Percutaneous cholecystostomy for high-risk patients with acute cholecystitis
- 459 Downloads
Cholecystectomy remains the best treatment for acute cholecystitis but may cause high morbidity and mortality in critically ill or elderly patients.
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).
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%).
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.
KeywordsAcute cholecystitis Critically ill patients Percutaneous cholecystostomy
- 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.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
- 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
- 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.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