Comparison of Early Versus Delayed Laparoscopic Cholecystectomy after Percutaneous Transhepatic Gallbladder Drainage (PTGBD) for Patient with Complicated Acute Cholecystitis

Kim, Hungdai; Kim, Hyung Ook; Shin, Jun Ho

Abstract

PURPOSE: This study was to evaluate the safety and conversion rate of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) in patients with a complicated acute cholecystitis (GB empyema, gangrenous cholecystitis and pericholecystic abscess) according to the timing of LC.
METHODS
One hundred and four patients, who underwent a laparoscopic cholecystectomy after PTGBD between March 2004 and December 2006, were analyzed. Thirty-four patients underwent LC within 7 days after PTGBD (early group, n=34) and 38 patients underwent LC between 14 and 39 days after PTGBD (delayed group, n=38). Thirty-two patients were excluded because of gallbladder cancer (n=2), simple acute cholecystitis (n=12), a history of previous abdominal surgery (n=5), and LC between 8 and 13 days after PTGBD (n=13).
RESULTS
There was no significant difference in age (early group, 58.4+/-11.2; delayed group, 61.0+/-12.1), diagnosis, duration of symptoms, WBC counts, interval of admission and PTGBD, improvement of symptoms after PTGBD, American Society of Anesthesiologists (ASA) score, prior medical history, post-PTGBD and postoperative complications, and operation time. The rate of conversion to an open laparotomy was 14.7% (5/34) in the early group and 2.6% (1/38) in the delayed group (statistically not significant).
CONCLUSION
The timing of LC after PTGBD for a complicated acute cholecystitis does not influence the rate of conversion to an open laparotomy, surgery time and complication. However, a delayed LC after PTGBD tends to decrease the rate of conversion to an open laparotomy.