Selective use of tube cholecystostomy with interval laparoscopic cholecystectomy in acute cholecystitis

Hypothesis: Tube cholecystostomy followed by interval laparoscopic cholecys tectomy is a safe and efficacious treatment option in critically ill patien ts with acute cholecystitis. Design: Retrospective cohort study within a 4 1/2-year period. Setting: University hospital. Patients: Of 324 patients who underwent laparoscopic cholecystectomy, 65 (2 0%) had acute cholecystitis; 15 of these 65 patients (mean age, 75 years) u nderwent tube cholecystostomy. Intervention: Thirteen patients at high risk for general anesthesia because of underlying medical conditions underwent percutaneous tube cholecystosto my with local anesthesia. Laparoscopic tube cholecystostomy was performed o n 2 patients during attempted laparoscopic cholecystectomy because of sever e inflammation. Interval laparoscopic cholecystectomy was attempted after a n average of 12 weeks. Main Outcome Measures: Technical details and clinical outcome. Results: Prompt clinical response was observed in 13 (87%) of the patients after tube cholecystostomy. Twelve patients (80%) underwent interval cholec ystectomy. Laparoscopic cholecystectomy was attempted in 11 patients and wa s successful in 10 (91%), with 1 conversion to open cholecystectomy. One pa tient had interval open cholecystectomy during definitive operation for eso phageal cancer and another had emergency open cholecystectomy due to tube d islodgment. Two patients (13%) had complications related to tube cholecysto stomy and 2 patients died from sepsis before interval operation. One patien t died from sepsis after combined esophagectomy and cholecystectomy. Postop erative minor complications developed in 2 patients. At a mean follow-up of 16.7 months (range, 0.5-53 months), all patients were free of biliary symp toms. Conclusions: Tube cholecystostomy allowed for resolution of sepsis and dela y of definitive surgery in selected patients, interval laparoscopic cholecy stectomy was safely performed once sepsis and acute infection had resolved in this patient group at high risk for general anesthesia and conversion to open cholecystectomy. Just as catheter drainage of acute infection with in terval appendectomy is accepted in patients with periappendiceal abscess, t ube cholecystostomy with interval laparoscopic cholecystectomy should have a role in the management of selected patients with acute cholecystitis.