Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis

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

doi:10.1186/s12876-017-0631-8

Abstract

BackgroundThe 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.MethodsSixty-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.ResultsThe 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).ConclusionsCholecystectomy for severe acute cholecystitis was technically difficult when performed within 216 h after percutaneous transhepatic gallbladder drainage.

Highlights

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
Ten patients who met one of the conditions below were excluded from this study: 1) hemorrhage associated with liver cirrhosis, 2) relapsed cholecystitis after percutaneous transhepatic gallbladder drainage (PTGBD) tube removal, and 3) need for procedures other than cholecystectomy
Detailed data of patient characteristics used in this study was shown in Additional file 1

Summary

Introduction

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. Acute cholecystitis (AC) is a common disease for which laparoscopic cholecystectomy (LC) has become the standard treatment [1]. Evaluation of the severity of AC is important in determining the appropriate treatment. The Tokyo Guidelines in 2007 was issued as the first international guidelines for the diagnosis and treatment. In the early 1980s, Radder introduced the procedure of PTGBD to immediately improve the symptoms of AC [5]. In some patients who undergo PTGBD and. Acute cholecystitis in a healthy patient with no organ dysfunction. Inflammatory changes in the gallbladder are mild, making cholecystectomy a safe and low-risk procedure

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