Cholecystectomy vs cholecystostomy in high risk surgical patients

Purpose: Emergency cholecystectomy under general anesthesia has been associated with high morbidity and mortality in critically ill patients. Percutaneus cholecystostomy was advocated as preferred treatment in high surgical risk patients. Hypothesis: Cholecystostomy is preferable treatment of acute cholecystitis in critically ill patients. Methods: Between 1997 and 2003 charts of 153 patients who underwent cholecystectomy or cholecystostomy secondary to acute cholecystitis were reviewed. 37 cholecystectomies and 28 cholecystostomies with ASA class III and IV were selected for study. Demographic data, comorbidities, procedure details, diagnostic data and outcomes were collected. APACHE II score at the day of diagnosis and 3 postoperative date, mortality 1, 3 postpoperative day and same hospital admission mortality was calculated. Comparison was made between cholecystostomy and cholecystectomy groups. Results: High surgical risk patients (ASA III and IV) with ac cholecystitis were divided in 2 groups: cholecystectomy and cholecystostomy.