title: Laparoscopic cholecystostomy with delayed cholecystectomy as an alternative to conversion to open procedure.
abstract: BACKGROUND
  Acute cholecystitis carries the highest incidence of conversion from planned laparoscopic cholecystectomy to open surgery due to unclear anatomy, excessive bleeding, complications, or other technical reasons.
  
  
  METHODS
  Laparoscopic tube cholecystostomy was performed instead of immediate conversion to laparotomy in 9 patients with acute cholecystitis after unsuccessful attempts at laparoscopic dissection. Elective laparoscopic cholecystectomy was done 3 months later.
  
  
  RESULTS
  Following this approach eight patients were treated successfully. After 3 months the acute process had subsided sufficiently to allow a safe laparoscopic cholecystectomy. One additional patient died of acute leukemia 6 weeks after cholecystostomy. Before adopting this technique we subjected 171 patients with acute calculous cholecystitis to laparoscopic cholecystectomy; there was an 11% (19 cases) rate of conversion. Since cholecystostomy has begun to be offered as an alternative to conversion, 121 patients with acute cholecystitis have had laparoscopic cholecystectomy and only 2 cases (1.5%) have been converted to immediate open cholecystectomy.
  
  
  CONCLUSIONS
  We recommend the alternative of performing a cholecystostomy with delayed laparoscopic cholecystectomy instead of conversion to open procedure when facing a case of acute cholecystitis not amenable to laparoscopic cholecystectomy.
authors.affiliation: Division of General Surgery, Scripps Clinic and Research Foundation, La Jolla, CA 92037, USA.
authors.forename: G G
authors.initials: GG
authors.lastname: Kuster
authors.forename: D
authors.initials: D
authors.lastname: Domagk
mesh_terms: D000208:Acute Disease; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods*; D005500:Follow-Up Studies; D005704:Gallbladder / Q000601:surgery*; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies