Timing of Cholecystectomy after Percutaneous Cholecystostomy for Acute Cholecystitis

Abstract

Background/Aims: Laparoscopic cholecystectomy is the standard treatment for acute cholecystitis. Percutaneous cholecystostomy is an alternative treatment to resolve acute inflammation in patients with severe comorbidities. The purpose of this study is to determine the optimal timing of laparoscopic cholecystectomy after percutaneous cholecystostomy for the patients with acute cholecystitis. Methods: This retrospective study was conducted in patients who underwent cholecystectomy after percutaneous cholecystostomy from January 2010 through November 2014. Seventy-four patients were included in this study. The patients were divided into two groups by the operation timing. Group I patients underwent cholecystectomy within 10 days after percutaneous cholecystostomy (n=30) and group II patients underwent cholecystectomy at more than 10 days after percutaneous cholecystostomy (n=44). Results: There was no significant difference between groups in conversion rate to open surgery, operation time, perioperative complications rate, and days of hospital stay after operation. However, complications related to cholecystostomy such as catheter dislodgement occurred significantly more often in group II than group I (group I:group II=0%:18.2%; p=0.013). Conclusions: Timing of laparoscopic cholecystectomy after percutaneous cholecystostomy did not influence postoperative outcomes. However, late surgery caused more complications related to cholecystostomy than early surgery. Therefore, early laparoscopic cholecystectomy should be considered over late surgery after percutaneous cholecystostomy insertion. (Korean J Gastroenterol 2015;66:209-214)

Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

“…There are no randomized controlled trials on the best time for Lap‐C after PTGBD. Four observational studies featured various different times before surgery after PTGBD, and we assign these studies as evidence level C. Table provides a summary of these studies .…”

Percutaneous Cholecystostomy is a Reasonable Alternative for the Treatment of Acute Cholecystitis in Critically Ill Patients: a Single Center Analysis

“…Our study was focused on the safety of the PC and the outcomes of critically ill patients after the procedure. According to numerous studies [8,16,20,24] PC can be used as a temporizing measure or as a definitive treatment option with a low number of delayed cholecystectomies [2]. Among 54 cases in our study, clinical status significantly improved and laparoscopic cholecystectomy was performed for 11 patients (20.37%).…”

“…Other studies introduce PC as a safe alternative treatment approach [22], especially useful when immediate cholecystectomy is unsafe [23]. There are several published studies comparing postoperative outcomes between early and late laparoscopic cholecystectomy following PC [24]. Jung et al reported no difference between groups in comorbid conditions that could affect surgical outcome.…”

Therapeutic experience of 289 elderly patients with biliary diseases

“…On the other hand, the increased surgical risk due to aggressive surgery should also be prevented. For example, conservative surgery of acute gangrenous cholecystitis, such as percutaneous cholecystostomy[43,44], an alternative treatment for resolving acute inflammation, is theoretically suitable for patients in poor general condition, with a serious illness, unstable blood pressure during surgery, and other special circumstances. However, percutaneous cholecystostomy should be avoided for the reasons mentioned above.…”