Value of Percutaneous Transhepatic Gallbladder Drainage for Advanced Acute Cholecystitis as a Bridging Procedure: A Single-Center Retrospective Study

Abstract

Background/Objective: Percutaneous transhepatic gallbladder drainage (PTGBD) is commonly used in patients with acute cholecystitis (AC) who are unfit for early laparoscopic cholecystectomy (LC). However, the efficacy, safety and long-term role of PTGBD remain debated. We aimed to evaluate the effectiveness and safety of PTGBD in managing AC, focusing on infection control, procedure-related complications, and need for secondary surgical intervention. Methods: We performed a single-center retrospective study including all patients who underwent PTGBD for AC from January 2018 to December 2023 at a tertiary care hospital. Patients were identified through an institutional database. Relevant clinical, procedural, and outcome data were extracted from electronic medical records. The primary outcome was infection control, defined as clinical and biochemical resolution of AC without the need for additional interventions beyond antibiotic therapy. Secondary outcomes included PTGBD-related complications, 30-day mortality, length of hospital stay, readmission rate, and the rate of subsequent LC. Results: A total of 105 patients were included (mean age 69.9 years; 63.8% male). Infection control was observed in 92.4% of patients following PTGBD. PTGBD-related complications occurred in 36.2%, mainly drain dislodgement and recurrent cholecystitis. Mortality was 4.8%. Delayed LC was performed in 80.9% of patients, with a 10.6% conversion rate and 16.5% postoperative complication rate. Conclusions: PTGBD is effective for infection control in high-risk AC patients unfit for immediate surgery. However, the complication rate and the frequent need for delayed LC underscore the importance of careful patient selection and standardized management strategies.

Keywords: acute cholecystitis; biliary decompression; cholecystectomy; gallbladder drainage; laparoscopic; percutaneous drainage; surgical outcomes.

Figure 1

(A) 8.5 French pigtail catheter (Resolve^®, Boston Scientific). (B) confirmation of the correct position of the drain by contrast injection and imaging.

Figure 2

Initial CT scan in a 73-year-old man, known for ischemic and rhythmic heart disease anticoagulated with Apixaban, with an ASA score = 3, presenting pain for 2 weeks, with a significant inflammatory syndrome (CRP = 251 mg/L).