Delayed Cholecystectomy for Acute Cholecystitis in Elderly Patients Treated Primarily with Antibiotics or Percutaneous Drainage of the Gallbladder

J Laparoendosc Adv Surg Tech A. 2018 Sep;28(9):1094-1099. doi: 10.1089/lap.2018.0092. Epub 2018 Apr 30.

Abstract

Background: In high-risk patients with acute cholecystitis, antibiotics with or without percutaneous drainage of the gallbladder followed by delayed cholecystectomy (DC) can be performed. This study aimed to review our current management of elderly patients with acute cholecystitis treated with DC.

Methods: All consecutive patients older than 70 with acute cholecystitis treated primarily with antibiotics with or without percutaneous drainage followed by DC between 2006 and 2015 were retrospectively reviewed.

Results: Overall 105 elderly patients had acute cholecystitis with planned DC. Ninety-three patients had antibiotherapy alone at first. Twenty-eight patients needed percutaneous drainage either in intention to treat (n = 12) or due to failure of antibiotic treatment (n = 16). Nine (32%) versus 11 patients (12%) required an emergency cholecystectomy (EC) due to failure of percutaneous drainage or antibiotic treatment, respectively. Eighteen patients (64%) underwent DC after percutaneous drainage. Postoperative morbidity was 39% (7/18) after DC in the percutaneous drainage group, and 1 patient died. Compared to DC after antibiotherapy (n = 53), elderly patients who underwent DC after percutaneous drainage (n = 18) had longer median hospital stay (10 days versus 3 days, P = .001) and higher postoperative complications (7/18 versus 6/53, P = .015).

Conclusion: In elderly patients with acute cholecystitis, DC can be a good alternative to EC. However, after percutaneous drainage DC is associated with high complication rate and long hospital stay.

Keywords: antibiotherapy; cholecystectomy; cholecystostomy; percutaneous drainage.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Cholecystectomy* / adverse effects
  • Cholecystitis, Acute / drug therapy
  • Cholecystitis, Acute / surgery*
  • Combined Modality Therapy
  • Drainage*
  • Emergencies
  • Female
  • Gallbladder / surgery
  • Humans
  • Length of Stay
  • Male
  • Postoperative Complications / surgery
  • Retrospective Studies
  • Time Factors

Substances

  • Anti-Bacterial Agents