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Treatment of Acute Cholecystitis in Non-Critically Ill Patients at High Surgical Risk

Comparison of Clinical Outcomes After Gallbladder Aspiration and After Percutaneous Cholecystostomy

¹ Department of Radiology, Mail Code 7800, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229.
² Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229.

OBJECTIVE. This study was performed to compare the clinical outcome after gallbladder aspiration with that after percutaneous cholecystostomy in non—critically ill patients with acute cholecystitis who were at high risk from surgery.

MATERIALS AND METHODS. Medical records of 53 consecutive non—critically ill, high-surgical-risk patients admitted with acute cholecystitis between July 1995 and July 1999 were reviewed. Thirty-one had gallbladder aspiration and 22 had percutaneous cholecystostomy. The primary outcome measure of clinical response within 72 hr and the secondary outcome measures of overall positive response rate, complication rate, time to resolution, and rate of recurrence of acute cholecystitis were compared between the two groups.

RESULTS. Gallbladder aspiration and percutaneous cholecystostomy were technically successful in 30 (97%) and 21 (97%) patients, respectively; of these, 23 (77%) and 19 (90%) patients responded clinically within 72 hr (p > 0.2). Complications occurred in three patients (12%) after percutaneous cholecystostomy and in none after gallbladder aspiration (p < 0.05). No significant difference was noted in the other secondary outcome measures of the two groups.

CONCLUSION. We found no significant difference in the clinical outcomes of gallbladder aspiration and percutaneous cholecystostomy in the treatment of acute cholecystitis in high-surgical-risk patients who are not critically ill. However, we found gallbladder aspiration to be significantly safer. Therefore, gallbladder aspiration should be the procedure of choice in high-risk patients with acute cholecystitis who are not critically ill, and percutaneous cholecystectomy should be reserved as a salvage procedure if gallbladder aspiration is technically or clinically unsuccessful.

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