Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis

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.

Fig. 1

Study flow chart. PTGBD: percutaneous transhepatic gallbladder drainage

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