Efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for acute cholecystitis in elderly and high-risk patients

Abstract

BackgroundStandards in treatment of acute cholecystitis (AC) in the elderly and high-risk patients has not been established. Our study evaluated the efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) in combination with laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) in elderly and high-risk patients.MethodsOur study enrolled 35 elderly and high-risk AC patients, hospitalized between January 2010 and April 2014 at the Wenzhou People's Hospital. The patients underwent B-mode ultrasound-guided PTGD and LC (PTGD + LC group). As controls, a separate group of 35 elderly and high-risk AC patients who underwent LC alone (LC group) during the same period at the same hospital were randomly selected from a pool of 186 such cases. The volume of bleeding, surgery time, postoperative length of stay, conversion rate to laparotomy and complication rates (bile leakage, bleeding, incisional hernia, incision infection, pulmonary infarction and respiratory failure) were recorded for each patient in the two groups.ResultsAll patients in the PTGD + LC group successfully underwent PTGD. In the PTGD + LC group, abdominal pain in patients was relieved and leukocyte count, alkaline phosphatase level, total bilirubin and carbohydrate antigen 19-9 (CA19-9) decreased to normal range, and alanine aminotransferase and aspartate aminotransferase levels improved significantly within 72 h after treatment. All patients in the PTGD + LC group underwent LC within 6–10 weeks after PTGD. Our study revealed that PTGD + LC showed a significantly higher efficacy and safety compared to LC alone in AC treatment, as measured by the following parameters: duration of operation, postoperative length of hospital stay, volume of bleeding, conversion rate to laparotomy and complication rate (operation time of LC: 55.6 ± 23.3 min vs. 91.35 ± 25.1 min; hospitalized period after LC: 3.0 ± 1.3 d vs. 7.0 ± 1.7 d; intraoperative bleeding: 28.7 ± 15.2 ml vs. 60.38 ± 16.4 ml; conversion to laparotomy: 3 cases vs. 10 cases; complication: 3 cases vs. 8 cases; all P < 0.05 ).ConclusionOur results suggest that B-mode ultrasound-guided PTGD in combination with LC is superior to LC alone for treatment of AC in elderly and high-risk patients, showing multiple advantages of minimal wounding, accelerated recovery, higher safety and efficacy, and fewer complications.

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III – Abdominal Treatment Procedures (Long Version)

“…Most studies lack comparative data so the conclusions are subjective, preventing valid comparison of success, morbidity, mortality and adverse events [447]. A comparative study of USCP followed by LCCE and primary LCCE in two matched groups of high-risk patients found USCP combined with LCCE superior to LCCE alone with regard to duration of operation, conversion rate to open CCE, length of postoperative hospital stay, and adverse events [448]. A retrospective study comparing outcomes of USCP followed by LCCE compared with LCCE alone in elderly high-risk patients with acute cholecystitis reported a significantly lower rate of conversion to open CCE for patients treated with USCP followed by LCCE.…”

Cholecystectomy outcomes after endoscopic sphincterotomy in patients with choledocholithiasis: a meta-analysis

“…Grouping according to gallstones and re-analysis may yield different conclusions. Single large stones have a lower risk of recurrence of biliary pancreatitis and cholangitis compared to small stones and biliary stones < 5 mm in size, but the incidence of cholecystitis in older patients increases with age, although recurrent pancreatitis is not increased, the risk of cholecystitis increases, and thus it is still recommended to remove the gallbladder after ES [27][28][29].…”

Cholecystectomy outcomes after endoscopic sphincterotomy in patients with choledocholithiasis: A meta-analysis

“…Grouping according to gallstones and re-analysis may yield different conclusions. Single large stones have a lower risk of recurrence of biliary pancreatitis and cholangitis compared to small stones and biliary stones < 5 mm in size, but the incidence of cholecystitis in older patients increases with age, although recurrent pancreatitis is not increased, the risk of cholecystitis increases, and thus it is still recommended to remove the gallbladder after ES [27][28][29]. Flow diagram of studies included in the meta-analysis.…”