Cholecystostomy in the high risk patient with biliary tract disease

The morbidity of complications and mortality following surgical operations for nonmalignant disease of the biliary tract is greatest among those 65 years and older. The reported overall mortality regardless of age ranges upward from 0.88%. At The New York Hospital-Cornell Medical Center for a 43-year period (1932-1975) it was 1.77%. For those 65 and older it was 5.1%. For patients with acute cholecystitis it was 3.5% and of those in this category 65 and older it was 9.2%. This experience and that reported from other comparable clinics is the basis for advocating that the procedure selected be within the capacity of the patient to tolerate it. Specifically a cholecystostomy, a compromise procedure, may be lifesaving for the presenting situation deferring cholecystectomy until later. Admittedly the more effectual approach is undelayed definite surgery when calculous disease is demonstrated.