Norimasa Koide, MD, Takehiko Enomkoto, MD, Kazuyoshi Suda. Department of Surgery, Niigatakensaiseikai Sanjyo Hospital
Introduction: The Tokyo guideline for acute cholecystitis (AC) recommends percutaneous transhepatic gallbladder drainage (PTGBD) followed by cholecystectomy for severe AC. But the optimal timing for the subsequent laparoscopic cholecystectomy remains unclear. And if PTGBD is performed, it appears to increase hospital stay and fee. So recently endoscopic gallbladder stenting (EGBS) after PTGBD has been performed in our institute, and interval laparoscopic cholecystectomy (ILC) performed more than three months from the onset of symptoms is recommended. The aim of this study is to investigate this procedure in our institution.
Methods and procedures: From April 2016 and September 2017, three patients with severe AC underwent ILC using EGBS at our institution. The surgical outcomes were analyzed retrospectively.
Results: The patients consisted of two men and one woman with a mean age of 66 years (ranging from 63-69). Mean white blood cell count was 11933 /m2 (ranging from 10000-13100). Mean duration from onset of AC to PTGBD was 6 days (ranging from 3-10). Mean duration from onset to EGBS was 20 days (ranging from 10-20). Mean duration from onset to surgery was 117 days (ranging from 94-149). One case was removed EGBS tube preoperatively. The number of ports was three or four. The dome down technique after dissection of gallbladder neck was performed in two cases. Mean operating time was 248 minutes (ranging from 112-350), and mean blood loss was 20 ml (ranging from 0-50). There were no conversions to open surgery and no intraoperative complications without contamination of bile juice because of gallbladder injury. The drainage tube was inserted in two cases. Average length of postoperative hospital stay was 4.3 days (ranging from 4-5). There were no postoperative complications and no 30 day readmission.
Conclusion: ILC using EGBS at our institution is a safe and feasible procedure. So this procedure seems to be one option of the treatment for severe AC.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86469
Program Number: P110
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster