Ulus Travma Acil Cerrahi Derg. 2017; 23(6): 501-506 | DOI: 10.5505/tjtes.2017.63668

Akut kolesistitli yaþlý hastalarda erken kolesistektomi için köprü tedavisi: Perkütan kolesistostomi

Sezgin Zeren¹, Zülfü Bayhan¹, Cengiz Koçak², Uður Kesici³, Mehmet Korkmaz⁴, Mehmet Fatih Ekici¹, Mustafa Cem Algýn¹, Faik Yaylak^1
1Dumlupýnar Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Kütahya
²Dumlupýnar Üniversitesi Týp Fakültesi, Patoloji Anabilim Dalý, Kütahya
³Beykent Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ýstanbul
⁴Dumlupýnar Üniversitesi Týp Fakültesi, Radyoloji Anabilim Dalý, Kütahya

AMAÇ: Akut kolesistitin (AC) baþlýca sebebi safra taþlarýdýr. Yaþlý hastalarda safra taþý insidansý artmaktadýr. Bu çalýþmada, akut kolesistitli yaþlý hastalarda erken kolesistektomi öncesi perkütan kolesistostominin (PK) etkinliðinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma konvansiyonel veya laparoskopik kolesistektomiye (LC) giden 85 erken evre akut taþlý kolesistitli hasta içermektedir. Tüm hastalar 65 yaþ üzerindedir.
BULGULAR: Hastalar iki gruba ayrýldý. Grup I; PK+erken kolesistektomi ve Grup II; yalnýzca kolesistektomi. Çalýþmamýzda yaþ, cinsiyet, cerrahi öncesi PK durumu, ameliyat sonrasý komplikasyon, ameliyat sonrasý mortalite, cerrahi yöntem ve ameliyat sonrasý hastanede kalýþ süresi kaydedildi. Ortalama yaþ 75.7±7.5 ve 73.7±7.2 idi. Ýki grup arasýnda anlamlý fark yoktu (p=0.041). Ameliyat sonrasý komplikasyon oraný PK uygulanmayan grupta iki kat iken, PK ile kolesistektomi yapýlan grupta az komplikasyon mevcuttu (p=0.032). Ameliyat sonrasý mortalite bariz þekilde PK sonrasý kolesistektomi uygulanan hastalarda düþüktü (p=0.017). Ortalama hastane yatýþ süresi grup I’de 5.6±2.4 gün ve Grup 2’de 11.2±7.7 gündü (p<0.001).
TARTIÞMA: Akut taþlý kolesistitte acil laparoskopik kolesistektomi hala en iyi cerrahi yöntemdir. Ayrýca çalýþmamýza göre, geriatrik hastalarda perkütan kolesistostomi geçiþ tedavisi ameliyat sonrasý komplikasyon oranlarýný azaltmada faydalý olabilir.

Anahtar Kelimeler: Akut kolesistit, erken cerrahi, geriatrik, hastanede kalýþ, kolesistektomi, perkütan kolesistostomi.

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Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis: Percutaneous cholecystostomy

Sezgin Zeren¹, Zülfü Bayhan¹, Cengiz Koçak², Uður Kesici³, Mehmet Korkmaz⁴, Mehmet Fatih Ekici¹, Mustafa Cem Algýn¹, Faik Yaylak^1
1Department of General Surgery, Dumlupýnar University Faculty of Medicine, Kütahya-Turkey
²Department of Pathology, Dumlupýnar University Faculty of Medicine, Kütahya-Turkey
³Department of General Surgery, Beykent University Faculty of Medicine, Ýstanbul-Turkey
⁴Department of Radiology, Dumlupýnar University Faculty of Medicine, Kütahya-Turkey

BACKGROUND: The main cause of acute cholecystitis (AC) is gallstones, and the incidence of gallstones in elderly patients is high.
METHODS: In this study, we aimed to investigate the efficacy of percutaneous cholecystostomy (PC) before early cholecystectomy in geriatric patients with AC. This retrospective study included 85 patients undergoing laparoscopic or conventional cholecystectomy during early stage of calculous AC.
RESULTS: All patients were over 65 years old and were divided into two groups: Group I, PC plus early cholecystectomy and Group II, only cholecystectomy without PC. Data on age, sex, status of PC before surgery, postoperative complications, postoperative mortality, surgical method, and postoperative hospitalization duration were recorded in our study. The average age in the groups I and II was 75.7±7.5 and 73.7±7.2 years, respectively, indicating insignificant difference (p=0.223). Although postoperative complication rate was two fold in the non-PC group, the PC plus cholecystectomy group has a few complications (p=0.032). Postoperative mortality was evidently lower in patients who first underwent PC and followed by cholecystectomy (p=0.017). The average hospitalization duration in groups I and II were 5.6±2.4 days and 11.2±7.7 days, respectively (p<0.001).
CONCLUSION: Urgent laparoscopic cholecystectomy is still the best surgical treatment modality for calculous AC. Further, our study results showed that in geriatric patients, bridge treatment, such as PC, can be useful for reducing postoperative complication rates.

Keywords: Acute cholecystitis, bridge treatment, cholecystectomy, percutaneous cholecystostomy, postoperative complication.

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