The Efficacy of PTGBD for Acute Cholecystitis Based on the Tokyo Guidelines 2018
Kodai Abe1, Keiichi Suzuki2,3, Masashi Yahagi1
1Department of Surgery, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan.
Insights
Percutaneous transhepatic gallbladder drainage (PTGBD) is effective for moderate and severe acute cholecystitis (AC). This procedure is particularly beneficial for high-risk AC patients, improving surgical outcomes and safety.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Clinical Outcomes Research
Background:
- Percutaneous transhepatic gallbladder drainage (PTGBD) is commonly used for moderate and severe acute cholecystitis (AC) before cholecystectomy.
- The clinical utility of preoperative drainage for AC remains a subject of debate.
- The Tokyo Guidelines 2018 provide a framework for AC management.
Purpose of the Study:
- To evaluate the efficacy and safety of PTGBD in patients with moderate and severe AC.
- To assess PTGBD's role in managing AC according to the Tokyo Guidelines 2018.
- To compare surgical outcomes and recovery periods between PTGBD and non-PTGBD groups.
Main Methods:
- Retrospective review of 146 AC patients (2012-2017).
- Classification of AC severity based on Tokyo Guidelines 2018.
- Comparison of clinical data, surgical performance, and recovery between PTGBD and non-PTGBD groups.
Main Results:
- For moderate AC, PTGBD patients had higher rates of age, diabetes mellitus (DM), and American Society of Anesthesiologists (ASA) classification, with lower serum albumin and hemoglobin.
- Surgical outcomes were comparable between PTGBD and non-PTGBD groups for moderate AC.
- In severe AC, PTGBD facilitated safe laparoscopic cholecystectomy, whereas non-PTGBD cases often required open laparotomy and blood transfusion due to bleeding.
Conclusions:
- Preoperative PTGBD is a safe and beneficial procedure for AC patients, especially those with comorbidities and severe AC.
- The Tokyo Guidelines 2018 treatment flowchart aids in identifying high-risk AC patients suitable for preoperative drainage.
Backgrounds:
We usually performed percutaneous transhepatic gallbladder drainage (PTGBD) for moderate and severe acute cholecystitis (AC) prior to cholecystectomy. But, the validity of preoperative drainage for AC is still controversial. The aim of this study is to evaluate the efficacy and safety of PTGBD for moderate and severe AC, based on the Tokyo Guidelines 2018.
Materials:
Total of 146 AC patients from 2012 to 2017 were enrolled. Patients were classified in the grade of severity according to TG18, compared with PTGBD and non-PTGBD group. We retrospectively reviewed clinical backgrounds and laboratory data at admission. We evaluated surgical performances as the primary outcomes and recovery periods based on guidelines.
Results:
A total of 61 cases were moderate, and 18 cases were severe AC, and PTGBD were performed in 34 cases. For moderate AC, age, DM rate and ASA in PTGBD group were significantly higher than those in non-PTGBD group. Also, serum albumin and hemoglobin at admission were significantly lower in the PTGBD group. However, surgical outcomes were almost the same. For severe AC patients, laparoscopic cholecystectomy was performed safely in all of pre-operating drainage cases, while almost all of non-PTGBD cases underwent open laparotomy and needed transfusion for massive bleeding.
Conclusions:
Preoperative PTGBD is a useful and safe procedure for AC patients with comorbidities, especially in severe AC cases. Treatment flowchart in TG18 can be feasible to make accurate prediction for surgically high-risk patients in AC.
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