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The influence of the interval between percutaneous transhepatic gallbladder drainage and cholecystectomy on
Koichi Kimura1, Eisuke Adachi2, Sachie Omori2
1Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1, Shiobaru, Minamiku, Fukuoka City, 815-8588, Japan. cubicseal@gmail.com.
Insights
This study found that the timing of surgery after percutaneous transhepatic gallbladder drainage (PTGBD) has minimal impact on patient outcomes. Shorter intervals (≤7 or ≤14 days) showed higher CRP levels but shorter hospital stays, suggesting no significant difference in overall perioperative results.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Interventional Radiology
Background:
- Percutaneous transhepatic gallbladder drainage (PTGBD) is a key intervention for high-risk acute cholecystitis patients.
- Optimal surgical timing post-PTGBD remains unclear, lacking robust evidence.
- This study addresses the gap by investigating the impact of PTGBD-to-surgery intervals on perioperative outcomes.
Purpose of the Study:
- To evaluate the influence of the time interval between PTGBD and cholecystectomy on perioperative outcomes.
- To determine the optimal timing for surgery after PTGBD in patients with acute cholecystitis.
Main Methods:
- Retrospective analysis of 22 patients undergoing cholecystectomy post-PTGBD (January 2008 - August 2019).
- Comparison of perioperative factors between groups with short intervals (≤7 days or ≤14 days) and long intervals (≥8 days or ≥15 days).
- Assessment of clinical parameters including C-reactive protein (CRP) levels, operative details, and complication rates.
Main Results:
- Shorter intervals (≤7 days and ≤14 days) were associated with significantly higher pre-operative CRP levels.
- Patients in the shorter interval groups experienced shorter total hospitalization durations.
- No significant differences were observed in hepatic enzymes, adhesion grade, bleeding, operative time, or post-operative complications between interval groups.
Conclusions:
- The interval between PTGBD and subsequent cholecystectomy appears to have minimal impact on overall perioperative outcomes.
- While shorter intervals may correlate with higher inflammatory markers and shorter hospital stays, they do not significantly affect surgical complications or recovery.
- Further research may be warranted to refine optimal timing strategies based on individual patient factors.
Background:
Percutaneous transhepatic gallbladder drainage (PTGBD) is recommended for acute cholecystitis patients at high risk for surgical treatment. However, there is no evidence about the best timing of surgery after PTGBD. Here, we retrospectively investigated the influence of the interval between PTGBD and surgery on perioperative outcomes and examined the optimal timing of surgery after PTGBD.
Methods:
We performed a retrospective analysis of 22 patients who underwent cholecystectomy after PTGBD from January 2008 to August 2019. We examined perioperative factors between patients with an interval of ≤ 7 days between PTGBD and cholecystectomy (≤ 7-day group; n = 12) and those with an interval of ≥ 8 days (≥ 8-day group; n = 10). Moreover, we also examined perioperative factors between patients with an interval of ≤ 14 days from PTGBD to cholecystectomy (≤ 14-day group; n = 10) and those with an interval of ≥ 15 days (≥ 15-day group; n = 12).
Results:
Of the 22 patients, 9 had Grade I cholecystitis, 12 had Grade II cholecystitis, and 2 had Grade III cholecystitis. Nine patients had high-grade cholecystitis before PTGBD and 13 had a poor general condition. We examined perioperative factors between patients with an interval of ≤ 7 days between PTGBD and cholecystectomy (≤ 7-day group; n = 12) and those with an interval of ≥ 8 days (≥ 8-day group; n = 10). The C-reactive protein (CRP) level before surgery was significantly higher (12.70 ± 1.95 mg/dL vs. 1.13 ± 2.13 mg/dL, p = 0.0007) and the total hospitalization was shorter (17.6 ± 8.0 days vs. 54.1 ± 8.8 days, p = 0.0060) in the ≤ 7-day group than in the ≥ 8-day group. We also examined perioperative factors between patients with an interval of ≤ 14 days from PTGBD to cholecystectomy (≤ 14-day group; n = 14) and those with an interval of ≥ 15 days (≥ 15-day group; n = 8). The CRP level before surgery was significantly higher (11.13 ± 2.00 mg/dL vs. 0.99 ± 2.64 mg/dL, p = 0.0062) and the total hospitalization was shorter (19.5 ± 7.2 days vs. 59.9 ± 9.5 days, p = 0.0029) in the ≤ 14-day group than in the ≥ 15-day group. However, there were no significant differences between the ≤ 14-day group and the ≥ 15-day group in the levels of hepatic enzymes before surgery, adhesion grade, amount of bleeding during surgery, operative duration, frequency of surgical complications, or length of hospitalization after surgery.
Conclusions:
The interval between PTGBD and surgery has little influence on perioperative outcomes.
