title: Timing of percutaneous cholecystostomy affects conversion rate of delayed laparoscopic cholecystectomy for severe acute cholecystitis.
abstract: BACKGROUND
  Percutaneous cholecystostomy is reserved for very high-operative-risk patients suffering from severe acute cholecystitis, who do not respond to conservative treatment. It is associated with high conversion rate to open surgery, when cholecystectomy is held later on. Our objective was to assess whether early timing of percutaneous cholecystostomy decreases conversion rate of delayed laparoscopic cholecystectomy to open surgery.
  
  
  METHODS
  The study population included 59 patients who underwent percutaneous cholecystostomy for severe cholecystitis and then proceeded to delayed interval laparoscopic cholecystectomy. The study consisted of a retrospective survey of medical files, based on a prospective enrollment of the data. We assessed conversion rate between two groups based on the time period from onset of symptoms and from admission to hospital until performance of cholecystostomy.
  
  
  RESULTS
  Regarding the time from onset of pain to drainage, early cholecystostomy (within 2 days, group I) was associated with 8.3% conversion rate, in contrast to 33.3% in group II (3-6 days from onset of symptoms). Regarding the day of admission to hospital, early drainage revealed 16% conversion rate in contrast to 40.7% in later drainage (p = 0.047, Chi-square test). We found correlation between time interval of symptoms and admission to conversion rate, according to Spearman's correlation coefficient.
  
  
  CONCLUSIONS
  Early percutaneous cholecystostomy does decrease conversion rate of delayed laparoscopic cholecystectomy, possibly by halting the propagation of the inflammatory process and its consequences. When decision regarding the necessity to perform drainage of the severely inflamed gallbladder is established, it is suggested to be done as soon as possible.
authors.affiliation: Department of Surgery, Galilee Medical Center, Nahariya, Israel. amitai@netvision.net.il.|Faculty of Medicine, Bar-Ilan University, Zafed, Israel. amitai@netvision.net.il.
authors.forename: Amitai
authors.initials: A
authors.lastname: Bickel
authors.affiliation: Department of Radiology, Galilee Medical Center, Nahariya, Israel.
authors.forename: Rotem Sivan
authors.initials: RS
authors.lastname: Hoffman
authors.affiliation: Department of Radiology, Galilee Medical Center, Nahariya, Israel.|Faculty of Medicine, Bar-Ilan University, Zafed, Israel.
authors.forename: Norman
authors.initials: N
authors.lastname: Loberant
authors.affiliation: Department of Surgery, Galilee Medical Center, Nahariya, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Weiss
authors.affiliation: Department of Surgery, Galilee Medical Center, Nahariya, Israel.|Faculty of Medicine, Bar-Ilan University, Zafed, Israel.
authors.forename: Arieh
authors.initials: A
authors.lastname: Eitan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cholecystitis; Cholecystostomy; Conversion to open; Laparoscopy