Ulus Travma Acil Cerrahi Derg. 2020; 26(2): 186-190 | DOI: 10.14744/tjtes.2020.73557

Perkütan kolesistostomi yönetimi zor olan tüm olgularda yapýlmalý mýdýr?

Erdem Barýþ Cartý¹, Koray Kutlutürk^2
1Adnan Menderes Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Aydýn
²Ýnönü Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Malatya

AMAÇ: Kolesistektomi, cerrahiye uygun olan kolesistit hastalarýnda kabul görmüþ bir tedavi yöntemidir. Perkütan kolesistostomi ise cerrahi açýdan yüksek riskli akut semptomlu kolesistit hastalarýnda geçici bir tedavi yöntemi olmakla beraber elektif kolesistektomi için hastaya zaman kazandýrabilir.
GEREÇ VE YÖNTEM: Bu çalýþmada ultrason eþliðinde perkütan transhepatik kolesistostomi yapýlmýþ ve dört–altý hafta sonra interval kolesistektomi uygulanmýþ olan 50 olgu sunuldu. Tüm hastalarda bilgisayarlý tomografide safra kesesi duvar bütünlüðünde bozulma veya Tokyo Guidelines 13 tanýsal kriterlerine göre grade II akut kolesistit bulgusu saptanmýþ olup beþ günlük týbbi tedaviye yanýt alýnamayan hastalara kolesistostomi iþlemi yapýlmasýna karar verildi.
BULGULAR: Kolesistostomi her ne kadar akut kolesistit tablosunun yatýþmasýnda etkili bir yöntem olsa da kolesistostomili olgularda dens fibrozis geliþimi nedeni ile yapýlacak olan interval kolesistektominin daha komplike bir hal aldýðý ve olgunun laparoskopik bitirilmesini zorlaþtýrdýðý görülmüþtür.
TARTIÞMA: Kolesistostomi iyileþme süreci içerisinde dens fibrozis geliþimine neden olarak laparoskopik kolesistektomiyi daha komplike hale getirmektedir. Dolayýsýyla kolesistostomi yapýlacak olgular bu bilgi de göz önünde bulundurularak daha dikkatle seçilmelidir.

Anahtar Kelimeler: Açýk kolesistektomi, akut kolesisti; laparoskopik kolesistektomi; perkütan kolesistostomi.

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Should percutaneous cholecystostomy be used in all cases difficult to manage?

Erdem Barýþ Cartý¹, Koray Kutlutürk^2
1Department of General Surgery, Adnan Menderes University Faculty of Medicine, Aydýn-Turkey
²Department of General Surgery, Ýnönü University Faculty of Medicine, Malatya-Turkey

BACKGROUND: Cholecystectomy is the well-accepted management method for acute cholecystitis in patients suitable for surgery. Percutaneous cholecystostomy is planned and used in patients at high surgical risk due to acute symptomatic cholecystitis and/or acute or chronic comorbidity. Percutaneous cholecystostomy can provide permanent treatment, or it may act as a bridge for elective cholecystectomy.
METHODS: We presented the outcomes of 50 patients who initially underwent ultrasound-guided transhepatic percutaneous cholecystostomy and 4–6 weeks later, an interval cholecystectomy. All patients had either impaired gallbladder wall integrity on contrast-enhanced abdominal computed tomography performed during admission or had grade II acute cholecystitis according to the Tokyo Guidelines 13 diagnostic criteria and severity grading of acute cholecystitis or exhibited clinical signs of acute cholecystitis on the fifth day of non-operative treatment.
RESULTS: Our results suggest that although percutaneous cholecystostomy is a useful method for alleviation of the emergency clinical condition in acute cholecystitis, it makes the interval cholecystectomy more difficult to perform due to the dense fibrosis developing during the healing process, eventually complicating laparoscopic cholecystectomy.
CONCLUSION: Cholecystostomy may cause fibrosis during the healing process, eventually complicating laparoscopic cholecystectomy. Thus, there is a need for better evaluation during the identification of indications for cholecystostomy.

Keywords: Acute cholecystitis, laparoscopic cholecystectomy, open cholecystectomy; percutaneous cholecystostomy.

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