In elderly patients emergent cholecystectomy for acute cholecystitis is a high risk procedure. We prospectively assessed the value of percutaneous cholecystostomy for acute cholecystitis in 38 consecutive elderly (≥ 80 years) patients. All 38 underwent percutaneous transhepatic cholecystostomy under ultrasonographic and fluoroscopic guidance for acute cholecystitis (25 calculous, 13 acalculous). Eight (21%) patients had acute severe medical problems, such as shock and respiratory distress. Thirty-one (82%) patients had chronic severe underlying diseases, including cardiovascular and neurologic diseases. Cholecystostomy was successful in all 38 patients. Prompt clinical improvement was obtained in 36 (95%) patients. Morbidity and mortality rates were 3% and 3%, respectively. After cholecystostomy, 10 patients with cholelithiasis underwent elective cholecystectomy without serious complications. Two patients underwent percutaneous cholecystolithotomy, which produced complete resolution of symptoms. Four of 12 patients with and none of 12 without cholelithiasis had recurrent cholecystitis after catheter removal during a mean follow-up of 1.8 years. A second cholecystostomy was successful in these four patients. Elderly patients are often poor surgical candidates because of severe cholecystitis or concomitant medical problems. Percutaneous cholecystostomy is a safe, effective treatment for acute cholecystitis even in elderly patients. For calculous cholecystitis, cholecystostomy can be followed by elective surgery, if possible, or by nonsurgical treatment or expectant conservative management in high-risk patients. Cholecystostomy may be a definitive treatment for acalculous cholecystitis.
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Similar content being viewed by others Explore related subjectsDiscover the latest articles and news from researchers in related subjects, suggested using machine learning. Author information Authors and AffiliationsFirst Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181, Japan, Japan
Masanori Sugiyama, Makoto Tokuhara & Yutaka Atomi
Sugiyama, M., Tokuhara, M. & Atomi, Y. Is Percutaneous Cholecystostomy the Optimal Treatment for Acute Cholecystitis in the Very Elderly?. World J Surg 22, 459–463 (1998). https://doi.org/10.1007/s002689900416
Published: 11 March 2016
Issue Date: May 1998
DOI: https://doi.org/10.1007/s002689900416
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