Comments on the Article About the Evaluation of the Results of Percutaneous Cholecystostomy Versus

about the evalu-ation of the results of percutaneous cholecys-tostomy tube (PCT) versus cholecystectomyfor acute cholecystitis (AC) comparing theiroutcomesovertime.Theyhaveconcludedthat“among patients with AC, PCTs were placedin older patients with increased comorbiditiescompared to cholecystectomy. Mortality ratesafter PCT decreased over time.”We congratulate the authors for theirextensiveexperienceintheapplicationofbothmethods and for the good results, especiallywhen using PCT during the second time pe-riod (over the more recent decade). However,we wish to highlight certain issues regardingthe study design and interpretation of the re-sults. In the “Methods” section, authors spec-ified that “patients who underwent operativemanagement of AC immediately before andafter each patient who underwent PCT place-mentservedascontrols,andwerematched2:1with PCT cases (143 patients).” It is not clearwhy the authors compared the patients sub-jected to cholecystectomy versus PTC, basedon the timing of intervention [especially inthe retrospective study design in which theyhad a great series (1559 patients) treated op-eratively, who were candidates for the controlgroup]. In this way, they got 2 very hetero-genic groups of patients for whom the onlything in common was that they had AC (seetheir Table 1) with too many uncontrolledconfounders. It is clear that the PCT group(Table 1) had more severe patients with sev-eral comorbidities and so it is logical to ex-pect a higher number of complications anddeaths in this group, which again is not di-rectly related to the type of treatment but isa consequence of uncontrolled confoundersassociated with their bad general condition.