Acute gallstone cholecystitis in the elderly

Macrì, Antonio; Scuderi, G; Saladino, Edoardo; Trimarchi, Giuseppe; Terranova, Maria Luisa; Versaci, A; Famulari, Ciro

doi:10.1007/s00464-005-0178-6

Cited by 53 publications

(9 citation statements)

References 32 publications

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“…Symptoms resolved within 3 days in 94% of our patients, comparable to other series [3,5,6,7,8,9,10,11,12]. Laboratory tests also significantly improved during the first 3 days, underlining the clinical improvement.…”

Section: Discussionsupporting

confidence: 74%

Percutaneous Cholecystostomy in Critically Ill Patients with a Cholecystitis: A Safe Option

Koebrugge¹,

Leuken

Ernst³

et al. 2010

Dig Surg

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Background: Cholecystectomy is the standard procedure in patients with acute cholecystitis. However, some patients might not be able to undergo immediate surgery because of severe sepsis or underlying comorbid conditions. Percutaneous cholecystostomy is a minimally invasive radiological procedure under local anesthesia which seems to be an effective alternative to conservative treatment or immediate laparoscopic/open cholecystectomy. Methods: We retrospectively analyzed 35 patients who underwent percutaneous cholecystostomy between 2003 and 2009. Results: Percutaneous cholecystostomy was technically successful in all patients. Symptoms resolved within 3 days in 33/35 patients. Two patients needed an emergency laparotomy. The catheter dislodged in 5 patients and was replaced in 2/5. The 30-day mortality rate was 3/35 (8.7%) due to gallbladder necrosis, myocardial infarction and multiorgan failure. Median length of hospital stay was 17 days and median drainage time was 28 days. 23 patients (66%) underwent open or laparoscopic cholecystectomy after a median interval of 44 days. Conclusion: Percutaneous cholecystostomy is an effective procedure and a good alternative for patients unfit to undergo immediate surgery because of severe sepsis or underlying comorbid conditions, preferably followed by interval cholecystectomy to prevent recurrent cholecystitis.

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Section: Discussionsupporting

confidence: 74%

Percutaneous Cholecystostomy in Critically Ill Patients with a Cholecystitis: A Safe Option

Koebrugge¹,

Leuken

Ernst³

et al. 2010

Dig Surg

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“…On reviewing the literature, we find that these indications seem to be widely accepted and PCS is often used as a bridge to delayed cholecystectomy, with interval laparoscopic or open cholecystectomy being performed in up to 90% or more patients primarily managed by PCS [19,22,23]. The interval, however, varies widely, from recommended laparoscopic cholecystectomy within 5 days [23] to 12 weeks [22].…”

Section: Discussionmentioning

confidence: 98%

Percutaneous cholecystostomy: A bridge to surgery or definite management of acute cholecystitis in high-risk patients?

Leveau

Andersson

Carlgren

et al. 2008

Scandinavian Journal of Gastroenterology

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“…Some authors have argued that the conventional wisdom about taking a gradual approach to the aging patient with acute cholecystitis is wrong. 20 Despite the attendant morbidity and mortality with complicated acute cholecystitis, outcomes were improved by early open cholecystectomy in a British population during the 1980s. 21 We did not attempt to quantitate comorbidities in our series, nor did we analyze men and women separately, though this will be done in a subsequent and much larger regional database analysis.…”

Section: Patient Factorsmentioning

confidence: 99%

Early Laparoscopic Cholecystectomy Is the Preferred Management of Acute Cholecystitis

Casillas¹

2008

Arch Surg

102

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Hypothesis: Early laparoscopic cholecystectomy (LC) results in a shorter length of stay and acceptable conversion and complication rates when compared with antibiotic therapy plus interval LC or percutaneous cholecystostomy in patients admitted to a surgical service because of acute cholecystitis. However, actual practice does not conform to current evidence. Design: Retrospective cohort study. Setting: Urban teaching hospital. Methods: Data were abstracted from the medical records of all patients with acute cholecystitis admitted to the surgical service via the emergency department during 36 months (October 1, 2002, to September 30, 2005). Patients were divided into 5 groups on the basis of treatment received. Length of stay, duration of symptoms, major complications, and conversion rates were analyzed. Results: Of 173 patients with acute cholecystitis, 71 (41%) underwent early LC. Of 102 patients treated with antibiotic therapy alone (59%), 57 were discharged; antibiotic therapy was unsuccessful in 45 patients. Of the patients in whom antibiotic therapy was unsuccessful, 26 underwent late LC and 19 underwent percutaneous cholecystostomy. Interval LC was eventually performed in 55 patients who did not undergo surgery during the index admission. Length of stay was significantly shorter in the early LC group compared with the interval LC group (PϽ.001). Conversion rates were not statistically different for the 3 LC groups (early LC, 5.6%; late LC, 11.5%; and interval LC, 9.1%). The only biliary complication occurred in the interval LC group. Conclusions: Early laparoscopic cholecystectomy resulted in a significantly reduced length of stay, no major complications, and no significant difference in conversion rates when compared with initial antibiotic treatment and interval LC. Despite these advantages, early LC is not the most common treatment for acute cholecystitis in practice.

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Acute gallstone cholecystitis in the elderly

Cited by 53 publications

References 32 publications

Percutaneous Cholecystostomy in Critically Ill Patients with a Cholecystitis: A Safe Option

Percutaneous Cholecystostomy in Critically Ill Patients with a Cholecystitis: A Safe Option

Percutaneous cholecystostomy: A bridge to surgery or definite management of acute cholecystitis in high-risk patients?

Early Laparoscopic Cholecystectomy Is the Preferred Management of Acute Cholecystitis

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