Prospective evaluation of patients with acute cholecystitis treated with percutaneous cholecystostomy and interval laparoscopic cholecystectomy

Background: Emergency laparoscopic cholecystectomy has been advocated for the treatment of acute cholecystitis; however it can be a difficult task, especially in public hospitals, with relatively high conversion and complication rates. Percutaneous cholecystostomy is a simple and effective procedure allowing patients to recover from the acute event and undergo elective laparoscopic surgery at a later stage. Methods: We prospectively assessed a protocol of initial conservative treatment in patients admitted with acute cholecystitis. Patients who did not respond to medical treatment were treated by percutaneous cholecystostomy. Following discharge the patients were seen in the outpatient clinic and elective laparoscopic cholecystectomy was considered and scheduled as necessary. The details of the operation were collected with emphasis on complications and conversion rate. Results: During a 3-year period, 224 patients who were admitted with acute calculous cholecystitis entered the protocol. Fifty-four patients did not improve under medical treatment and percutaneous cholecystostomy was performed. In spite of adequate drainage, 5 patients still did not improve: 3 patients were successfully operated upon urgently and recovered, while 2 patients who had severe concomitant diseases and multi-organ failure, died. Forty-nine patients were discharged with the catheter and later re-evaluated for elective operation. In 7 patients common bile duct stones were found and were removed by ERCP prior to the elective operation. Twenty-five patients underwent delayed laparoscopic cholecystectomy with a low conversion rate (8%), and only minor complications (16%). Conclusions: Conservative treatment and delayed operation is still an acceptable choice in the treatment of acute cholecystitis. Percutaneous cholecystostomy is an effective tool, with high success rate and low morbidity, and allows for better pre-operative evaluation of the biliary system and safe interval laparoscopic surgery. Laparoscopic cholecystectomy after drainage of the gall bladder is a low morbidity procedure with relatively low conversion rate.