[Percutaneous cholecystostomy for acute cholecystitis in high-risk patients].
OBJECTIVE
The aim of this retrospective study was to report the results of percutaneous cholecystostomy in a selected group of high-risk patients with contraindications of general anesthesia.


METHODS
From October 1995 to December 1999, a percutaneous cholecystostomy was performed in 29 patients with acute cholecystitis. There were 20 women and nine men with a mean age of 80.6 years (range: 59 to 95 years). All the patients were ASA III (N = 23) or ASA IV (N = 6). Ultrasound-guided percutaneous cholecystostomy was performed in 24 cases and computed tomography-guided cholecystostomy in five cases.


RESULTS
Percutaneous cholecystostomy was easily performed in 28 cases; there was one failed procedure. The drainage was not efficient in three patients who were operated on with one postoperative death of a patient who had a necrotic cholecystitis. There was no mortality in relation with cholecystostomy. One patient died at day 15 from myocardia infarction. The morbidity rate was 3.4% (one case). Postoperative length of hospital stay was 13 days (range: 7-30 days). The duration of the entire procedure ranged from 9 to 60 days (mean: 20 days). The mean follow-up of patients was 17 months (range: 4-40 months). One patient had recurrent acute cholecystitis and another one had angiocholitis; two patients underwent delayed elective laparoscopic cholecystectomy; 20 patients remained asymptomatic and 16 were still alive at the time of this study (13 with biliary stones and three without).


CONCLUSIONS
Percutaneous cholecystostomy is a valuable alternative procedure for high-risk patients with acute cholecystitis. It's a safe and usually effective procedure without mortality and with a low morbidity. Whenever possible, percutaneous cholecystostomy should be followed by laparoscopic cholecystectomy.
Pessaux
P
P
Service de chirurgie viscérale, CHU, Angers, France.
Lebigot
J
J
Tuech
J J
JJ
Regenet
N
N
Aube
C
C
Ridereau
C
C
Arnaud
J P
JP
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D002764:Cholecystitis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002767:Cholecystostomy / Q000009:adverse effects / Q000379:methods*; D000075202:Contraindications; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome