Effect of Percutaneous Cholecystostomy on Laparoscopic Cholecystectomy

Kim, Ju Sik; Cho, Byung Sun; Kang, Yoon Jung; Park, Joo Seung

Abstract

PURPOSES: A laparoscopic cholecystectomy has many clinical advantages and is now recognize as the choice of treatment for gallstones. However a laparoscopic cholecystectomy is often not feasible or is converted to the conventional open method in patients with acute cholecystitis because of inflammation around the gallbladder, surrounding adhesion, unclear anatomy, or intraoperative complications, such as excessive bleeding, bile duct and other organ injury, or other technical problems. Recent studies recommended that acute cholecystitis patients or gallbladder empyema patients with pain undergo a cholecystostomy first and a laparoscopic cholecystectomy later because a cholecystostomy can be very helpful for improving the patient's state: for example, gallbladder decompression, early control of acute inflammation, and alleviating gallbladder adhesion alleviation.
METHODS
This study was carried out on 62 patients (Group I) who underwent a laparoscopic cholecystectomy after a percutaneous cholecystostomy at EulJi Medical College between January 1996 and March 2000. These cases were compared with a control group of 41 patients (Group II) who showed similar symptoms, ultrasonographic findings, operative findings, and pathologic results before January 1996 when a cholecystostomy was not yet used at this hospital.
RESULTS
Among Group I, a successful laparoscopic cholecystectomy was possible in 40 patients (64.5%), the other 22 patients were converted to open cholecystectomy. In Group II, only 15 patients (36.6%) out of 41 underwent a successful laparoscopic cholecystectomy. This difference was statistically significant (p=0.005). In other words, the open conversion rates were 35.5% in Group I and 63.4% in Group II. There were no differences in the age and the sexdistributions, the symptom duration, Alk-phosphatase, total bilirubin, and leucocytosis. The degree of inflammation didn't have a singificant influence. Neither did the gallbladder wall thickness.
CONCLUSION
We think that a laparoscopic cholecystectomy perfomed some time after a percutaneous cholecystostomy to improve the patient's condition by eliminating acute inflammation or decompressing the gallbladder may be recommended for management of acute cholecystitis patients with severe clinical symptoms and ultrasonographic findings of marked gallbladder dilatation or pericholecystic fluid collection.