OPERATIVE TUBE VERSUS PERCUTANEOUS CHOLECYSTOSTOMY FOR ACUTE CHOLECYSTITIS

The records of 26 patients who underwent cholecystostomy procedures fo r presumed acute cholecystitis during a 6-year period were reviewed. N ine patients had operative tube cholecystostomy (OC), and 17 patients had radiologic percutaneous cholecystostomy (PC). A correct diagnosis of acute cholecystitis was made in 22 of 26 patients (84%), including 14 of 17 PC patients and 8 of 9 in the OC group. The rate of resolutio n of cholecystitis was the same in each group (75% OC versus 78% K). A PACHE II scores prior to treatment were significantly higher in OC pat ients (20.9 OC versus 12.4 PC, p <0.01). There were 5 deaths, includin g 3 in the OC groups and 2 in the K group. Nonfatal complications were more frequent in the K group. Two of the 14 correctly diagnosed K pat ients (14%) subsequently required emergency cholecystectomy for persis tent biliary sepsis, and 6 patients (43%) required at least 1 tube exc hange for occlusion or dislodgement. Overall, only 5 of the 14 patient s (36%) in the K group were successfully treated without complications compared with 5 of 8 patients (63%) in the OC group. Despite its theo retical advantages, K was no more effective than OC in the treatment o f acute cholecystitis. These data suggest that OC remains a viable tre atment option in critically ill patients with acute cholecystitis.