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    • Complicated Acute Cholecystitis; Protocol of Management

    Mokhtar Abd Elrahman Bahbah, MD; Ehab M Oraby, MD.
    Department of General Surgery, Benha University, Benha, Egypt

    Objectives: To evaluate the outcome of management plan for acute cholecystitis (AC) patients according to patients' general condition and disease severity. Patients & Methods: advanced cases of acute cholecystitis (grades II-III) were evaluated for fitness for general anesthesia (GA) according to criteria of American Society of Anesthesiologists and fit patients underwent laparoscopic cholecystectomy (LC), while unfit patients underwent percutaneous cholecystostomy (PC). Results: Eighteen fit patients underwent LC; two patients (11.1%) required open conversion. 13 patients developed PO morbidities, but only two complications were surgery-related. Only one patient died secondary to surgery-related cause (MR of 5.6%). Eight patients underwent PC; 6 patients developed PO morbidities and one patient died during hospital stay due to surgery related cause (MR of 12.5%). Patients had PC or LC showed non-significant difference as regards time till 1st ambulation or oral intake and for ICU stay, but PC patients required significantly longer hospital stay (12.6 vs. 14.6 days). Conclusion: LC is effective definitive therapy if patient was fit for GA. For patients who are unfit for GA, PC is a feasible, safe and effective option with acceptable outcomes. Keywords: Acute cholecystitis, Laparoscopic cholecystectomy, percutaneous cholecystostomy, Mortality rate.

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