Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2024; 16(11): 3445-3452
Published online Nov 27, 2024. doi: 10.4240/wjgs.v16.i11.3445
Effect of surgical timing on postoperative outcomes in patients with acute cholecystitis after delayed percutaneous transhepatic gallbladder drainage
Wei Gao, Jun Zheng, Ji-Gang Bai, Zhao Han
Wei Gao, Department of Hepatobiliary Surgery, Hanzhong Central Hospital, Hanzhong 723000, Shaanxi Province, China
Jun Zheng, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
Ji-Gang Bai, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Zhao Han, Department of General Surgery, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang 712000, Shaanxi Province, China
Author contributions: Gao W and Han Z contributed to the study conception and design; Gao W, Zheng J and Bai JG performed material preparation, data collection and analysis, and wrote the first draft of the manuscript; Han Z reviewed and revised the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of No. 215 Hospital of Shaanxi Nuclear Industry.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhao Han, MD, Professor, Department of General Surgery, No. 215 Hospital of Shaanxi Nuclear Industry, No. 35 Weiyang West Road, Qindu District, Xianyang 712000, Shaanxi Province, China. hanzhao_004@163.com
Received: July 10, 2024
Revised: August 27, 2024
Accepted: September 9, 2024
Published online: November 27, 2024
Processing time: 112 Days and 3.3 Hours
Abstract
BACKGROUND

To date, the optimal timing for percutaneous transhepatic gallbladder drainage (PTGBD), particularly for patients who have missed the optimal window for emergency laparoscopic cholecystectomy (LC) (within 72 hours of symptom onset) has not been determined.

AIM

To study the effects of LC timing on outcomes of grade II/III acute cholecystitis (AC) in patients with delayed PTGBD.

METHODS

Data of patients diagnosed with Tokyo Guidelines 2018 grade II or III AC who underwent delayed PTGBD followed by LC at a single hospital between 2018 and 2022 were retrospectively studied. According to the interval between gallbladder drainage and cholecystectomy, the patients were divided into early and delayed LC groups. Outcomes including surgery time, postoperative complications and hospital stay, and patient satisfaction were analyzed and compared between the two groups using t- and χ2 tests.

RESULTS

There were no significant differences between the two groups in intraoperative blood loss, postoperative abdominal drainage tube placement time, pain index, or total disease duration (all P > 0.05). Compared with those of the early LC group, the delayed group showed significant decreases in the length of procedure (surgery time), conversion rate to open surgery, degree of adhesions, surgical complications, postoperative hospital stay, and total treatment costs, and increased patient satisfaction despite a longer interval before PTGBD (all P < 0.05).

CONCLUSION

For patients with grade II/III AC with delayed PTGBD, LC should be performed 2 weeks after PTGBD to decrease postoperative complications and hospital stays and improve patient satisfaction.

Keywords: Acute cholecystitis; Percutaneous transhepatic gallbladder drainage; Laparoscopic cholecystectomy; Surgical timing; Postoperative outcomes

Core Tip: Previous studies have proposed that percutaneous transhepatic gallbladder drainage (PTGBD) should be performed as early as possible in patients with moderate-to-severe acute cholecystitis (AC). However, to date, no consensus has been reached on the optimal timing for PTGBD, particularly for patients who have missed the 72-hour emergency laparoscopic cholecystectomy (LC) window. This study assessed the effects of different operation times on postoperative outcomes of patients with grade II or III AC with delayed PTGBD (time from symptom onset to PTGBD exceeding 7 days). Our results suggest that LC should be performed 2 weeks after PTGBD.