title: Percutaneous cholecystostomy: a bridge to surgery or definite management of acute cholecystitis in high-risk patients?
abstract: OBJECTIVE
  Cholecystectomy is the standard treatment for acute cholecystitis, but in high-risk patients with serious comorbidity and in patients of advanced age there is substantial morbidity and mortality associated with the intervention. In these selected patients, percutaneous cholecystostomy (PCS) is an alternative mode of management. The aim of the present study was to evaluate the outcome of PCS in selected patients with acute cholecystitis.
  
  
  METHODS
  Thirty-five patients, representing 0.6% of all acute cholecystitis patients managed during the period 1994-2003, were subjected to PCS. Patients' charts were reviewed retrospectively for age, gender, comorbidity, hospital stay, procedure, complications and final outcome, including requirement of additional interventions.
  
  
  RESULTS
  PCS was considered successful in 34/35 patients, 26 of whom responded within 3 days. Two patients required additional cholecystectomy 3 days and 20 months, respectively, after the PCS procedure. Two patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and one patient underwent rotation lithotripsy. Four patients suffered recurrent biliary complaints after the acute episode of cholecystitis, while the only serious procedure-related complication was bile leakage from the gallbladder in one patient, which necessitated cholecystectomy.
  
  
  CONCLUSIONS
  PCS is a comparatively safe and efficient procedure in the treatment of acute cholecystitis in high-risk patients with serious comorbidity and in elderly patients, contraindicating the general anaesthesia required for laparoscopic or open cholecystectomy.
authors.affiliation: Department of Surgery, Lund University Hospital, Lund, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Leveau
authors.forename: Ellen
authors.initials: E
authors.lastname: Andersson
authors.forename: Ingela
authors.initials: I
authors.lastname: Carlgren
authors.forename: Julian
authors.initials: J
authors.lastname: Willner
authors.forename: Roland
authors.initials: R
authors.lastname: Andersson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000601:surgery*; D002767:Cholecystostomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors