Percutaneous cholecystostomy for acute cholecystitis in high-risk patients

Aim of the study: The aim of this retrospective study was to report the res ults of percutaneous cholecystostomy in a selected group of high-risk patie nts with contraindications of general anesthesia. Patients and methods: From October 1995 to December 1999, a percutaneous ch olecystostomy was performed in 29 patients with acute cholecystitis, There were 20 women and nine men with a mean age of 80.6 years (range: 59 to 95 y ears). All the patients were ASA III (N = 23) or ASA IV (N = 6). Ultrasound -guided percutaneous cholecystostomy was performed in 24 cases and computed tomography-guided cholecystostomy in five cases. Results: Percutaneous cholecystostomy was easily performed in 28 cases; the re was one failed procedure. The drainage was not efficient in three patien ts who were operated on with one postoperative death of a patient who had a necrotic cholecystitis. There was no mortality in relation with cholecysto stomy. One patient died at day 15 from myocardic infarction. The morbidity rate was 3.4% (one case). Postoperative length of hospital stay was 13 days (range: 7-30 days). The duration of the entire procedure ranged from 9 to 60 days (mean: 20 days). The mean follow-up of patients was 17 months (rang e: 4-40 months). One patient had recurrent acute cholecystitis and another one had angiocholitis; two patients underwent delayed elective laparoscopic cholecystectomy; 20 patients remained asymptomatic and 16 were still alive at the time of this study (13 with biliary stones and three without). Conclusion: Percutaneous cholecystostomy is a Valuable alternative procedur e for high-risk patients with acute cholecystitis. It's a safe and usually effective procedure without mortality and with a low morbidity. Whenever po ssible, percutaneous cholecystostomy should be followed by laparoscopic cho lecystectomy. (C) 2000 Editions scientifiques et medicales Elsevier SAS.