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1999 Abstract: 2068 INTERVAL CHOLECYSTECTOMY FOLLOWING PERCUTANEOUS CHOLECYSTOSTOMY FOR ACUTE CHOLECYSTITIS

Abstracts
1999 Digestive Disease Week

# 2068 INTERVAL CHOLECYSTECTOMY FOLLOWING PERCUTANEOUS CHOLECYSTOSTOMY FOR ACUTE CHOLECYSTITIS
S Lorenzo-Rivero, R A Underwood, J S Wu, M E Bowdish, S Philip, B Littenberg, D D Picus, N J Soper, Washington Univ Sch of Medicine, St Louis, MO

Acute cholecystitis (AC) is one of the most common diagnoses requiring surgical intervention, especially in the geriatric population in whom associated comorbidities often make them poor operative candidates. Percutaneous cholecystostomy (PC) has commonly been used as a temporizing measure for initial treatment of AC in poor surgical candidates. The purpose of this study was to retrospectively review our experience with interval cholecystectomy (CCK) following PC which was initially placed for temporizing treatment of AC in acutely ill patients deemed unfit for immediate surgical therapy. Data from a retrospective review of 120 patients undergoing PC treatment of AC over a 7 year period were combined with data from patient follow-up questionnaires. Totals, means, and ranges were calculated and Kruskal-Wallis nonparametric analysis was performed. Only 93/120 (78%) patients (mean age 67years; range 24-93 years) survived the initial hospitalization and 12 (10%) were lost to follow-up. 41/93 (44%) received interval CCK (laparoscopic or open) and 40/93 (43%) did not undergo further surgical treatment. The distribution of the surgical group was: 15/41 (37.5%) laparoscopic CCK, 6/41 (15%) converted laparoscopic CCK, and 19/41 (47.5%) open CCK. The average interval between PC and interval CCK was 85 days (laparoscopic CCK=112 days, converted laparoscopic CCK=175 days, open CCK=33 days (p=0.007)). No complications occurred in the laparoscopic CCK group and only 2 complications occurred in the open CCK group (complication rate 11%). There were no deaths in either operative group. The conversion rate from laparoscopic CCK to open CCK was 29%. Approximately half of the patients who received PC for AC received a subsequent CCK at a mean interval of 85 days with minimal morbidity and no mortality. Differences in interval to operation between surgical groups are statistically significant and may represent recognition of different clinical subgroups within this patient population. The conversion rate of 29% was comparable to that of similar studies conducted in elderly patients with multiple comorbidities undergoing CCK for AC. Based on this retrospective single institution review, interval CCK following PC for treatment of AC appears to represent a reasonable treatment modality for patients initially at high risk for surgical management of AC.

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