Clinical Benefits of Preoperative Percutaneous Transhepatic Gallbladder Drainage in Patients Older than Sixty with Acute Cholecystitis

PURPOSE: The purpose of this study was to evaluate the clinical benefits of preoperative percutaneous transhepatic drainage (PTGBD), especially regarding morbidity and mortality, in patients aged 60 or older with acute cholecystitis. METHODS: A retrospective study was done on a series of elderly patients (>60 years old; n=132) who had been diagnosed between January 2007 and December 2009 as having acute cholecystitis. The patients were divided into 4 groups; cases in which only laparoscopic cholecystectomy (LC) was done (Group 1, n=84), cases in which LC was done after preoperative PTGBD (Group 2, n=15), cases in which only open cholecystectomy was done (Group 3, n=23), and cases in which open cholecystectomy was done after preoperative PTGBD (Group 4, n=10). We analyzed between group differences in surgical outcomes including periods of postoperative fast and postoperative hospital stay, OP. morbidity, and open conversion rate. RESULTS: Patients in Group 1 had fewer underlying medical problems and lower ASA scores than patients in groups 2, 3, or 4 (p<0.05). Mean operating time in Group 2 (113.66+/-107.5 min) was significantly longer than in group 1 (72.02.9+/-34.2 min) (p<0.05) and the open conversion rate was higher (8.33% vs 26.67%). But, blood loss (ml) and OP time in Group 2 were lower than in Group 3 or 4 (p<0.001). Postoperative recovery progression (periods of postoperative fasting and length of postoperative hospital stay) of Group 2 were better than in groups 3 or 4 (p<0.001). CONCLUSION: Pre-operative PTGBD procedures in elderly patients with acute cholecystitis is a good clinical option as a pretreatment to a cholecystitis operation.

Application of the Alvarado Score to the Diagnosis of Acute Appendicitis

PURPOSE: The purpose of this study is to confirm the clinical usefulness of the Alvarado score's application and the differences in diagnostic values between male and female for patients who were diagnosed with acute appendicitis when they came to the hospital for pain in the right lower abdomen. METHODS: The subjects of this study were 211 patients who entered the surgical department of this hospital for doubtful acute appendicitis from June 2003 to May 2005. Using a retrospective method, we examined the patients' records and compared their ages, sex, symptoms, preoperative physical examinations, leukocyte and neutrophils figures, and the final postoperative pathological diagnosis. RESULTS: One hundred twelve patients were male, and 99 were female. A clinical Alvarado score of above 7 in sensitivity, specificity, positive predictive value, and negative predictive value was the standard for being judged positive. In this study, the sensitivity of the Alvarado score was 86.2%, its specificity was 61.6%, and the accuracy of diagnosis was 82.9%. The positive predictive value was 92.6%, and the negative predictive value was 51.0%. The accuracies were 83.9% and 81.8%, respectively, that for males being a little higher than that for female, but with no statistically significant differences. CONCLUSIONS: This study showed that the diagnosis of acute appendicitis was highly accurate for an Alvarado score above 7 (82.9%). The diagnosis of acute appendicitis by using the Alvarado score is simple, fast, reliable, and repeatable, and it can be used under any conditions without other expensive and complicated diagnostic tools.