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Cholecystostomy in elderly patients
Cholecystostomy in elderly patients
Cholecystostomy in elderly patients
Cholecystostomy in elderly patients
Cholecystostomy in elderly patients
Cholecystostomy in elderly patients
Cholecystostomy in elderly patients
Cholecystostomy in elderly patients
Cholecystostomy in elderly patients
Cholecystostomy in elderly patients
Cholecystostomy in elderly patients
Cholecystostomy in elderly patients
Cholecystostomy in elderly patients
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Cholecystostomy in elderly patients

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  1. Ultrasonographic percutaneous cholecystostomy as a definitivetreatment for acute cholecystitis in the elderly high risk patients Montserrat Juvany, Mireia Amillo, Núria Rosón*, Xavier Guirao, Miquel Casal, Esther Nve, Josep Maria Badia. Hospital General de Granollers, Barcelona. Spain. *Radiological Department. 24th European Congress on Surgical Infection, 26th May, Leon.
  2. Introduction• LAPAROSCOPIC CHOLECYSTECTOMY is the gold standard treatment of acute cholecystitis (mortality rate=0-0.8%)• However, in the elderly high risk patients the mortality rate of cholecystectomy is 14-30% and even 77% in ASA IV• In the elderly high risk patients, ultrasound guided cholecystostomy (described by Radder, 1980) is likely to be a good option. But, will this patients require a surgical intervention afterwards? 24th European Congress on Surgical Infection, 26th May, Leon.
  3. Objectives• To evaluate in the elderly high risk patients with acute cholecystitis treated by ultrasound guided cholecystostomy: 1. Clinical efficacy of the technique (complications related) 2. Need of surgery after the episode of acute cholecystitis 24th European Congress on Surgical Infection, 26th May, Leon.
  4. Material and methods• Retrospective study from September 2005 until September 2010 (5 years)• Inclusion of all patients with acute cholecystitis treated by ultrasound guided cholecystostomy during this period• Collected data: – age, gender, ASA – duration catheter, calculous cholecystitis – SIRS parameters and blood analysis (diagnosis) – biliary cultures results – antibiothic adequacy• Main variables: – clinical outcome (first 30 days) – surgical requirement (medium follow-up of 16 weeks)• Comparison of patients with good and bad primmary outcomes 24th European Congress on Surgical Infection, 26th May, Leon.
  5. ResultsEpidemiological data n 35 Age (y) 81±10 Gender M (17); F (18) ASA III (15); IV (19); V (1) Duration 15±14 catheter (d) Calculous Yes (31); No (4) cholecystitis 24th European Congress on Surgical Infection, 26th May, Leon.
  6. ResultsBiliary culture results Biliary cultures: Positive (25) Negative (8) Not done (2) Polimicrobial (16) Monomicrobial (9) 24th European Congress on Surgical Infection, 26th May, Leon.
  7. ResultsAdequacy of treatmentPositivity of biliary culture: 25 Antibiothic treatment 21 antibiogram; 4 mixed flora Piperacillin-Tazobactam 23 Carbapenems 6 Carbapenems+glycopeptids 2 Other 4 Adequacy of treatment: 90% (19/21) Reasons for inadequacy: E.coli and enterococcus R to PipTazo 24th European Congress on Surgical Infection, 26th May, Leon.
  8. ResultsClinical outcome n=35 26 9 Good Bad 8 exitus 1 alive (1surg) 2 technique 6 non-technique related related (1 surg) •Clinical efficacy: 74% (26/35)  Major complications related to technique : 5.7% (2/35) 1 gallbladder perforation; 1 bleeding hepatic surface 24th European Congress on Surgical Infection, 26th May, Leon.
  9. ResultsSurgical requirements 26 Good 19 5 no recurrence recurrence 17 alive 2 exitus 3 alive 2 exitus (2 surg) (non-biliary) (3 surg) (2 ab’s) • Surgical requirements : 19 % (5/26)  Recurrence of acute cholecystitis: 19% (5/26) 24th European Congress on Surgical Infection, 26th May, Leon.
  10. ResultsComparison of good and bad primmary outcome Good Bad p (n=26) (n=9) Age (y) 7810 857 0.08 Epidemiologics Vital signs (N.S.) ASA III (14) III (1) 0.07 IV (12) IV (7) V (1) (N.S.) SBP (Hg mm) 12321 11928 Patients with bad outcome N.S. showed a tendency of being Heart rate (BPM) 88.614.9 87.224.5 older and having a more N.S. advanced ASA classification Temperature (ºC) 37.00.7 37.01.2 N.S. 24th European Congress on Surgical Infection, 26th May, Leon.
  11. ResultsComparison of good and bad primmary outcome Good Bad p (n=26) (n=9) WCC (/mL) 163886987 156335811 N.S. Blood analysis C-reactive protein 20789 26898 0.09 (mg/L) (N.S.) Total bilirrubine 1.61.8 5.18.2 0.04* (mg/dL) They showed a tendency of having higher levels of CRP Total bilirrubine was higher (suggesting associated cholangitis as a marker of worst prognosis) 24th European Congress on Surgical Infection, 26th May, Leon.
  12. Conclusions• Ultrasonographic percutaneous cholecystostomy is the technique of choice for acute cholecystitis in the elderly high risk patients (74% of clinical efficacy)• It is a definitive treatment in 81% of the patients with good primary outcome• High levels of total bilirrubine at the moment of diagnosis are associated with bad primmary outcome 24th European Congress on Surgical Infection, 26th May, Leon.
  13. 24th European Congress on Surgical Infection, 26th May, Leon.

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