Percutaneous gallbladder drainage for delayed laparoscopic cholecystectomy in patients with acute cholecystitis

• Published in: The American journal of surgery Vol. 179; no. 2; pp. 111 - 113
• Main Authors: Kim, Kon Hong, Sung, Chun Ki, Park, Bae Keon, Kim, Woo Kil, Oh, Chang Whan, Kim, Ki Sung
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2000; Elsevier; Elsevier Limited
• Subjects: Acute Disease; Adult; Age Factors; Aged; Aged, 80 and over; Bile; Biological and medical sciences; Catheters; Chi-square test; Cholecystectomy; Cholecystectomy, Laparoscopic - adverse effects; Cholecystitis; Cholecystitis - surgery; Comorbidity; Conversion; Critical Illness; Decompression, Surgical; Drainage - methods; Emergency procedures; Female; Gallbladder; Gallbladder - surgery; Gallbladder diseases; Hospitalization; Hospitals; Humans; Inflammation; Laparoscopy; Length of Stay; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Morbidity; Mortality; Patient Admission; Patients; Retrospective Studies; Risk Factors; Risk groups; Safety; Statistical analysis; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Time Factors; Treatment Outcome; Wound drainage; Cholecystectomy; Human; Postoperative; Endoscopic surgery; Prognosis; Acute; Surgical drainage; Instrumentation therapy; Laparoscopic surgery; Biliary tract disease; Morbidity; Percutaneous route; Treatment; Digestive diseases; Delay time; Cholecystitis
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(00)00247-6

Background: Many studies have concluded that delayed or interval laparoscopic cholecystectomy (LC) in patients with acute cholecystitis (AC) demonstrated higher conversion rates and complication rates compared with early LC. However, if the acutely inflamed gallbladder is decompressed by emergent percutaneous gallbladder drainage (PGBD), it may decrease the technical difficulty of LC allowing successful delayed LC when the patient is in better condition. The purpose of this retrospective study was to assess the outcomes of delayed LC following PGBD in patients with AC. Methods: A total of 72 LC for AC were divided into PGBD (n = 27) and non-PGBD groups (n = 45). The PGBD group had delayed LC (after 72 hours of admission). Thirty-two non-PGBD patients had early LC (within 72 hours of admission) and 13 non-PGBD had delayed LC. Outcome of delayed LC for the PGBD group was assessed by LC time, conversion rate, morbidity rate, and hospital stay, and compared with that of the non-PGBD group. Results: Compared with early and delayed LC of the non-PGBD group, the PGBD group showed longer LC time (median 110 minutes versus 87.5 minutes versus 85 minutes, P <0.05), a little lower conversion rate (15% versus 25% versus 23%), similar morbidity rate (15% versus 9% versus 15%), and prolonged hospital stay (13 days versus 7 days versus 10 days). Conclusions: PGBD did not significantly improve the outcome of LC for AC as assessed by conversion and morbidity rate and hospital stay compared with no PGBD. Thus, we can conclude that although PGBD is a safe and effective emergency procedure for AC, it should be limited to higher risk groups such as elderly or critically ill patients and to acalculous cholecystitis.