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Urgent Versus Elective Laparoscopic Cholecystectomy Following Percutaneous Transhepatic Gallbladder Drainage for
Musa Yaermaimaiti1, Abudukeremu Miersalijiang1, Xue-Jun Wang1
1Department of General Surgery, Kashgar Prefecture Second People's Hospital, Kashgar Region, China.
Insights
Percutaneous transhepatic gallbladder drainage (PTGBD) followed by laparoscopic cholecystectomy (LC) offers significant advantages for moderate acute cholecystitis (AC) compared to emergency LC (ELC). This approach reduces complications and shortens hospital stays, improving patient outcomes.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Innovation
- Evidence-Based Medicine
Background:
- Moderate acute cholecystitis (AC) treatment remains debated.
- Percutaneous transhepatic gallbladder drainage (PTGBD) followed by laparoscopic cholecystectomy (LC) shows promise.
- Controversy exists regarding its superiority over emergency LC (ELC).
Purpose of the Study:
- To conduct an updated meta-analysis comparing PTGBD + LC versus ELC for moderate AC.
- To clarify the comparative effectiveness and safety of these treatment strategies.
Main Methods:
- Comprehensive literature search for comparative studies.
- Inclusion of 14 relevant studies.
- Statistical analysis performed using Stata.
Main Results:
- PTGBD + LC demonstrated shorter operation times and less intraoperative bleeding.
- Lower conversion rates, postoperative complications, and wound infection rates were observed with PTGBD + LC.
- PTGBD + LC resulted in shorter postoperative hospital stays but higher hospitalization expenses.
Conclusions:
- PTGBD + LC offers significant advantages for moderate AC.
- This strategy leads to reduced surgical difficulty and fewer postoperative complications.
- Shorter hospital stays are a key benefit of the PTGBD + LC approach.
Background:
There is still controversy regarding the treatment strategy for moderate acute cholecystitis (AC). Percutaneous transhepatic gallbladder drainage (PTGBD) followed laparoscopic cholecystectomy (LC) has shown advantages compared to emergency LC (ELC). However, the results are controversial. Therefore, we conducted this updated meta-analysis to clarify this issue.
Materials And Methods:
A comprehensive literature search for relevant studies comparing the PTGBD + LC and ELC for moderate AC was performed. The statistical analysis was conducted using Stata.
Results:
A total of 14 studies were included. The pooled analysis revealed that PTGBD + LC group had a shorter operation time (SMD = -1.07, 95%CI = -1.19 to -0.95), lower amount of intraoperative bleeding (SMD = -0.93, 95%CI = -1.07 to -0.79), lower conversion rate (OR = 0.28, 95% CI = 0.17-0.44), lower postoperative complications (OR = 0.45, 95% CI = 0.23-0.88) shorter postoperative hospital stay (SMD = -1.20, 95%CI = -1.33 to -1.07), lower wound infection rate (OR = 0.41, 95%CI = 0.23-0.74) and higher hospitalization expenses (SMD = 1.13, 95%CI = 0.96 to 1.29) compared with ELC group. There was no significant difference in the incidence of bile leak, bile duct injury and total hospital stay.
Conclusion:
This meta-analysis suggested that PTGBD + LC has significant advantages over ELC for moderate AC patients, including lower surgical difficulty, lower conversion rate, fewer postoperative complications, and shorter hospital stay.
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