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Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis
Yunxiao Lyu1, Ting Li2, Bin Wang3
1Department of Hepatobiliary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, 60 West Wuning Road, Dongyang, 322100, Zhejiang, People's Republic of China. lvyunxiao1986@gmail.com.
Insights
Performing laparoscopic cholecystectomy (LC) within one week after percutaneous transhepatic gallbladder drainage (PTGBD) for acute cholecystitis is safe and effective. Early LC reduces hospital stays and medical costs without compromising surgical outcomes.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Surgical Outcomes Research
Background:
- Optimal timing for laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) in acute cholecystitis (AC) remains debated.
- Percutaneous transhepatic gallbladder drainage is a temporizing measure for AC, necessitating subsequent definitive surgical management.
Purpose of the Study:
- To evaluate the perioperative outcomes of LC performed at different intervals after PTGBD in patients with AC.
- To determine if early LC (within 1 week) offers advantages over delayed procedures.
Main Methods:
- Retrospective analysis of 100 patients who underwent LC after PTGBD between February 2016 and February 2020.
- Patients were stratified into three groups based on the time interval between PTGBD and LC: within 1 week (Group I), 1 week to 1 month (Group II), and >1 month (Group III).
- Comparison of perioperative outcomes including operation time, blood loss, conversion rates, and postoperative complications.
Main Results:
- No significant differences were observed in baseline characteristics, operation time, estimated blood loss, conversion rates to open cholecystectomy, or postoperative complications among the three groups.
- Group I (LC within 1 week) demonstrated significantly shorter total hospital stays and lower medical costs compared to Group II and Group III.
- Early LC within one week post-PTGBD is associated with reduced healthcare resource utilization.
Conclusions:
- Laparoscopic cholecystectomy within one week following percutaneous transhepatic gallbladder drainage for acute cholecystitis is a safe and effective strategy.
- Early LC is associated with comparable intraoperative and postoperative outcomes to delayed procedures.
- Performing LC within one week of PTGBD can lead to decreased hospital length of stay and reduced medical costs, suggesting an optimal timing for intervention.
Abstract:
There is no consensus on the optimal timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute cholecystitis (AC). We retrospectively evaluated patients who underwent LC after PTGBD between 1 February 2016 and 1 February 2020. We divided patients into three groups according to the interval time between PTGBD and LC as follows: Group I (within 1 week), (Group II, 1 week to 1 month), and Group III (> 1 month) and analyzed patients' perioperative outcomes. We enrolled 100 patients in this study (Group I, n = 22; Group II, n = 30; Group III, n = 48). We found no significant difference between the groups regarding patients' baseline characteristics and no significant difference regarding operation time and estimated blood loss (p = 0.69, p = 0.26, respectively). The incidence of conversion to open cholecystectomy was similar in the three groups (p = 0.37), and we found no significant difference regarding postoperative complications (p = 0.987). Group I had shorter total hospital stays and medical costs (p = 0.005, p < 0.001, respectively) vs Group II and Group III. Early LC within 1 week after PTGBD is safe and effective, with comparable intraoperative outcomes, postoperative complications, and conversion rates to open cholecystectomy. Furthermore, early LC could decrease postoperative length of hospital stay and medical costs.
