title: Operative tube versus percutaneous cholecystostomy for acute cholecystitis.
abstract: The records of 26 patients who underwent cholecystostomy procedures for presumed acute cholecystitis during a 6-year period were reviewed. Nine patients had operative tube cholecystostomy (OC), and 17 patients had radiologic percutaneous cholecystostomy (PC). A correct diagnosis of acute cholecystitis was made in 22 of 26 patients (84%), including 14 of 17 PC patients and 8 of 9 in the OC group. The rate of resolution of cholecystitis was the same in each group (75% OC versus 78% PC). APACHE II scores prior to treatment were significantly higher in OC patients (20.9 OC versus 12.4 PC, p < 0.01). There were 5 deaths, including 3 in the OC groups and 2 in the PC group. Nonfatal complications were more frequent in the PC group. Two of the 14 correctly diagnosed PC patients (14%) subsequently required emergency cholecystectomy for persistent biliary sepsis, and 6 patients (43%) required at least 1 tube exchange for occlusion or dislodgement. Overall, only 5 of the 14 patients (36%) in the PC group were successfully treated without complications compared with 5 of 8 patients (63%) in the OC group. Despite its theoretical advantages, PC was no more effective than OC in the treatment of acute cholecystitis. These data suggest that OC remains a viable treatment option in critically ill patients with acute cholecystitis.
authors.affiliation: Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903.
authors.forename: D A
authors.initials: DA
authors.lastname: Spain
authors.forename: C
authors.initials: C
authors.lastname: Bibbo
authors.forename: T
authors.initials: T
authors.lastname: Ecker
authors.forename: J L
authors.initials: JL
authors.lastname: Nosher
authors.forename: R E
authors.initials: RE
authors.lastname: Brolin
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D001663:Bilirubin / Q000097:blood; D002763:Cholecystectomy; D002764:Cholecystitis / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D002767:Cholecystostomy / Q000009:adverse effects / Q000379:methods*; D016638:Critical Illness; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin