title: Percutaneous transhepatic gallbladder drainage followed by elective laparoscopic cholecystectomy in patients with moderate acute cholecystitis under antithrombotic therapy.
abstract: BACKGROUND
  Standard treatment for acute cholecystitis (AC) in patients receiving antithrombotic drugs has not been established. We evaluated the safety of percutaneous transhepatic gallbladder drainage (PTGBD) followed by elective laparoscopic cholecystectomy (LC) in patients with moderate AC who were receiving antithrombotics.
  
  
  METHODS
  Seventy-five patients received PTGBD from January 2006 to March 2013 followed by elective LC for moderate AC. Patients were divided into Group A, which consisted of patients receiving antithrombotic therapy (n = 23), and Group B, which included the remaining patients (n = 52). We analyzed clinical outcomes and perioperative complications between groups.
  
  
  RESULTS
  No hemorrhagic events occurred during PTGBD insertion regardless of antithrombotic treatment. The open conversion rate was not significantly different between the two groups. Postoperative complications were found in 10 patients (13.3%). The rate of postoperative complications in Group A was slightly higher than that in Group B, but the difference was not significant (21.7% vs. 9.6%; P = 0.15). Complications associated with PTGBD occurred in six patients (8%). There were no significant differences in the incidence of these complications, operation time, intraoperative blood loss, or length of postoperative hospital stay.
  
  
  CONCLUSIONS
  Percutaneous transhepatic gallbladder drainage followed by elective LC may be an effective therapeutic strategy for moderate AC in patients receiving antithrombotic therapy.
authors.affiliation: Department of Surgery, Hokushinkai Megumino Hospital, Eniwa, Hokkaido, Japan; Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, N15 W7 Kita-ku, Sapporo, Hokkaido, 060-8638, Japan. susumushi48@mist.ocn.ne.jp.
authors.forename: Susumu
authors.initials: S
authors.lastname: Shibasaki
authors.forename: Norihiko
authors.initials: N
authors.lastname: Takahashi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Toi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tsuda
authors.forename: Takahisa
authors.initials: T
authors.lastname: Nakamura
authors.forename: Taiji
authors.initials: T
authors.lastname: Hase
authors.forename: Nozomi
authors.initials: N
authors.lastname: Minagawa
authors.forename: Shigenori
authors.initials: S
authors.lastname: Homma
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawamura
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000601:surgery*; D004322:Drainage; D017558:Elective Surgical Procedures; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Acute cholecystitis; Antithrombotic therapy; Laparoscopic cholecystectomy; Percutaneous transhepatic gallbladder drainage