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KMID : 0978820020050020125
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Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons
2002 Volume.5 No. 2 p.125 ~ p.132
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Percutaneous cholecystostomy in acute cholecystitis followed by interval laparoscopic cholecystectomy
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Abstract
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Purpose : This study is to evaluate the safety and effectiveness of interval laparoscopic cholecystectomy after the percutaneous cholecystostomy.
Methods : Retrospective medical records were reviewed from December 1998 to March 2002. All thirty-eight patients who underwent interval laparoscopic cholecystectomy after the percutaneous cholecystostomy had acute cholecystitis with underlying medical disorders or nonoperatively retrieved diseases. We analyzed clinical responses after the percutaneous cholecystostomy and the predictive factors for conversion to laparotomy, and also compared operative time, length of postoperative hospital stay, morbidity and mortality between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) patients.
Results : The percutaneous cholecystostomy was performed successfully in all patients (38 patients) and clinical conditions were improved in 28 patients (68%) with 48 hours and in 36 patients (95%) within 5 days after the percutaneous cholecystostomy. The conversion from LC to OC was necessary in 28% of the patients. The significant predictors of conversion to OC were non-patient cystic duct on cholangiography (p<0.026), below 100 ml of average drainage/day (p<0.029), above 2 days of cliinical responses after the percutaneous cholecystostomy (p<0.05). Postoperative complications were 3 wound infections (2 OC versus 1 LC) and 2 pulmonary atelectasis (1 OC versus 1 LC).
Conclusion : The interval laparoscopic cholecystectomy after the percutaneous cholecystectomy is a safe and effective treatment modality in selected patients with acute cholecystitis, especially associated with critical illness and underlying medical disorders. Preoprative cholangiography via the cholecystostomy tube may be helpful to clarify the anatomy and minimize the risk of serious bile duct injury at LC, and reduce the conversion to OC.
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