BACKGROUND:?In?low-risk?patients?with?acute?cholecystitis?who? did? not? respond? to? nonoperative? treatment,? we?prospectively?compared?treatment?with?emergency?laparoscopic?cholecystectomy?or?percutaneous?transhepatic?cholecystostomy?followed?by?delayed?cholecystectomy.
METHODS:?In?91?patients?(American?Society?of?Anesthesiologists?class?I?or?II)?who?had?symptoms?of?acute?cholecystitis?≥72?hours?at?hospital?admission?and?who?did?not?respond?to?nonoperative?treatment?(48?hours),?48?patients?were?treated?with?emergency?laparoscopic? cholecystectomy? and? 43? patients? were? treated?with?delayed?cholecystectomy?at?≥4?weeks?after?insertion?of?a?percutaneous?transhepatic?cholecystostomy?catheter.?After?initial?treatment,?the?patients?were?followed?up?for?23?months?on?average?(range?7-29).
RESULT:?Compared? with? the? patients? who? had? emergency?laparoscopic?cholecystectomy,?the?patients?who?were?treated?with?percutaneous?transhepatic?cholecystostomy?and?delayed?cholecystectomy? had? a? lower? frequency? of? conversion? to?open?surgery?[19?(40%)?vs?8?(19%);?P=0.029],?a?frequency?of?intraoperative?bleeding?≥100?mL?[16?(33%)?vs?4?(9%);?P=0.006],?a?mean?postoperative?hospital?stay?(5.3±3.3?vs?3.0±2.4?days;?P=0.001),?and?a?frequency?of?complications?[17?(35%)?vs?4?(9%);?P=0.003].
CONCLUSION:?In? patients? with? acute? cholecystitis? who?presented?to?the?hospital?≥72?hours?after?symptom?onset?and?did?not?respond?to?nonoperative?treatment?for?48?hours,?percutaneous?transhepatic?cholecystostomy?with?delayed?laparoscopic?chole-cystectomy?produced?better?outcomes?and?fewer?complications?than?emergency?laparoscopic?cholecystectomy.