Cholecystostomy as a definitive operation.
Cholecystostomy for decompression and drainage of the biliary tree is indicated when the elderly, poor risk patient with destructive inflammatory process in the gallbladder is unable to tolerate a more extensive operation. Cholecystostomy is often criticized as an inferior operation, because it provides some palliation but leaves the patient with most problems unattended. To re-evaluate the role of cholecystostomy in the management of acute disease of the gallbladder, we reviewed our experience with it. During the years 1974 to 1987, 37 patients underwent a cholecystostomy. Patients ranged in age from 58 to 90 years, with an average age of 69 years. Twenty-eight patients had acute destructive cholecystitis, usually complicated by perforation, peritonitis or ascending cholangitis. Five had severe pancreatitis; three, cholelithiasis, and one patient, carcinoma of the bladder. Twenty-seven of the 37 patients had severe systemic disease and were critically ill. At the operation, calculi were extracted and the gallbladder and abscess were drained. Two patients died, yielding a mortality rate of 5.4 per cent. Tube cholangiography was done in 33 patients. Although residual stones were demonstrated in seven patients, the stones were removed electively at a later date under much more favorable conditions. None of the 35 survivors had symptoms of disease of the gallbladder during the follow-up period, which ranged from one to 12 years. Cholecystostomy is a curative operation indicated in critically ill and elderly patients for whom extensive operation is a prohibitive risk.
Kaufman
M
M
Department of Surgery, Tel Aviv University Sackler School of Medicine, Israel.
Weissberg
D
D
Schwartz
I
I
Moses
Y
Y
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002764:Cholecystitis / Q000150:complications / Q000601:surgery*; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors