cholecystectomy.

Keywords

Acute cholecystitis Critically ill patients Percutaneous cholecystostomy 

References

  1. 1.
    Boggi U, Di Candio G, Campatelli A, Oleggini M, Pietrabissa A, Filipponi F, Bellini R, Massotta D, Mosca F (1999) Percutaneous cholecystostomy for acute cholecystitis in critically ill patients Hepato-gastroenterology 46:112–125Google Scholar
  2. 2.
    Boland GW, Lee MJ, Leung J, Mueller PR, (1994) Percutaneous cholecystostomy in critically ill patients: early response and final outcome in 82 patients Am J Roentgenol 163:339–342Google Scholar
  3. 3.
    Chang L, Moonka R, Stelzner M (2000) Percutaneous cholecystostomy for acute cholecystitis in veteran patients Am J Surg 150:198–202CrossRefGoogle Scholar
  4. 4.
    Gilliland TM, Traverso W (1990) Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long term relief of symptoms Surg Gynecol Obstet 170:39–44PubMedGoogle Scholar
  5. 5.
    Grandlund A, Karlson BM, Elvin A, Rasmussen I (2001) Ultrasound-guided percutaneous cholecystostomy in high-risk surgical patients Langenbeck’s Arch Surg 386:212–217CrossRefGoogle Scholar
  6. 6.
    Hamy A, Hennekinne S, Pessaux P, et al. (2003) Endoscopic sphincterotomy prior to laparoscopic cholecystectomy for the treatment of cholelithiasis Surg Endosc 17:872–875CrossRefPubMedGoogle Scholar
  7. 7.
    Hamy A, Visset J, Likholatnikov D, Lerat F, Gibaud H, Savigny B, Paineau J (1997) Percutaneous cholecystostomy for acute cholecystitis in critically ill patients Surgery 121:398–403CrossRefPubMedGoogle Scholar
  8. 8.
    Houghton PW, Jenkinson LR, Donaldson LA (1985) Cholecystectomy in the elderly: a prospective study Br J Surg 72:220–222PubMedGoogle Scholar
  9. 9.
    Huber DF, Martin EW Jr., Cooperman M (1983) Cholecystectomy in elderly patients Am J Surg 146:719–722CrossRefPubMedGoogle Scholar
  10. 10.
    Inui K, Nakazawa S, Naito Y, Kimoto E, Yamao K (1988)) Non surgical treatment of cholecystolithiasis with percutaneous cholecystoscopy Am J Gastroenterol 83:1124–1127PubMedGoogle Scholar
  11. 11.
    McSherry CK., (1989) Cholecystectomy: the gold standard Am J Surg 158:174–178CrossRefPubMedGoogle Scholar
  12. 12.
    Patterson EJ, McLouhlin RF, Mathieson JR (1996) An alternative approach to acute cholecystitis. Percutaneous cholecystostomy and interval laparoscopic cholecystectomy Surg, Endosc 10:1185–1188Google Scholar
  13. 13.
    Pessaux P, Tuech JJ, Rouge C, Du Plessis R, Cervi C, Arnaud JP (2000) Laparoscopic cholecystectomy in acute cholecystitis: a prospective comparative study in patients with acute versus chronic cholecystitis Surg Endosc 14:358–361CrossRefGoogle Scholar
  14. 14.
    Radder W, (1980) Ultrasonically guided percutaneous catheter drainage for gallbladder empyema Diagn Imaging 49:330–333PubMedGoogle Scholar
  15. 15.
    Shirai Y, Tsukada K, Kawaguchi H, Ohtani T, Muto T, Hatakeyama K (1993) Percutaneous transhepatic cholecystostomy for acute acalculous cholecystitis Br J Surg 80:1440–1442PubMedGoogle Scholar
  16. 16.
    Sugiyama M, Tokuhara M, Atomi Y (1998) Is percutaneous cholecystostomy the optimal treatment for acute cholecystitis in the very elderly World J Surg 22 459–463CrossRefPubMedGoogle Scholar
  17. 17.
    Van Steenbergen W, Ponette E, Marchal G, Pelemans W, Aert R, Fevery J, De Groote J (1990) Percuteneous transhepatic cholecystostomy for acute complicated cholecystitis in elderly patients Am J Gastroenterol 83:1363–1369Google Scholar
  18. 18.
    Vauthey JN, Lerut J, Martini M, Becker C, Gertsch P, Blumgart LH (1993) Percutaneous cholecystostomy for acute cholecystitis in critically ill patients Surgery 121:398–401Google Scholar
  19. 19.
    Verbanck JJ, Demol JW, Ghillebert GL, Rutgeerts LJ, Surmont IP (1993) Ultrasound-guided puncture of the gallbladder for acute cholecystitis Lancet 341:1132–1133CrossRefPubMedGoogle Scholar
  20. 20.
    Vingan H, (1995) Don’t forget cholecystostomy in the era of ERCP and laparoscopic cholecystectomy Am J Gastroenterol 90: 669–670PubMedGoogle Scholar
  21. 21.
    Werbel GB, Narhwold DL, Joehl RJ, Vogelzang RC, Rege RV, (1989) Percutaneous cholecystotomy in tne high risk patient Arch Surg 124:782–786PubMedGoogle Scholar
  22. 22.
    Wong SKH, Yu SC, Lam YH, Chung SSC (1999) Percutaneous cholecystostomy and endoscopic cholecystolithotripsy in the management of acute cholecystitis Surg Endosc 13:48–52CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • K. Welschbillig-Meunier
    • 1
  • P. Pessaux
    • 1
  • J. Lebigot
    • 2
  • E. Lermite
    • 1
  • Ch. Aube
    • 2
  • O. Brehant
    • 1
  • A. Hamy
    • 1
  • J. P. Arnaud
    • 1
  1. 1.Department of Visceral SurgeryChu Angers, 4 rue LarreyAngers CedexFrance
  2. 2.Radiological DepartmentChu Angers, 4 rue LarreyAngers CedexFrance

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