An evaluation of laparoscopic cholecystectomy after selective percutaneous transhepatic gallbladder drainage for acute cholecystitis

BACKGROUND: The aim of this study was to evaluate the safety and usefulness of laparoscopic cholecystectomy after selective percutaneous transhepatic gallbladder drainage in patients with severe acute cholecystitis and patients with acute cholecystitis and severe comorbid disease. METHODS: According to whether percutaneous transhepatic gallbladder drainage was performed before surgery, 133 patients with acute cholecystitis were divided into a percutaneous transhepatic gallbladder drainage group (n=60) and non-percutaneous-transhepatic-gallbladder-drainage group (n=73). Background factors, safety, and postoperative course were retrospectively evaluated and compared between these two groups. RESULTS: Compared with the non-percutaneous-transhepatic-gallbladder-drainage group, the percutaneous transhepatic gallbladder drainage group was significantly older (p=0.0009), had a higher frequency of comorbid disease (p=0.0252), and a worse American Society of Anesthesiology classification (p=0.0021). In individual statistical tests, body temperature (p=0.0288), white blood cell count (p=0.0175), and C-reactive protein value (p=0.0022) were significantly elevated in the percutaneous transhepatic gallbladder drainage group; however, for frequency of comorbid disease, body temperature, and white blood cell count, significance was removed by correction for multiple testing of data. There was no significant difference in gender distribution, history of upper abdominal surgery, or body mass index between the two groups. The duration of surgery was marginally but significantly longer in the percutaneous transhepatic gallbladder drainage group (p=0.0414; in a single statistical test; however, that significance was removed by correction for the multiple testing of data). Between the two groups, there was no significant difference in blood loss at surgery, frequency of postoperative complications, rate of conversion to open laparotomy, interval until oral feeding was resumed, and length of postoperative hospital stay. CONCLUSIONS: These data suggest that satisfactory outcomes can be achieved with selective pre-operative gallbladder drainage in older and sicker patients with acute cholecystitis.