Optimal timing for laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage

Takeshi Gocho, MD, Takeyuki Misawa, MD, PhD, Yuichi Nakaseko, MD, Yuki Takano, MD, Koichiro Haruki, Kenei Furukawa, MD, PhD, Masaru Kanehira, MD, Shinji Onda, MD, Taro Sakamoto, MD, Ryota Saito, MD, PhD, Hiroaki Shiba, MD, PhD, Yasuro Futagawa, MD, PhD, Yuichi Ishida, MD, PhD, Katsuhiko Yanaga, MD, PhD. Jikei University School of Medicine

Background and Objective: According to TG13 (Updated Tokyo Guidelines for acute cholangitis and acute cholecystitis), percutaneous transhepatic gallbladder drainage (PTGBD) is recommended for patients with severe acute cholecystitis and moderate acute cholecystitis without response to initial medical treatment. For patients after PTGBD, we usually plan laparoscopic cholecystectomy (LC) more than 30 days after PTGBD. However, the optimal timing of LC after PTGBD remains controversial. The aim of this study was to assess the optimal timing of LC after PTGBD.

Patients and methods: Between January 2006 and March 2015, we attempted LC for 83 patients after PTGBD at Jikeu Univ. Hospital and Kashiwa Hospital (age 32 – 82 [mean 66] years, M:F = 58 : 25. We divided such patients into two groups according to the interval between PTGBD and LC (O30 group; more than 30 days, U30 group; within 30 days) and evaluated the patients’ clinical background, operative factors, conversion rate to open surgery (CR), complications, length of postoperative hospital stay (HS) and overall treatment period (OTP: from PTGBD to discharge after LC).

Results: In two groups (O30 group vs. U30 group), age (years old, median) (65.5 vs. 66, p = 0.2558), sex (%, male) (70.1% vs. 66.7%, p = 0.7853), operative time (min, median) (160 vs. 157.5, p = 0.4980), intraoperative blood loss (g, median) (5 vs. 50, p = 0.5606), CR (23% vs. 33%, p = 0.3273) and HS (days, median) (4 vs. 7.5, p = 0.4980) were similar. However, OTP was longer in O30 group than in U30 group (days, median) (88 vs. 20, p < 0.0001). There was no bile duct injury in either group.

Conclusion: Early LC after PTGBD can shorten the overall treatment period without increasing CR or bile duct injury.