Role of percutaneous cholecystostomy before laparoscopic cholecystectomy in severe acute cholecystitis.

Introduction: The aim of the study was to investigate the role of percutaneous cholecystostomy before laparoscopic cholecystectomy in gangrenous and phlegmonous cholecystitis. Patients and Methods: Medical records of 100 patients submitted to cholecystectomy with a definitive diagnosis of severe acute cholecystitis were reviewed. The surgical outcomes of 40 patients submitted to cholecystostomy (PC + Cholecystectomy Group) prior to cholecystectomy were compared to those of 60 patients submitted directly to cholecystectomy (Cholecystectomy Group). Results: No differences were found in the rate of first intention laparoscopic cholecystectomy, conversion rate of laparoscopy, the duration of cholecystectomy, post-operative complications, in-hospital mortality and post-operative stay. A higher rate of pre-operative adverse events, longer time lapses since admission to cholecystectomy and longer overall post-operative stays were observed in the PC + cholecystectomy group. Significant failure of cholecystostomy in resolving the acute clinical picture was found in cases of gangrenous cholecystitis. Cholecystostomy allowed resolution of acute phase in phlegmonous cholecystitis but no benefits of pre-operative cholecystostomy were observed in these cases. Conclusion: Percutaneous pre-operative cholecystostomy appears to be of limited utility in patients with severe acute cholecystitis candidate for cholecystectomy.