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Percutaneous transhepatic gallbladder drainage followed by elective laparoscopic cholecystectomy in patients with
Susumu Shibasaki1, Norihiko Takahashi, Hirofumi Toi
1Department of Surgery, Hokushinkai Megumino Hospital, Eniwa, Hokkaido, Japan; Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, N15 W7 Kita-ku, Sapporo, Hokkaido, 060-8638, Japan. susumushi48@mist.ocn.ne.jp.
Insights
Percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy is safe for acute cholecystitis patients on antithrombotics. This approach offers an effective treatment strategy without significantly increasing complications.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Patient Safety
Background:
- Standard treatment for acute cholecystitis (AC) in patients on antithrombotic drugs is not well-established.
- Antithrombotic therapy poses challenges for surgical interventions due to bleeding risks.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous transhepatic gallbladder drainage (PTGBD) followed by elective laparoscopic cholecystectomy (LC) in patients with moderate AC receiving antithrombotics.
Main Methods:
- A retrospective study of 75 patients with moderate AC undergoing PTGBD and elective LC.
- Patients were divided into two groups: Group A (on antithrombotics, n=23) and Group B (not on antithrombotics, n=52).
- Clinical outcomes and perioperative complications were analyzed and compared between groups.
Main Results:
- No hemorrhagic events occurred during PTGBD insertion in either group.
- The open conversion rate and PTGBD-associated complications were similar between groups.
- Postoperative complication rates were slightly higher in the antithrombotic group but not statistically significant (21.7% vs. 9.6%, P=0.15).
Conclusions:
- PTGBD followed by elective LC is a potentially effective and safe strategy for managing moderate AC in patients on antithrombotic therapy.
- The procedure does not significantly increase perioperative risks compared to patients not on antithrombotics.
Background:
Standard treatment for acute cholecystitis (AC) in patients receiving antithrombotic drugs has not been established. We evaluated the safety of percutaneous transhepatic gallbladder drainage (PTGBD) followed by elective laparoscopic cholecystectomy (LC) in patients with moderate AC who were receiving antithrombotics.
Methods:
Seventy-five patients received PTGBD from January 2006 to March 2013 followed by elective LC for moderate AC. Patients were divided into Group A, which consisted of patients receiving antithrombotic therapy (n = 23), and Group B, which included the remaining patients (n = 52). We analyzed clinical outcomes and perioperative complications between groups.
Results:
No hemorrhagic events occurred during PTGBD insertion regardless of antithrombotic treatment. The open conversion rate was not significantly different between the two groups. Postoperative complications were found in 10 patients (13.3%). The rate of postoperative complications in Group A was slightly higher than that in Group B, but the difference was not significant (21.7% vs. 9.6%; P = 0.15). Complications associated with PTGBD occurred in six patients (8%). There were no significant differences in the incidence of these complications, operation time, intraoperative blood loss, or length of postoperative hospital stay.
Conclusions:
Percutaneous transhepatic gallbladder drainage followed by elective LC may be an effective therapeutic strategy for moderate AC in patients receiving antithrombotic therapy.
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