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According to Tokyo Guidelines 2007 for the magagemant of acute cholecystitis, early cholecystectomy has been recommended as first option. However percutaneous transhepatic gallbladder drainage (PTGBD) is available for patients with moderate or severe acute cholecystitis. After PTGBD, while most patients undergo cholecystectomy, some patients are treated by drainage alone, especially in very elder or high-risk patients. The indication of cholecystectomy after PTGBD remains unclear.
Materials and Methods:
Medical records of 340 patients who were admitted to our hospital with acute cholecystitis between November 2006 and October 2011 were reviewed.
Results:
Sixty-six patients underwent PTGBD under ultrasonographic guidance. Thirty-two patients underwent cholecystectomy after PTGBD (Group A), and 34 patients were treated by drainage alone (Group B). Because all the patients of Group B suffered from severe medical problems such as cardiovascular disease, neurologic disease, and dementia, they were not considered as indications for surgery under general anesthesia.
All patients were categorized as moderate or severe cholecystitis. Average age of Group A and Group B were 74 and 83. One patient of each group died (3.1% and 2.9%) without discharge from the hospital. Rate of acalculous cholecystitis was 25% and 38%, respectively. Cholecystitis recurred in four patients of Group B (12%) and all of them were calculous. No significant difference was noted in the prognosis of the two groups.
Conclusion:
Though the recurrence rate of Group B was not negligible, total prognosis of each group was not significant. Therefore, PTGBD without cholecystectomy is likely to be acceptable for high-risk patients with acute cholecystitis, and cholecystectomy should be reserved for a salvage procedure after recurrence.