Invited Critique |

Invited Critique: Effective Use of Percutaneous Cholecystostomy in High-Risk Surgical Patients

David L. Nahrwold, MD
Arch Surg. 1999;134(7):732. doi:10.1001/archsurg.134.7.732.
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Surgeons have sought to reduce the mortality and morbidity of gallstone disease since Bobbs performed the first cholecystostomy in 1867. The highest death rates are in patients with acute cholecystitis who are sick from other diseases or are recovering from major surgical procedures. Percutaneous cholecystostomy is advocated in these patients to avoid the risks of general anesthesia and the trauma of a major procedure. The authors' results are similar to those reported by others; they show that acute cholecystitis in high-risk surgical patients is a devastating problem. Approximately 41% of patients died in the first 2 months, and of those who survived, 3 still have cholecystostomy drains, 2 had cholecystectomy, 1 needs cholecystectomy, 1 required endoscopic retrograde cholangiopancreatography, and 1 has an asymptomatic stone. Only 5 patients, 23% of the entire group, had no biliary problems after percutaneous cholecystostomy. Unlike cholecystectomy, percutaneous cholecystostomy does not cure most patients of biliary tract disease.

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