title: Two staged minimally invasive treatment for acute cholecystitis in high risk patients.
abstract: OBJECTIVE
  The most optimal treatment for acute cholecystitis in high risk patients and severe acute cholecystitis remains still controversial. We review the outcomes of a two step treatment with percutaneous cholecystostomy and delayed laparoscopic cholecystectomy (DLC).
  
  
  METHODS
  We collected data prospectively from January 2004 to April 2010 from 26 patients that underwent percutaneous transhepatic CT-guided cholecystostomy and DLC.
  
  
  RESULTS
  Percutaneous transhepatic CT-guided cholecystostomy was achieved in all cases with no complications. There was just one catheter dislodgement. Most of patients, 92%, improved after drainage. There was one case of mortality. Laparoscopic cholecystectomy was achieved in 88% of patients with no mortality, and a low rate of morbidity (7.6%) and of conversion to open surgery. Pre-operative percutaneous cholangiogram showed additional and useful information in 55.5% of patients.
  
  
  CONCLUSIONS
  Two-step minimally invasive treatment combining percutaneous transhepatic CT-guided cholecystostomy and DLC is safe and feasible and report low morbi-mortality rates.
authors: Unite des Maladies de l'Appareil Digestif et Endocrine (UMADE),Centre Hospitalier de Luxembourg.
authors: Antonio
authors: A
authors: Vázquez Tarragón
authors: Juan Santiago
authors: JS
authors: Azagra Soria
authors: Vincent
authors: V
authors: Lens
authors: Daniel
authors: D
authors: Manzoni
authors: Paolo
authors: P
authors: Fabiano
authors: Martine
authors: M
authors: Goergen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000401:mortality; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008189:Luxembourg / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome