Percutaneous drainage versus emergency cholecystectomy for the treatment of acute XXXX in critically ill @entity1 : does it matter?

@entity1 @entity295 @entity14784 @entity5173 @entity2679 @entity7140 @entity881
BACKGROUND: The aim if this study was to compare @entity5173 ( @entity5173 ) of the gallbladder to emergency cholecystectomy (EC) in a well-defined @entity1 group with @entity295 related to acute calculous/ @entity7140 (ACC/AAC). METHODS: Between 2001 and 2007, all consecutive @entity1 of our ICU treated by either @entity5173 or EC were retrospectively analyzed. Cases were collected from a prospective database. Percutaneous drainage was performed by a transhepatic route and EC by open or laparoscopic approach. @entity1 ' general condition and organ dysfunction were assessed by two validated scoring systems (SAPS II and SOFA, respectively). Morbidity, mortality, and long-term outcome were systematically reviewed and analyzed in both groups. RESULTS: Forty-two @entity1 [median age = 65.5 years (range = 32-94)] were included; 45% underwent EC (ten laparoscopic, nine open) and 55% @entity5173 (n = 23). Both @entity1 groups had similar preoperative characteristics. Percutaneous drainage and EC were successful in 91 and 100% of @entity1 , respectively. @entity881 were similarly improved by the third postoperative/postdrainage days. Despite undergoing @entity5173 , two @entity1 required EC due to @entity2679 . The conversion rate after laparoscopy was 20%. Overall morbidity was 8.7% after @entity5173 and 47% after EC (P = 0.011). Major morbidity was 0% after @entity5173 and 21% after EC (P = 0.034). The mortality rate was not different (13% after @entity5173 and 16% after EC, P = 1.0) and the deaths were all related to the @entity1 ' preexisting disease. Hospital and ICU stays were not different. Recurrent symptoms (17%) occurred only after ACC in the @entity5173 group. CONCLUSIONS: In high-risk @entity1 , @entity5173 and EC are both efficient in the resolution of @entity14784 . However, EC is associated with a higher procedure-related morbidity and the laparoscopic approach is not always possible. Percutaneous drainage represents a valuable intervention, but secondary cholecystectomy is mandatory in cases of acute @entity2679 .
