Two staged minimally invasive treatment for acute cholecystitis in high risk patients

• Published in: Hepato-gastroenterology Vol. 60; no. 123; p. 466
• Main Authors: Vázquez Tarragón, Antonio, Azagra Soria, Juan Santiago, Lens, Vincent, Manzoni, Daniel, Fabiano, Paolo, Goergen, Martine
• Format: Journal Article
• Language: English
• Published: Greece 01.05.2013
• Subjects: Adult; Aged; Aged, 80 and over; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy - adverse effects; Cholecystectomy - methods; Cholecystectomy - mortality; Cholecystectomy, Laparoscopic - adverse effects; Cholecystectomy, Laparoscopic - mortality; Cholecystitis, Acute - diagnosis; Cholecystitis, Acute - mortality; Cholecystitis, Acute - surgery; Comorbidity; Female; Humans; Luxembourg - epidemiology; Male; Middle Aged; Prospective Studies; Radiography, Interventional; Risk Assessment; Risk Factors; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome; Luxembourg
• ISSN: 0172-6390
• DOI: 10.5754/hge11861

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). We collected data prospectively from January 2004 to April 2010 from 26 patients that underwent percutaneous transhepatic CT-guided cholecystostomy and DLC. 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. Two-step minimally invasive treatment combining percutaneous transhepatic CT-guided cholecystostomy and DLC is safe and feasible and report low morbi-mortality rates.