Abstract
Background
Acute calculous cholecystitis is a common disease presentation in critically ill patients. It is associated with increased mortality and morbidity rates in case of insufficient treatment. However, the best approach to management is still debatable.
Patients and methods
This is a retrospective analysis of prospectively designed study for the evaluation of different management planes in critically ill patients presented with acute cholecystitis in a single university hospital from 2013-2017. The study included all patients with acute cholecystitis as the main reason for patient deterioration and hospital admission and also those patients already admitted in hospital ICU and consulted other departments for symptoms of acute cholecystitis. Preoperative data and operative outcomes were analyzed.
Results
A total of 225 patients (median age68 years; range=57-91 years) were included. Overall, 28.9% (65 patients) underwent percutaneous cholecystostomy drainage (PCD), 34.2% (77 patients) underwent open cholecystectomy (OC), and 36.9% (83 patients) underwent laparoscopic cholecystectomy. The patient's demographics were comparable in all groups, except for age and BMI. Laparoscopic cholecystectomy was successful in 85.5% of patients. Nine patients in PCD group needed completion OC (13.8%). Preoperative comorbidities were similar in the studied groups. The postoperative infection was high in OC group (P=0.013). The overall mortality was 4%, with the highest value in the PCD group, and no significant difference was observed among all groups (0.197). Hospital and ICU stays were increased in the OC group (P=0.001).
Conclusion
Open and laparoscopic approaches are safe in critically ill patients and have comparable results to PCD. The advantage of disease eradication cannot be overlooked. The laparoscopic approach is better in the view of short hospital stay and infection rate.