title: Tube cholecystostomy before cholecystectomy for the treatment of acute cholecystitis.
abstract: OBJECTIVE
  Percutaneous cholecystostomy is currently indicated for patients with cholecystitis who might be poor candidates for operative cholecystectomy. We performed a study to evaluate the long-term outcome of patients undergoing emergent tube cholecystostomy.
  
  
  METHODS
  This study was a retrospective chart review of patients who underwent tube cholecystostomy from July 1, 2005, to July 1, 2012.
  
  
  RESULTS
  During the study period, 82 patients underwent 125 cholecystostomy tube placements. Four patients (5%) died during the year after tube placement. The mean hospital length of stay for survivors was 8.8 days (range, 1-59 days). Twenty-eight patients (34%) required at least 1 additional percutaneous procedure (range, 1-6) for gallbladder drainage. Twenty-nine patients (34%) ultimately underwent cholecystectomy. Surgery was performed a mean of 7 weeks after cholecystostomy tube placement. Laparoscopic cholecystectomy was attempted in 25 operative patients but required conversion to an open approach in 8 cases (32%). In another 4 cases, planned open cholecystectomy was performed. Major postoperative complications were limited to 2 patients with postoperative common bile duct obstruction requiring endoscopic retrograde cholangiopancreatography, 1 patient requiring a return to the operating room for hemoperitoneum, and 2 patients with bile leak from the cystic duct stump.
  
  
  CONCLUSIONS
  In high-risk patients receiving cholecystostomy tubes for acute cholecystitis, only about one third will undergo surgical cholecystectomy. Laparoscopic cholecystectomy performed in this circumstance has a higher rate of conversion to open surgery and higher hepatobiliary morbidity rate.
authors.affiliation: Department of Surgery, Mount Sinai Beth Israel Medical Center, NY, New York, USA.
authors.forename: Kei
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Surgery, Mount Sinai Beth Israel Medical Center, NY, New York, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Bower
authors.affiliation: Department of Surgery, Mount Sinai Beth Israel Medical Center, NY, New York, USA.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Cassaro
authors.affiliation: Departments of Interventional Radiology, Mount Sinai Beth Israel Medical Center, NY, New York, USA.
authors.forename: Rajesh I
authors.initials: RI
authors.lastname: Patel
authors.affiliation: Department of Surgery, Mount Sinai Beth Israel Medical Center, NY, New York, USA.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Karpeh
authors.affiliation: Department of Surgery, Mount Sinai Beth Israel Medical Center, NY, New York, USA.
authors.forename: I Michael
authors.initials: IM
authors.lastname: Leitman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000601:surgery*; D002767:Cholecystostomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Acute cholecystitis; Cholecystectomy; Percutaneous cholecystostomy
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