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Increased difficulty and complications of delayed laparoscopic cholecystectomy following percutaneous transhepatic

Ya-Qi Liu1, Xuan Cai1, Zhi-Xue Zheng1

  • 1Department of General Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.

BMC Surgery
|September 13, 2023
PubMed

Insights

Percutaneous transhepatic gallbladder drainage (PTGBD) effectively treats acute cholecystitis but may complicate delayed laparoscopic cholecystectomy (DLC). Patients undergoing PTGBD prior to DLC experienced longer surgeries, increased blood loss, and higher complication rates.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Clinical Outcomes Research

Background:

  • Percutaneous transhepatic gallbladder drainage (PTGBD) offers a less invasive approach compared to cholecystostomy for acute cholecystitis.
  • The impact of prior PTGBD on the complexity and outcomes of subsequent delayed laparoscopic cholecystectomy (DLC) is not well-established.

Purpose of the Study:

  • To investigate the clinical effects and surgical difficulty of DLC in patients with moderate acute cholecystitis who previously underwent PTGBD.

Main Methods:

  • Retrospective analysis of 113 patients with moderate acute cholecystitis (Tokyo Guidelines 2018) undergoing DLC.
  • Patients were divided into PTGBD (n=27) and no-PTGBD (n=86) groups.
  • Surgical difficulty was assessed using the TG18 score based on video review; clinical outcomes were compared.

Main Results:

  • The PTGBD group exhibited significantly longer postoperative stays, increased blood loss, longer operation times, and higher TG18 difficulty scores compared to the no-PTGBD group.
  • No significant difference was observed in conversion rates between the groups.
  • The morbidity rate was statistically higher in the PTGBD group.

Conclusions:

  • PTGBD is effective for symptom relief in acute cholecystitis.
  • However, preceding PTGBD may increase the surgical difficulty and complication rates associated with subsequent DLC.
Abstract

Keywords:
Acute cholecystitisDelayed laparoscopic cholecystectomyMorbidity ratePercutaneous transhepatic gallbladder drainageRetrospective study

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