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Operative outcomes of interval cholecystectomy after gallbladder drainage for acute cholecystitis: a systematic
Hariruk Yodying1, Vichit Viriyaroj2, Thammanij Rookkachart2
1Department of Surgery, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand. hariruk@g.swu.ac.th.
Insights
Gallbladder drainage before surgery for acute cholecystitis shows no significant difference in operative outcomes between endoscopic and percutaneous methods. Selection should consider efficacy, patient factors, and expertise.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Medical Technology
Background:
- Acute cholecystitis management in high-risk patients often involves gallbladder drainage as a precursor to interval cholecystectomy.
- Percutaneous transhepatic (PTGBD), EUS-guided (EUS-GBD), and endoscopic transpapillary (ETGBD) drainage methods have distinct anatomical impacts.
- Existing meta-analyses confirm drainage efficacy but lack comparative data on subsequent operative outcomes.
Purpose of the Study:
- To systematically review and compare the operative outcomes of interval cholecystectomy following different gallbladder drainage modalities.
- To evaluate differences in conversion to open cholecystectomy and rates of subtotal cholecystectomy between PTGBD, EUS-GBD, and ETGBD.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA 2020 guidelines was conducted.
- Comparative studies published between January 2000 and December 2025 were identified across five databases.
- Random-effects models were employed to analyze primary outcomes: conversion to open cholecystectomy and subtotal cholecystectomy, with evidence certainty assessed by GRADE.
Main Results:
- Ten comparative studies (2019-2025) involving 215 to 416 patients were analyzed.
- No significant difference in conversion to open cholecystectomy was observed between EUS-GBD and PTGBD (6.4% vs. 16.5%).
- Similarly, no significant differences in conversion or subtotal cholecystectomy rates were found between ETGBD and PTGBD, though evidence certainty was low to very low.
Conclusions:
- Current evidence indicates no statistically significant differences in operative outcomes for interval cholecystectomy based on the type of gallbladder drainage modality used.
- The choice of drainage method may be influenced by drainage efficacy, patient-specific anatomy, and the expertise available at the institution.
- Further high-quality research is needed to definitively establish optimal drainage strategies due to the low to very low certainty of existing evidence.
Background:
Acute cholecystitis in high-risk surgical candidates is frequently managed with gallbladder drainage as a bridge to interval cholecystectomy. Each drainage modality-percutaneous transhepatic (PTGBD), EUS-guided (EUS-GBD), and endoscopic transpapillary (ETGBD)-has distinct anatomical effects that may influence subsequent cholecystectomy. While multiple meta-analyses have established drainage efficacy, comparative evidence regarding operative outcomes of interval surgery remains limited.
Methods:
We performed a systematic review and meta-analysis following PRISMA 2020 (PROSPERO: CRD420251232718). Five databases were searched (January 2000-December 2025) for comparative studies reporting operative outcomes of interval cholecystectomy after gallbladder drainage. Primary outcomes were conversion to open cholecystectomy and subtotal cholecystectomy. Random-effects models with Hartung-Knapp adjusted confidence intervals were used. Certainty of evidence was assessed using the GRADE approach.
Results:
Ten comparative studies (2019-2025) were included. Meta-analysis of EUS-GBD versus PTGBD (3 studies, n = 215) showed no statistically significant difference in conversion to open cholecystectomy (6.4% vs. 16.5%; RR 0.51, 95% CI 0.23-1.13; P = 0.07; I²=0%). Meta-analysis of EGBS versus PTGBD (6 studies, n = 416) found no statistically significant difference in conversion (18.9% vs. 17.6%; RR 1.14, 95% CI 0.25-5.23; P = 0.83; I²=77%) or subtotal cholecystectomy (RR 1.16, 95% CI 0.61-2.18; P = 0.52; I²=0%). One RCT comparing ENGBD versus PTGBD (n = 22) was synthesized descriptively. Certainty of evidence was low to very low.
Conclusions:
No statistically significant differences in operative outcomes of interval cholecystectomy were found between endoscopic and percutaneous gallbladder drainage modalities (low to very low certainty of evidence). Given comparable operative outcomes, drainage modality selection may be guided by drainage efficacy, patient anatomy, and institutional expertise.
Prospero Registration:
CRD420251232718.
