Korean J Hepatobiliary Pancreat Surg.  2011 Feb;15(1):28-34.

Comparison of Clinical Result between Early Laparoscopic Cholecystectomy and Delayed Laparoscopic Cholecystectomy after Percutaneous Transhepatic Gallbladder Drainage (PTGBFD) in more than 70 Years Old Patients with Acute Cholecystitis

• Kim SH
• Jung GO
• Chae KM
• Oh JT
• Park DE

Abstract

PURPOSE
Operative management of acute cholecystitis in aged patients has been shown to have relatively higher morbidity and mortality. The aim of this study was to determine appropriate management protocols for acute cholecystitis in those more than 70 years old.
METHODS
From May 2003 to Dec 2009, we performed this study of patients over 70 years old that were diagnosed with acute cholecystitis (n=257). We excluded patients that had a hepatobilliary malignancy, a previous laparotomy history, secondary cholecystitis, or a high operative risk factor (n=78). Eligible participants were divided into two groups according to the first management of acute cholecystitis. One hundred two of the 179 (group A) had undergone a laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) within 48 hr after arriving at the emergency room; 77 of the 179 (group 2) had PTGBD done as the first management protocol. We divided group 2 into group C (n=47) and D (n=30) according to cholecystectomy or not. We compared clinical outcomes of the two groups.
RESULTS
The mean age of patients was 77.5 years old (102 for Group A and 77 for Group B. Univariant analysis of pre-operative clinical findings between groups A and B showed a significant difference only in age and in type of acute cholecystitis, However, the pre-operative co-morbidity of group B was significantly higher than that for group A. Comparing postoperative results between groups A and C, postoperative complications, open conversion rate, and mortality after cholecystectomy were not significantly different.
CONCLUSION
PTGBD could be considered as appropriate management in aged patients with acute cholecystitis. Moreover, PTGBD can reduce unnecessary cholecytectomies.

Keyword

Acute cholecystitis; Old age patients; Percutaneous transhepatic cholecystostomy; Early laparoscopic cholecystectomy; Delayed laparoscopic cholecystectomy

MeSH Terms

Aged
Cholecystectomy
Cholecystectomy, Laparoscopic
Cholecystitis
Cholecystitis, Acute
Drainage
Emergencies
Gallbladder
Humans
Laparotomy
Postoperative Complications
Risk Factors