Cholecystectomy is the definitive treatment for patients with acute cholecystitis. It´s a surgery with scarce mortality (0.8%) in patients with no surgical risk, but this mortality raises to 18% in cases with high surgical risk. There is a therapeutic alternative for this kind of patients with and increasingly utility for the last decades, but still not widespread in all hospital settings: percutaneous cholecystostomy (PC). A useful approach for this technique, and the most published one by majority of autors, is transhepatic approach. Despite this, in...

A total of 228 patients underwent percutaneous cholecystostomy between march 1992 and august 2013. Patients were diagnosed according to anamnesis, exploration, laboratory análisis and imaging: ultrasound and/or computed tomography. Patients candidates for cholecystostomy were those considered to be at high surgical risk and/or poor evolution of their cholecystitis with medical treatment. Mean age was 78 years, ranking from 23 to 99 years (median: 80 years). 130 men (58%), and 98 women (42%). (FIGURE 1). TECHNIQUE Intervention is usually carried out with no sedation nor analgesia,...

203 patients who underwent cholecystostomy had colelithiasis (89%) and the 63 of them (28%) had choledocolithiasis. Just 25 patients presented with alithiasis acute colecistitis (11%). (FIGURE 8). In 26 cases patients, other associated procederes were performed in the same intervention time , these ones were: one biliary stent placement, eleven subhepatic or perihepatic colection or abscess drainages, six perivesicular abscesses drainages, 4 hepatic abscesses drainages, one intraabdominal fluid drainage, two hepatic biopsias and one diagnostic and therapeutic angiography (FIGURE 9). Fundus puncture via transperitoneal was...

Percutaneous cholecystostomy is a usefull treatment in patient with high surgical risk and remains definitive treatment in cases of alithiasic acute cholecystitis, non-gangrenous variant. Transperitoneal via has scarce complications and undoubted technical advantages ovser transhepatic via. Catheter removal can safety be performed three weeks after procedure, when clinical evolution is favorable, cystic duct is permeable and there are no lithiasis at biliary tract.

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