Early scheduled laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for patients with acute cholecystitis.
OBJECTIVE
The present study was conducted to evaluate the effectiveness of early scheduled laparoscopic cholecystectomy (LC) following percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute cholecystitis.


METHODS
31 patients with acute cholecystitis were treated by early scheduled LC following PTGBD (group 1). These patients were compared with 9 patients treated by early LC without PTGBD (group 2) and with 12 patients treated by delayed LC following conservative therapy (group 3) for the success rate of intraoperative cholangiography, the conversion rate to open cholecystectomy, operative time, and hospital stay. Early scheduled LC following PTGBD was defined as scheduled LC when the patient's condition recovered and it was performed 1-7 days (mean: 4 days) after admission. The patients' age in group 1, 2, and 3 was 66 +/- 13, 65 +/- 10, and 64 +/- 9 years, respectively, without significant difference. Most of the patients had additional diseases.


RESULTS
The success rate of intraoperative cholangiography was 97% (30/31) in group 1, 67% (6/9) in group 2, and 67% (8/12) in group 3. The conversion rate to open cholecystectomy was 3% (1/31) in group 1, 33% (3/9) in group 2, and 33% (4/12) in group 3. The operative time for LC was 89 +/- 33 min in group 1, 116 +/- 24 min in group 2, and 135 +/- 30 min in group 3. The mean hospital stay after LC was 9 +/- 4 days in group 1, 9 +/- 3 days in group 2, and 17 +/- 7 days in group 3. In group 1, the success rate of intraoperative cholangiography was higher, the conversion rate to open cholecystectomy was lower, and operative time was shorter than in groups 2 and 3 with significant difference (p <0.05, p <0.05, and p <0.01, respectively).


CONCLUSIONS
The findings of this study indicate that early scheduled LC following PTGBD is a safe and effective therapeutic option for patients with acute cholecystitis especially in elderly and complicated patients.
Chikamori
F
F
Department of Surgery, Kuniyoshi Hospital, Kochi, Japan. chikamor@i-kochi.or.jp
Kuniyoshi
N
N
Shibuya
S
S
Takase
Y
Y
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D002758:Cholangiography / Q000379:methods; D002763:Cholecystectomy / Q000379:methods / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000379:methods* / Q000706:statistics & numerical data; D002764:Cholecystitis / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D005260:Female; D005704:Gallbladder / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013997:Time Factors