Role of percutaneous transhepatic gallbladder aspiration in the early management of acute cholecystitis.

Abstract

Early cholecystectomy is currently the gold standard treatment for acute cholecystitis (AC). However, the acceptability and safety of this strategy remain in dispute. The aim of this study was to clarify the role of percutaneous transhepatic gallbladder aspiration (PTGBA) in the early management of AC in a single center. A total of 147 consecutive patients who were treated with PTGBA for AC from 2008 to 2012 were included in the study. The therapeutic outcomes and adverse events were evaluated. A single PTGBA was adequate for 96 (65.3%) patients with AC. Of the remaining 51 patients, 43 (29.3%) showed an improvement after repeated PTGBA and/or percutaneous transhepatic gallbladder drainage (PTGBD), while semi-emergency cholecystectomy was needed in eight patients. Although five patients experienced adverse events (intra-abdominal hemorrhage in two, bile leakage in two and gallbladder hemorrhage in one), no patient died of treatment-related complications. Subsequently, 87 (59.2%) patients underwent cholecystectomy after PTGBA (a single PTGBA in 48 and repeated PTGBA and/or PTGBD in 39 patients). No significant differences were observed in the conversion rate from laparoscopic surgery to open cholecystectomy, operative time or intraoperative hemorrhage volume between the two groups. The present study demonstrated the safety and acceptability of treatment with PTGBA for AC at our center. This elective treatment strategy may be a useful alternative option in the treatment of AC.