Ann Hepatobiliary Pancreat Surg.  2022 May;26(2):159-167. 10.14701/ahbps.21-125.

Optimal timing of percutaneous transhepatic gallbladder drainage and subsequent laparoscopic cholecystectomy according to the severity of acute cholecystitis

• Lee JS
• Lee SJ
• Choi IS
• Moon JI

• KMID: 2530095
• DOI: http://doi.org/10.14701/ahbps.21-125

Abstract

Backgrounds/Aims
The optimal timing of percutaneous transhepatic gallbladder drainage (PTGBD) and subsequent laparoscopic cholecystectomy (LC) according to the severity of acute cholecystitis (AC) has not been established yet.
Methods
This single-center, retrospective study included 695 patients with grade I or II AC without common bile duct stones who underwent PTGBD and subsequent LC between January 2010 and December 2019. Difficult surgery (DS) (open conversion, subtotal cholecystectomy, adjacent organ injury, transfusion, operation time ≥ 90 minutes, or estimated blood loss ≥ 100 mL) and poor postoperative outcome (PPO) (postoperative hospital stay ≥ 7 days or Clavien-Dindo grade ≥ II postoperative complication) were defined to comprehensively evaluate intraoperative and postoperative outcomes, respectively.
Results
Of 695 patients, 403 had grade I AC and 292 had grade II AC. According to the receiver operating characteristic curve and multivariate logistic regression analyses, an interval from symptom onset to PTGBD of > 3.5 days and an interval from PTGBD to LC of > 7.5 days were significant predictors of DS and PPO, respectively, in grade I AC. In grade II AC, the timing of PTGBD and subsequent LC were not statistically related to DS or PPO.
Conclusions
In grade I AC, performing PTGBD within 3.5 days after symptom onset can reduce surgical difficulties and subsequently performing LC within 7.5 days after PTGBD can improve postoperative outcomes. In grade II AC, early PTGBD cannot improve the surgical difficulty. In addition, the timing of subsequent LC is not correlated with surgical difficulties or postoperative outcomes.

Keyword

Acute cholecystitis; Laparoscopic cholecystectomy; Gallbladder; Drainage

Figure

• 

  Fig. 1 ROC curve analysis in patients with grade I acute cholecystitis. (A) ROC curves between difficult surgery and interval from symptom onset to PTGBD. The AUC is 0.589. *The cutoff is calculated as 3.5 days. (B) ROC curves between difficult surgery and interval from PTGBD to LC. The AUC is 0.473. (C) ROC curves between poor postoperative outcome and interval from symptom onset to PTGBD. The AUC is 0.487. (D) ROC curves between poor postoperative outcome and interval from PTGBD to LC. The AUC is 0.622. *The cutoff is calculated as 7.5 days. AUC, area under the curve; CI, confidence interval; LC, laparoscopic cholecystectomy; PTGBD, percutaneous transhepatic gallbladder drainage; ROC, receiver operating characteristic.

• 

  Fig. 2 ROC analysis in patients with grade II acute cholecystitis. (A) ROC curves between difficult surgery and interval from symptom onset to PTGBD. The AUC is 0.437. (B) ROC curves between difficult surgery and interval from PTGBD to LC. The AUC is 0.493. (C) ROC curves between poor postoperative outcome and interval from symptom onset to PTGBD. The AUC is 0.376. *The cutoff is calculated as 2.5 days. (D) ROC curves between poor postoperative outcome and interval from PTGBD to LC. The AUC is 0.560. AUC, area under the curve; CI, confidence interval; LC, laparoscopic cholecystectomy; PTGBD, percutaneous transhepatic gallbladder drainage; ROC, receiver operating characteristic.

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