title: Better treatment strategies for patients with acute cholecystitis and American Society of Anesthesiologists classification 3 or greater.
abstract: OBJECTIVE
  Laparoscopic cholecystectomy is the best treatment choice for acute cholecystitis. However, it still carries high conversion and mortality rates. The purpose of this study was to find out better treatment strategies for high surgical risk patients with acute cholecystitis.
  
  
  METHODS
  Between January 2002 and June 2008, we performed percutaneous cholecystostomy instead of emergency cholecystectomy in 44 patients with acute cholecystitis and American Society of Anesthesiologists (ASA) classification 3 or greater. This was performed in 31 patients as a bridge procedure before elective cholecystectomy (bridge group) and as a palliative procedure in 11 patients (palliation group).
  
  
  RESULTS
  The mean age of patients was 71.6 years (range 52-86 years). The mean ASA classifications before and after percutaneous cholecystostomy were 3.3 +/- 0.5 and 2.5 +/- 0.6, respectively, in the bridge group, and 3.6 +/- 0.7 and 3.1 +/- 1.0, in the palliation group, respectively. Percutaneous cholecystostomy was technically successful in all patients. There were two deaths after percutaneous cholecystostomy in the palliation group due to underlying ischemic heart disease and multiple organ failure. Resumption of oral intake was possible 2.9 +/- 1.8 days in the bridge group and 3.9 +/- 3.5 days in the palliation group after percutaneous cholecystostomy. We attempted 17 laparoscopic cholecystectomies and experienced one failure due to bile duct injury (success rate: 94.1%). The postoperative course of all cholecystectomy patients was uneventful.
  
  
  CONCLUSIONS
  Percutaneous cholecystostomy is an effective bridge procedure before cholecystectomy in patients with acute cholecystitis and ASA classification 3 or greater.
authors.affiliation: Department of Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Sung Su
authors.initials: SS
authors.lastname: Yun
authors.forename: Dae Wook
authors.initials: DW
authors.lastname: Hwang
authors.forename: Se Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Sang Hwan
authors.initials: SH
authors.lastname: Park
authors.forename: Sang Jin
authors.initials: SJ
authors.lastname: Park
authors.forename: Dong Shick
authors.initials: DS
authors.lastname: Lee
authors.forename: Hong Jin
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery*; D002767:Cholecystostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D012955:Societies, Medical