Optimal timing for performing percutaneous transhepatic gallbladder drainage and subsequent cholecystectomy for better management of acute cholecystitis.

Abstract

We aimed to clarify the appropriate timing for performing percutaneous transhepatic gallbladder drainage (PTGBD) and cholecystectomy, and the effect of PTGBD on surgical difficulty in acute cholecystitis patients. We retrospectively examined 46 patients who underwent laparoscopic cholecystectomy (LC) after PTGBD for acute cholecystitis. We evaluated the duration from acute cholecystitis onset to PTGBD and the appropriate interval from PTGBD to elective LC. Intraoperative blood loss, operating time, rate of conversion to open surgery, and rate of severe adhesion were the objective and subjective measures. Based on the cut-off value calculated using the Youden index, the group with a duration from acute cholecystitis onset to PTGBD of ≤73.5h had a significantly shorter operating time (127.5min vs. 180.0min, P = 0.007), lower rate of severe adhesion (3/20 vs. 14/26, P = 0.007), and lower rate of conversion to open surgery (2/20 vs. 13/26, P = 0.004); moreover, the interval from PTGBD to elective LC did not significantly differ between these groups. The most important predictor of successful LC following PTGBD for acute cholecystitis was a duration from acute cholecystitis onset to PTGBD of ≤73.5h. Hence, PTGBD should be performed immediately in cases where early cholecystectomy is not indicated.