Better treatment strategies for patients with acute cholecystitis and American Society of Anesthesiologists classification 3 or greater.
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.
Yun
Sung Su
SS
Department of Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.
Hwang
Dae Wook
DW
Kim
Se Won
SW
Park
Sang Hwan
SH
Park
Sang Jin
SJ
Lee
Dong Shick
DS
Kim
Hong Jin
HJ
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