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Natural Course of Acute Cholecystitis in Patients Treated With Percutaneous Transhepatic Gallbladder Drainage Without

Yu-Liang Hung1, Sio-Wai Chong2, Chi-Tung Cheng3

  • 1School of Traditional Chinese Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Republic of China.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|April 5, 2019
PubMed

Insights

Patients treated for acute cholecystitis (AC) with percutaneous transhepatic gallbladder drainage (PTGBD) without definitive surgery face a high risk of subsequent biliary events. Continued monitoring and evaluation are crucial for these patients.

Area of Science:

  • Gastroenterology
  • Interventional Radiology
  • Surgical Outcomes

Background:

  • Percutaneous transhepatic gallbladder drainage (PTGBD) serves as an alternative treatment for acute cholecystitis (AC).
  • The natural progression of AC in patients managed with PTGBD but without subsequent definitive treatment remains incompletely understood.

Purpose of the Study:

  • To investigate the long-term outcomes of acute cholecystitis (AC) patients treated with percutaneous transhepatic gallbladder drainage (PTGBD) who did not undergo definitive surgical management.
  • To identify risk factors associated with biliary events and competing risks of mortality in this patient cohort.

Main Methods:

  • Retrospective analysis of 2371 AC patients from June 2010 to December 2016.
  • Focus on 237 patients who received PTGBD but no definitive treatment.
  • Competing risk model applied to analyze biliary events and unrelated mortality.

Main Results:

  • Cumulative incidence of biliary events was 29.8% with a median of 4.27 months.
  • Competing risk of death unrelated to biliary causes occurred in 14.9% of patients (median 23.54 months).
  • Risk factors for biliary events included prolonged PTGBD indwelling and abnormal cholangiogram; risk factors for mortality included high Charlson comorbidity index and initial AC severity.

Conclusions:

  • Definitive cholecystectomy is recommended for patients treated with PTGBD due to the significant incidence of later biliary events.
  • Thorough preoperative evaluation is essential for patients considering elective cholecystectomy post-PTGBD, given their potentially inferior life expectancy and physical status.
Abstract

Keywords:
Acute cholecystitisCholecystectomyPercutaneous transhepatic gallbladder drainage

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