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Percutaneous drainage for acute calculous cholecystitis
K Kortram1, T S de Vries Reilingh, M J Wiezer
1Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, Postbus 2500, 3430, EM, Nieuwegein, The Netherlands.
Surgical Endoscopy
|June 4, 2011
Summary
Percutaneous drainage (PC) is a safe and effective treatment for acute calculous cholecystitis in high-risk surgical patients. This procedure offers an alternative when laparoscopic cholecystectomy is too risky due to age or comorbidities.
Area of Science:
- Interventional Radiology
- Hepatobiliary Surgery
- Gastroenterology
Background:
- Acute calculous cholecystitis (ACC) is common, with laparoscopic cholecystectomy (LC) as standard treatment.
- LC for ACC is more complex than elective LC, posing risks for elderly, comorbid patients.
- Percutaneous drainage (PC) offers a potential alternative for high-risk ACC patients.
Purpose of the Study:
- To assess the safety and efficacy of percutaneous drainage (PC) for acute calculous cholecystitis (ACC) in high-risk surgical patients.
Main Methods:
- A retrospective study of 101 ACC patients treated between January 2009 and May 2010.
- 27 high-risk patients underwent PC; data on comorbidity, ASA classification, and procedure details were collected.
- Primary outcomes included morbidity, mortality, and recurrent biliary events; secondary outcomes focused on recovery time and interval LC.
Main Results:
- The study included 27 elderly patients (median age 83) with high comorbidity (24 ASA 3 or 4).
- PC provided symptom relief in 26 patients, with a low procedure-related mortality of 3.7%.
- Median recovery time was 8 days, with 4 patients undergoing interval LC after a median follow-up of 8 weeks.
Conclusions:
- Percutaneous drainage (PC) is a safe and successful option for acute calculous cholecystitis in high-risk patients.
- Further evidence-based guidelines are needed to define optimal indications for PC in ACC treatment.
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