title: Cholecystostomy: a review of recent experience.
abstract: BACKGROUND
  Operative (OC) and percutaneous cholecystostomy (PC) are rarely undertaken for severe acute cholecystitis in patients in whom cholecystectomy is technically difficult or those with significant comorbidity.
  
  
  METHODS
  A retrospective review was undertaken of the clinical, radiological and audit records of patients who were treated by cholecystostomy between 1988 and 1997 at Auckland Hospital.
  
  
  RESULTS
  During the 10-year period 19 patients (eight male, 11 female; median age: 70 years, range: 35-90 years) had a cholecystostomy (OC: n = 8; PC: n = 11). The main indication for PC was high anaesthetic risk (10 cases). The main indication for OC was failed cholecystectomy (six cases). The patients undergoing PC tended to have a higher American Society of Anesthesiologists (ASA) grade than patients undergoing OC. The median delay from presentation to cholecystostomy was 3 days. More than half (11/19) were done during the 3 years (1992-94) after the introduction of laparoscopic cholecystectomy. The number of tube-related complications was significantly higher in PC patients (10/11 vs 3/8; P = 0.04), and the number of systemic complications was higher in the OC patients (4/8 vs 0/11; P = 0.018). The median duration of tube drainage was 17 days (range: 0-82 days) for OC and 24 days (range: 5-93 days) for PC. Four patients had stone extraction at the time of OC, including two who also had a partial cholecystectomy. One OC patient had stone extraction via the cholecystostomy tract. A cholecystectomy was performed in four patients.
  
  
  CONCLUSIONS
  The data indicate that PC is a safe approach for high-risk patients. Operative cholecystostomy had a role following failed cholecystectomy. But PC might be safer in these patients if they could be identified pre-operatively.
authors.affiliation: Department of General Surgery, Auckland Hospital, Grafton, New Zealand.
authors.forename: A
authors.initials: A
authors.lastname: Ghahreman
authors.forename: J L
authors.initials: JL
authors.lastname: McCall
authors.forename: J A
authors.initials: JA
authors.lastname: Windsor
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery*; D002767:Cholecystostomy / Q000009:adverse effects; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies