LAPAROSCOPIC CHOLECYSTECTOMY AFTER PERCUTANEOUS CHOLECYSTOSTOMY : ASSESSING FEASIBILITY AND SAFETY.

Abstract

Acute calculous cholecystitis is one of the most common surgical entities seen in practice and laparoscopic cholecystectomy is the gold standard surgical procedure for its treatment. According to the Tokyo guidelines , Grade 3 cases present with organ dysfunction and hence Percutaneous cholecystostomy (PCT) has been recommended as a bridge to surgery to control sepsis when a patient is unt for surgery or has a high ASA grading and the ones who do not respond to antibiotics. Successful laparoscopic cholecystectomy after percutaneous cholecystostomy can be safely carried out without the need for conversion to open surgery with a thorough knowledge of the biliary anatomy, surgical modications such as subtotal cholecystectomy and access to advanced imaging system and procedures such as intravenous indocyanine green and intra-operative ERCP.