INTRODUCTION C HOLECYSTOSTOMY HAS FREQUENTLY BEEN CRITICIZED as an inferior operation to cholecystectomy because it is a temporizing procedure that palliates the patient’s symptoms but leaves the patient at risk of developing fur- ther stones, as the gallbladder is left in situ. Despite this, it still has a place in the management of critically ill pa- tients who are unfit for surgery because of comorbidities (ASA status III/IV) or old age. Though percutaneous cholecystostomy has superseded open cholecystostomy in such a setting, the advent of laparoscopy has provided the surgeon with a safe and effective alternative for decom- pressing the gallbladder. We describe our experience of laparoscopic cholecystostomy in two critically ill patients with multiorgan failure and acute fulminant cholecystitis. CASE REPORTS Case 1 A 56-year-old male, with known diabetes, and hyper- tensive with coronary artery disease, was admitted to the JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 17, Number 1, 2007 © Mary Ann Liebert, Inc. DOI: 10.1089/lap.2006.05078 Case Report Laparoscopic Cholecystostomy Is a Safe and Effective Alternative in Critically Ill Patients with Acute Cholecystitis: Two Cases PRADEEP K. CHOWBEY, MS, MNAMS, FIMSA, FAIS, FICS, R. VENKATASUBRAMANIAN, MS, MNAMS, MRCS, NABANITA BAGCHI, MS, DNB, ANIL SHARMA, MS, FRCS, FICS, RAJESH KHULLAR, MS, FICS, VANDANA SONI, MS, and MANISH BAIJAL, DNB, MNAMS ABSTRACT Emergency cholecystectomy for acute cholecystitis in critically ill patients with organ failure and sepsis carries a high risk of morbidity and mortality. Temporizing interventions such as laparo- scopic cholecystostomy can help the patient to recover from the critical illness by deferring the de- finitive procedure to a later, safer period. We describe our experience of laparoscopic cholecys- tostomy performed in two critically ill patients. In the first case, a 56-year-old man with hypertension, diabetes, and ischemic heart disease, was admitted for evaluation of malena. During the course of his stay, he developed acute calculous cholecystitis, acute renal failure, and right pleural effusion. In the second case, a 68-year-old man presented with diabetes, hypertension, diabetic nephropathy, acute chronic renal failure, and acute calculous cholecystitis. Both patients failed to improve with conservative measures and underwent laparoscopic cholecystostomy under local anesthesia and se- dation in view of severe comorbidities and sepsis. Both patients recovered from sepsis. Laparoscopic cholecystectomy was performed uneventfully after six and eight weeks, respectively, and both pa- tients were doing well at one-year follow-up. Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India. 43