Preceding PTGBD Decreases Complications of Laparoscopic Cholecystectomy for Patients with Acute Suppurative Cholecystitis

Abstract

Laparoscopic cholecystectomy (LC) has become one of the options for the treatment of acute cholecystitis as surgeons gain facility with this procedure. However, acute suppurative cholecystitis is still a severe condition, because a high mortality rate still exists. In the early years (1991 to 1992), 4 patients were operated on without a preceding percutaneous transhepatic gallbladder drainage (PTGBD) at our hospital, however, one patient died of septic shock after a laparoscopic cholecystectomy. Conversion to open surgery was performed on two patients. However, in later years (1992 to 1995), 14 patients were operated on with preceding PTGBDs safely. Here, we report the safeness and significance of the combination therapy of PTGBD and LC for patients with severe acute suppurative cholecystitis.

Surgical Outcomes of Laparoscopic Cholecystectomy for Severe Acute Cholecystitis

“…On the other hand, zero conversion rate was reported in 34 days of interval to operation after PTGBD. 3 In our study, patients with PTGBD were significantly older and comorbid conditions were significantly more common than the other groups. There was one complication related to PTGBD: bile leakage at the puncture site after LC.…”

“…For the treatment of AC, there has been controversy over the advantages of early laparoscopic cholecystectomy (LC) versus delayed surgical treatment after gallbladder drainage such as PTGBD. [1][2][3] Recently, early LC is recommended on the basis of randomized studies, [4][5][6] as failure of initial conservative treatments has been reported in up to 32% of cases and early cholecystectomy has been proved to reduce total hospital stay.…”

“…9,10 Moreover, treatment modalities other than LC, such as cholecystectomy or subtotal cholecystectomy have been considered, 3,[11][12][13] however, the treatment of SAC has not exactly been specified in most literature.…”

Early scheduled laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for patients with acute cholecystitis

“…Mo et al [13] reported that the conversion rate in LC 2 to 5 days after PTGBD was 0% (0/7). Watanabe et al [20] reported that the conversion rate to open cholecystectomy in delayed LC with a mean of 34 days after PTGBD for acute cholecystitis was 0% (0/14). Patterson et al [15] reported that the conversion rate in LC with a mean of 36 days after PTGBD was 31% (4/13).…”

“…However, the usefulness of LC for acute cholecystitis has not yet been established because of technical difficulty and the timing of LC for acute cholecystitis is also still unsettled. Percutaneous transhepatic gallbladder drainage (PTGBD) has a good decompression ability for swollen gallbladders [15,19,20], however, the usefulness of PTGBD before LC has not yet been established. Here we report the usefulness of early scheduled LC following PTGBD for patients with acute cholecystitis.…”