Is Surgical Cholecystectomy Better than Percutaneous in Treatment of Acute Cholecystitis in Patients Unfit for Surgery?

摘要

Dear Editor, We read with great interest the original article by Gunay et al. about the evaluation of the results of surgical cholecys-tectomy versus percutaneous cholecystostomy for acute cholecystitis in chronic hemodialysis patients. In their retrospective study, they evaluated the results of 47 patients with end-stage renal disease who had undergone surgical cholecystectomy (26 patients) or percutaneous cholecystostomy (21 patients) for acute cholecystitis as an initial treatment. They have concluded that the safety and effectiveness of surgical cholecystectomy had a higher success rate and lower morbidity and mortality rate compared with percutaneous cholecystostomy for acute cholecystitis in chronic hemodialysis patients. However, there are several important points that need to be addressed. In subsection "Treatment", authors specified: "If there was no clinical and laboratory improvement, patients who were considered unfit for surgery underwent percutaneous cholecystostomy. Patients who had gangrenous or perforated gallbladders and had no response to conservative treatment but were considered fit for surgery underwent urgent cholecystectomy". We consider that authors conclusion that the safety and effectiveness of surgical cholecystectomy had a higher success rate and lower morbidity and mortality rate compared with percutaneous cholecystostomy for acute cholecystitis in chronic hemodialysis patients, is questionable because they compared patients "unfit for surgery" versus "fit for surgery".