title: Percutaneous cholecystostomy in the management of high-risk patients presenting with acute cholecystitis: Timing and outcome at a single institution.
abstract: BACKGROUND
  Cholecystectomy is the standard of care in acute cholecystitis (AC). Percutaneous cholecystostomy (PC) is an effective alternative for high-risk surgical cases.
  
  
  METHODS
  A retrospective analysis is presented of AC patients treated with PC drainage at a single tertiary institution over a 21 month period, assessing outcome and complications.
  
  
  RESULTS
  Of 119 patients, 103 had clinical improvement after PC insertion. There were 7 peri-procedural deaths (5.9%), all in elderly high-risk cases. Overall, 56/103 cases (54%) were definitively managed with PC drainage with 41 patients (40%) undergoing an elective cholecystectomy (75% performed laparoscopically). The timing of PC insertion did not affect AC resolution or drain-related complications, although more patients underwent an elective cholecystectomy if PC placement was delayed (>24 h after admission).
  
  
  CONCLUSIONS
  In AC, drainage by a PC catheter is a safe and effective procedure. It may be used either as a bridge to elective cholecystectomy or in selected cases as definitive therapy.
authors.affiliation: Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel. Electronic address: Shiri.fh@gmail.com.
authors.forename: Shiri
authors.initials: S
authors.lastname: Zarour
authors.affiliation: Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel. Electronic address: ash_imam04@hotmail.com.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Imam
authors.affiliation: Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel. Electronic address: guennadiko@clalit.org.il.
authors.forename: Guennadi
authors.initials: G
authors.lastname: Kouniavsky
authors.affiliation: Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel. Electronic address: guy.lin@clalit.org.il.
authors.forename: Guy
authors.initials: G
authors.lastname: Lin
authors.affiliation: Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel. Electronic address: apzbar1355@yahoo.com.
authors.forename: Andrew
authors.initials: A
authors.lastname: Zbar
authors.affiliation: Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel. Electronic address: eli_m@clalit.org.il.
authors.forename: Eli
authors.initials: E
authors.lastname: Mavor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods; D004322:Drainage; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute cholecystitis; Conversion; Laparoscopic; Percutaneous cholecystostomy