Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis

Koetsu Inoue, Tatsuya Ueno, Orie Nishina, Daisuke Douchi, Kentaro Shima, Shinji Goto, Michinaga Takahashi, Chikashi Shibata, Hiroo Naito, Koetsu Inoue, Tatsuya Ueno, Orie Nishina, Daisuke Douchi, Kentaro Shima, Shinji Goto, Michinaga Takahashi, Chikashi Shibata, Hiroo Naito

Abstract

Background: The Tokyo guideline for acute cholecystitis recommended percutaneous transhepatic gallbladder drainage followed by cholecystectomy for severe acute cholecystitis, but the optimal timing for the subsequent cholecystectomy remains controversial.

Methods: Sixty-seven patients who underwent either laparoscopic or open cholecystectomy after percutaneous transhepatic gallbladder drainage for severe acute cholecystitis were enrolled and divided into difficult cholecystectomy (group A) and non-difficult cholecystectomy (group B). Patients who had one of these conditions were placed in group A: 1) conversion from laparoscopic to open cholecystectomy; 2) subtotal cholecystectomy and/or mucoclasis; 3) necrotizing cholecystitis or pericholecystic abscess formation; 4) tight adhesions around the gallbladder neck; and 5) unsuccessfully treated using PTGBD. Preoperative characteristics and postoperative outcomes were analyzed.

Results: The interval between percutaneous transhepatic gallbladder drainage and cholecystectomy in Group B was longer than that in Group A (631 h vs. 325 h; p = 0.031). Postoperative complications occurred more frequently when the interval was less than 216 h compared to when it was more than 216 h (35.7 vs. 7.6%; p = 0.006).

Conclusions: Cholecystectomy for severe acute cholecystitis was technically difficult when performed within 216 h after percutaneous transhepatic gallbladder drainage.

Keywords: Cholecystectomy; Cholecystitis; Percutaneous transhepatic gallbladder drainage.

Figures

Fig. 1
Fig. 1
Study flow chart. PTGBD: percutaneous transhepatic gallbladder drainage
Fig. 2
Fig. 2
ROC curve analysis of the interval between PTGBD and cholecystectomy and the technical difficulty of cholecystectomy. The area under the curve (AUC) is 0.712. The cut-off value for the interval between PTGBD and cholecystectomy was calculated as 216 h

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