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

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 MET...

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Autores principales: Yun, Sung Su, Hwang, Dae Wook, Kim, Se Won, Park, Sang Hwan, Park, Sang Jin, Lee, Dong Shick, Kim, Hong Jin
Formato: Texto
Lenguaje:English
Publicado: Yonsei University College of Medicine 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880266/
https://www.ncbi.nlm.nih.gov/pubmed/20499419
http://dx.doi.org/10.3349/ymj.2010.51.4.540
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author Yun, Sung Su
Hwang, Dae Wook
Kim, Se Won
Park, Sang Hwan
Park, Sang Jin
Lee, Dong Shick
Kim, Hong Jin
author_facet Yun, Sung Su
Hwang, Dae Wook
Kim, Se Won
Park, Sang Hwan
Park, Sang Jin
Lee, Dong Shick
Kim, Hong Jin
author_sort Yun, Sung Su
collection PubMed
description 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.
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spelling pubmed-28802662010-07-01 Better Treatment Strategies for Patients with Acute Cholecystitis and American Society of Anesthesiologists Classification 3 or Greater Yun, Sung Su Hwang, Dae Wook Kim, Se Won Park, Sang Hwan Park, Sang Jin Lee, Dong Shick Kim, Hong Jin Yonsei Med J Original Article 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. Yonsei University College of Medicine 2010-07-01 2010-05-24 /pmc/articles/PMC2880266/ /pubmed/20499419 http://dx.doi.org/10.3349/ymj.2010.51.4.540 Text en © Copyright: Yonsei University College of Medicine 2010 http://creativecommons.org/licenses/by-nc/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Yun, Sung Su
Hwang, Dae Wook
Kim, Se Won
Park, Sang Hwan
Park, Sang Jin
Lee, Dong Shick
Kim, Hong Jin
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
title_full Better Treatment Strategies for Patients with Acute Cholecystitis and American Society of Anesthesiologists Classification 3 or Greater
title_fullStr Better Treatment Strategies for Patients with Acute Cholecystitis and American Society of Anesthesiologists Classification 3 or Greater
title_full_unstemmed Better Treatment Strategies for Patients with Acute Cholecystitis and American Society of Anesthesiologists Classification 3 or Greater
title_short Better Treatment Strategies for Patients with Acute Cholecystitis and American Society of Anesthesiologists Classification 3 or Greater
title_sort better treatment strategies for patients with acute cholecystitis and american society of anesthesiologists classification 3 or greater
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880266/
https://www.ncbi.nlm.nih.gov/pubmed/20499419
http://dx.doi.org/10.3349/ymj.2010.51.4.540
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