Laparoscopic cholecystectomy (LC) is a treatment of choice for patients with acute cholecystitis. However, LC may carry significant morbidity and high conversion rate, particularly in cases of late acute cholecystitis (symptoms lasting longer than 72 hrs). Percutaneous cholecystostomy (PC) and delayed LC might be a good option in this setting.
We performed a retrospective case review of 77 non-high-risk patients who underwent transhepatic PC, using ultrasound guidance for treatment of late acute calculous cholecystitis.
PC was successful in 100% of the cases with no morbidity or major complications. The mean time for clinical improvement was 1.3 (range 1-5) days. The mean duration of drainage after cholecystostomy was 5.7 (range 2-12) days. The mean hospital stay was 8 (range 3-21) days. Recurrent acute cholecystitis occurred in 26% of these patients. Forty two patients underwent elective delayed surgery: 41 underwent LC, 1 of which (2.4%) was converted to open cholecystectomy. Postoperative outcome was uneventful in all surgical cases.
This study confirms that PC is a safe and efficient procedure in treatment of late acute calculous cholecystitis. It enables rapid improvement of acute cholecystitis and maintains the benefits and advantages of LC.