高リスク急性胆嚢炎における経皮経肝胆嚢ドレナージ後の腹腔鏡下胆嚢摘出術の最適な時期

The Tokyo Guidelines 2018 recommend early laparoscopic cholecystectomy for acute cholecystitis once the diagnosis is made. In surgical high-risk patients, however, initial management with antibiotics and gallbladder drainage is advised, followed by standby surgery. The optimal timing of standby surgery after percutaneous transhepatic gallbladder drainage remains unclear. This study aimed to evaluate the timing of standby cholecystectomy after gallbladder drainage in surgical high-risk patients.

We retrospectively reviewed 97 patients who underwent cholecystectomy after percutaneous transhepatic gallbladder drainage between January 2019 and July 2024 at our hospital. Patients were classified as surgical high-risk (n = 56) or low-risk (n = 41) according to the Tokyo Guidelines 2018. In the high-risk group, both the total cohort and a propensity score-matched cohort (n = 22) were analyzed, comparing an early group (surgery within 7 days after gallbladder drainage) and a delay group (surgery ≥ 8 days); patients with Grade III acute cholecystitis were excluded before matching. Clinical characteristics and surgical outcomes were compared.

In the total cohort, C-reactive protein levels at initial presentation were significantly higher in the delay group (p < 0.05). All patients with Grade III acute cholecystitis (n = 9) were included in the delay group. In the matched cohort, surgical outcomes did not differ significantly between groups. However, total hospitalization was significantly shorter in the early group (p < 0.05).

In surgical high-risk patients, standby surgery within 7 days after percutaneous transhepatic gallbladder drainage may be preferable, as it shortens hospitalization without compromising surgical outcomes.