A laparoscope may be used to gain direct access to the gallbladder through the abdominal wall in the cases of acute cholecystitis, empyema and perforated gallbladder with local abscess. The percutaneous approach is particularly indicated for frail, elderly patients when an open procedure would be associated with too great a risk.
The inflamed site can be accurately punctured, so releasing pus and relieving symptoms. With resolution of the acute event, any precipitant stones can then be removed by the same route.
The mortality in compromised patients in the emergency situation is around 10-14%. This compares with 5% for elective procedures.
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