title: Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis.
abstract: BACKGROUND
  In low-risk patients with acute cholecystitis who did not respond to nonoperative treatment, we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cholecystostomy followed by delayed cholecystectomy.
  
  
  METHODS
  In 91 patients (American Society of Anesthesiologists class I or II) who had symptoms of acute cholecystitis ≥72 hours at hospital admission and who did not respond to nonoperative treatment (48 hours), 48 patients were treated with emergency laparoscopic cholecystectomy and 43 patients were treated with delayed cholecystectomy at ≥4 weeks after insertion of a percutaneous transhepatic cholecystostomy catheter. After initial treatment, the patients were followed up for 23 months on average (range 7-29).
  
  
  RESULTS
  Compared with the patients who had emergency laparoscopic cholecystectomy, the patients who were treated with percutaneous transhepatic cholecystostomy and delayed cholecystectomy had a lower frequency of conversion to open surgery [19 (40%) vs 8 (19%); P=0.029], a frequency of intraoperative bleeding ≥100 mL [16 (33%) vs 4 (9%); P=0.006], a mean postoperative hospital stay (5.3+/-3.3 vs 3.0+/-2.4 days; P=0.001), and a frequency of complications [17 (35%) vs 4 (9%); P=0.003].
  
  
  CONCLUSIONS
  In patients with acute cholecystitis who presented to the hospital ≥72 hours after symptom onset and did not respond to nonoperative treatment for 48 hours, percutaneous transhepatic cholecystostomy with delayed laparoscopic cholecystectomy produced better outcomes and fewer complications than emergency laparoscopic cholecystectomy.
authors.affiliation: Department of General Surgery, Baskent University School of Medicine, Ankara, Turkey. fezaykar@yahoo.com.
authors.forename: Feza Y
authors.initials: FY
authors.lastname: Karakayali
authors.forename: Aydincan
authors.initials: A
authors.lastname: Akdur
authors.forename: Mahir
authors.initials: M
authors.lastname: Kirnap
authors.forename: Ali
authors.initials: A
authors.lastname: Harman
authors.forename: Yahya
authors.initials: Y
authors.lastname: Ekici
authors.forename: Gokhan
authors.initials: G
authors.lastname: Moray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D057785:Catheters; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000601:surgery*; D002767:Cholecystostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D061887:Conversion to Open Surgery; D004630:Emergencies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome