Premium
CHOLECYSTOSTOMY: A REVIEW OF RECENT EXPERIENCE
Author(s) -
Ghahreman A.,
Mccall J. L.,
Windsor J. A.
Publication year - 1999
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1046/j.1440-1622.1999.01712.x
Subject(s) - medicine , cholecystostomy , cholecystectomy , acute cholecystitis , american society of anesthesiologists , cholecystitis , surgery , general surgery , retrospective cohort study , gallbladder
Background : Operative (OC) and percutaneous cholecystostomy (PC) are rarely undertaken for severe acute cholecystitis in patients in whom cholecystectomy is technically difficult or those with significant comorbidity. Methods : A retrospective review was undertaken of the clinical, radiological and audit records of patients who were treated by cholecystostomy between 1988 and 1997 at Auckland Hospital. Results : During the 10‐year period 19 patients (eight male, 11 female; median age: 70 years, range: 35–90 years) had a cholecystostomy (OC: n = 8; PC: n = 11). The main indication for PC was high anaesthetic risk (10 cases). The main indication for OC was failed cholecystectomy (six cases). The patients undergoing PC tended to have a higher American Society of Anesthesiologists (ASA) grade than patients undergoing OC. The median delay from presentation to cholecystostomy was 3 days. More than half (11/19) were done during the 3 years (1992–94) after the introduction of laparoscopic cholecystectomy. The number of tube‐related complications was significantly higher in PC patients (10/11 vs 3/8; P = 0.04), and the number of systemic complications was higher in the OC patients (4/8 vs 0/11; P = 0.018). The median duration of tube drainage was 17 days (range: 0–82 days) for OC and 24 days (range: 5–93 days) for PC. Four patients had stone extraction at the time of OC, including two who also had a partial cholecystectomy. One OC patient had stone extraction via the cholecystostomy tract. A cholecystectomy was performed in four patients. Conclusion : The data indicate that PC is a safe approach for high‐risk patients. Operative cholecystostomy had a role following failed cholecystectomy. But PC might be safer in these patients if they could be identified pre‐operatively.