Percutaneous transhepatic gallbladder drainage and delayed laparoscopic cholecystectomy for acute cholecystitis in the elderly / 中国微创外科杂志

ABSTRACT

65 years) with acute cholecystitis treated by PTGBD in this hospital between January 2001 and December 2005. All the patients were not symptomatically relieved after conservative therapy and/or had severe accompanying co-morbidities. Results A successful tube insertion was achieved in 29 patients, whereas insertion failure was encountered in 1 patient because the gallbladder was full of stones, in which a bile aspiration was performed. The dislodgement of drainage tube occurred in 2 patients (one patient underwent a re-insertion and the other was symptomatically relieved without insertion). Exacerbation of the condition developed in 1 patient after the treatment, and an open cholecystostomy with abdominal irrigation and drainage was performed. Twenty-seven patients were discharged from hospital with the drainage tube intact. Of them, the drainage tube was removed 3 weeks after PTGBD in 25 patients, was maintained for 8 weeks until surgery in 1 patient, and was dislodged in 1 patient. Twenty-eight patients with calculous cholecystitis underwent a delayed surgery, including LC in 25 patients, stone removal by choledochofiberscope in 2 patients, and open surgery in 1 patient because of accompanying choledocholithiasis and retroperitoneal mass (adrenal tumor). In another 4 patients with choledocholithiasis, an intraoperative choledochofiberscopy during LC was performed in 2 patients, and endoscopic sphincterotomy after LC was conducted in 2. No surgery related deaths or bile duct injuries occurred. Conclusions Combined use of PTGBD and delayed LC in elderly patients with acute cholecystitis is safe and effective.