Korean J Hepatobiliary Pancreat Surg.  2012 Nov;16(4):147-153. 10.14701/kjhbps.2012.16.4.147.

Comparison of clinical result between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis

• Choi JW
• Park SH
• Choi SY
• Kim HS
• Kim TH

• KMID: 2243193
• DOI: http://doi.org/10.14701/kjhbps.2012.16.4.147

Abstract

BACKGROUNDS/AIMS
In the treatment of complicated cholecystitis, laparoscopic cholecystectomy (LC) has limited efficacy due to its substantial post-operative complications. In addition, the clinical characteristics of complicated cholecystitis (CC) patients were suspected as advanced age with highly risky comorbidity. Percutaneous transhepatic gall bladder (PTGBD) drainage could be an alternative option for successful LC. Hence, this study evaluated the outcome of PTGBD for CC within and after 5 days.
METHODS
The medical records of 109 consecutive CC patients who had undergone an LC between January 2007 and December 2011 were retrospectively reviewed and compared with the medical records of CC patients who had undergone an LC within 72 hours of (group I, n=63) or 5 days after PTGBD (group II, n=40). In addition, group I was divided into group Ia (n=46) and group Ib (n=17), according to the patients' development of open-conversion or post-operative complications. The clinical outcomes of the four groups were analyzed.
RESULTS
There was a significantly higher reference to age, the ASA score grading, and predominant comorbidities in group II than in group I. The peri-operative results of group II showed lower blood loss and relatively shorter operating times than those of group I. In the cases of early LC within 72 hours (group Ia vs. group Ib), the difference was statistically insignificant.
CONCLUSIONS
The delayed LC after PTGBD for complicated cholecystitis with high clinical risk had better results in this study, although it prolonged the patient's hospital stay.

Keyword

Complicated cholecystitis; Percutaneous transhepatic gallbladder drainage; Early laparoscopic cholecystectomy; Delayed laparoscopic cholecystectomy

MeSH Terms

Cholecystectomy, Laparoscopic
Cholecystitis
Cholecystitis, Acute
Comorbidity
Drainage
Gallbladder
Humans
Length of Stay
Medical Records
Retrospective Studies
Urinary Bladder

Figure

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  Fig. 1 Axial (A, B) and coronal (C, D) CT images of empyema of the gallbladder in an 82 year-old female patient. (A, C) Computed tomography scan shows a markedly dilated and gallbladder with ascites collection at perihepatic space. (B, D) Follow up CT image obtained 14 days after percutaneous transhepatic gallbladder drainage shows marked resolution of the abscess with drainage tube.

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