Better Treatment Strategies for Patients with Acute Cholecystitis and American Society of Anesthesiologists Classification 3 or Greater

Title
Better Treatment Strategies for Patients with Acute Cholecystitis and American Society of Anesthesiologists Classification 3 or Greater
Author(s)
윤성수황대욱[황대욱]김세원박상환[박상환]이동식박상진김홍진
Keywords
HIGH-RISK PATIENTS; PERCUTANEOUS TRANSHEPATIC CHOLECYSTOSTOMY; DELAYED LAPAROSCOPIC CHOLECYSTECTOMY; GALLBLADDER DRAINAGE; MANAGEMENT
Issue Date
201007
Publisher
YONSEI UNIV COLLEGE MEDICINE
Citation
YONSEI MEDICAL JOURNAL, v.51, no.4, pp.540 - 545
Abstract
Purpose: Laparoscopic cholecystectomy is the best treatment choice for acute cholecystitis. However, it still carries high conversion and mortality rates. The purpose of this study was to find out better treatment strategies for high surgical risk patients with acute cholecystitis. Materials and Methods: Between January 2002 and June 2008, we performed percutaneous cholecystostomy instead of emergency cholecystectomy in 44 patients with acute cholecystitis and American Society of Anesthesiologists (ASA) classification 3 or greater. This was performed in 31 patients as a bridge procedure before elective cholecystectomy (bridge group) and as a palliative procedure in 11 patients (palliation group). Results: The mean age of patients was 71.6 years (range 52-86 years). The mean ASA classifications before and after percutaneous cholecystostomy were 3.3 +/- 0.5 and 2.5 +/- 0.6, respectively, in the bridge group, and 3.6 +/- 0.7 and 3.1 +/- 1.0, in the palliation group, respectively. Percutaneous cholecystostomy was technically successful in all patients. There were two deaths after percutaneous cholecystostomy in the palliation group due to underlying ischemic heart disease and multiple organ failure. Resumption of oral intake was possible 2.9 +/- 1.8 days in the bridge group and 3.9 +/- 3.5 days in the palliation group after percutaneous cholecystostomy. We attempted 17 laparoscopic cholecystectomies and experienced one failure due to bile duct injury (success rate: 94.1%). The postoperative course of all cholecystectomy patients was uneventful. Conclusion: Percutaneous cholecystostomy is an effective bridge procedure before cholecystectomy in patients with acute cholecystitis and ASA classification 3 or greater.
URI
http://hdl.handle.net/YU.REPOSITORY/22186http://dx.doi.org/10.3349/ymj.2010.51.4.540
ISSN
0513-5796
Appears in Collections:
의과대학 > 성형외과학교실 > Articles
의과대학 > 마취통증의학교실 > Articles
Files in This Item:
There are no files associated with this item.
Export
RIS (EndNote)
XLS (Excel)
XML


qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

BROWSE