Nonlinear Analysis of Optimal Timing for Laparoscopic Cholecystectomy After Percutaneous Cholecystostomy in High-Risk Acute Cholecystitis
Related Experiment Video
Updated: Oct 31, 2026
Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture
Published on: November 25, 2025
Offir Ben Ishay1, Hen Abergil1, Nira Beck2
1Department of General Surgery, Rambam Health Care Center, Haifa, Israel; Ruth and Bruce Rapaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
Introduction:
The optimal timing for interval laparoscopic cholecystectomy (LC) after percutaneous cholecystostomy (PTC) in high-risk patients remains uncertain. We aimed to identify a timing window associated with lower morbidity using a continuous risk model.
Methods:
Retrospective cohort study of 176 patients undergoing elective LC after PTC. Outcomes were analyzed using a nonlinear "rolling risk" model to identify predictors of major complications (Clavien-Dindo ≥3).
Results:
The major complication rate was 14.2%. A "U-shaped" relationship revealed the lowest risk between 4 and 12 wk postdrainage. Patients operated within this window had significantly lower major complication rates (8.5%) than those operated after 12 wk (23.8%; P = 0.006). Multivariate analysis confirmed surgery beyond 12 wk as an independent risk factor (odds ratio 4.11, P = 0.004).
Conclusions:
Interval LC performed 4-12 wk after PTC was associated with the lowest morbidity. Delaying surgery beyond 12 wk carries substantially higher risk.
