Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis.

Percutaneous transhepatic cholecystostomy is a reliable treatment method used for decompression in patients with high risk for surgery, unresponsive to medical treatment or complicated cholecystitis. In this study, we aimed to compare the clinical results of interval cholecystectomy after percutaneous cholecystectomy and early cholecystectomy in patients with complicated cholecystitis and the cost analysis of both treatment methods. The study was started prospectively in May 2005. 100 cases with complicated cholecystitis were included in our study. The first 50 patients with complicated cholecystitis were included in Group 1, and the next 50 patients in group 2. The study was terminated when 100 patients were completed in January 2009. For both groups, ASA 4/5 patients considered to be surgically high risk, patients with choledocholithiasis and failed ERCP, patients who had previous upper abdominal surgery were excluded from the study. Emergency cholecystectomy was performed in 50 patients (Group 1). Two patients in this group were excluded from the study because they needed common bile duct exploration during surgery. Percutaneous cholecystectomy was placed in 50 patients in Group 2, and 43 of these patients underwent interval cholecystectomy 6-11 weeks later. Early and late clinical results and all treatment expenses of the patients were recorded in both groups. Conversion rate to open cholecystectomy was 54.2% (n: 26) in Group 1, while it was 18.6% (n = 8) in Group 2. A statistically significant difference was found in favor of Group II in terms of conversion to open cholecystectomy between the groups (p = 0.0001). Complications observed in the perioperative period were 60% in Group 1 and 17% in Group 2. When evaluated in terms of complications, there was a statistically significant difference between the two groups (p = 0.0001). While the treatment expenses in Group 1 were approximately 1673 dollars, it was calculated as 2952 dollars in Group 2 (p <0.05). In interval cholecystectomy, the cost of treatment was found to be higher than early cholecystectomy due to reasons such as placement of cholecystostomy catheter, performing control cholangiographies and applying a follow-up program. In complicated cholecystitis cases, interval cholecystectomy after percutaneous cholecystectomy is a safe treatment method, although it has a high cost, and can be preferred in complicated cholecystitis cases.