title: Role of percutaneous transhepatic gallbladder aspiration in the early management of acute cholecystitis.
abstract: OBJECTIVE
  Early cholecystectomy is currently the gold standard treatment for acute cholecystitis (AC). However, the acceptability and safety of this strategy remain in dispute. The aim of this study was to clarify the role of percutaneous transhepatic gallbladder aspiration (PTGBA) in the early management of AC in a single center.
  
  
  METHODS
  A total of 147 consecutive patients who were treated with PTGBA for AC from 2008 to 2012 were included in the study. The therapeutic outcomes and adverse events were evaluated.
  
  
  RESULTS
  A single PTGBA was adequate for 96 (65.3%) patients with AC. Of the remaining 51 patients, 43 (29.3%) showed an improvement after repeated PTGBA and/or percutaneous transhepatic gallbladder drainage (PTGBD), while semi-emergency cholecystectomy was needed in eight patients. Although five patients experienced adverse events (intra-abdominal hemorrhage in two, bile leakage in two and gallbladder hemorrhage in one), no patient died of treatment-related complications. Subsequently, 87 (59.2%) patients underwent cholecystectomy after PTGBA (a single PTGBA in 48 and repeated PTGBA and/or PTGBD in 39 patients). No significant differences were observed in the conversion rate from laparoscopic surgery to open cholecystectomy, operative time or intraoperative hemorrhage volume between the two groups.
  
  
  CONCLUSIONS
  The present study demonstrated the safety and acceptability of treatment with PTGBA for AC at our center. This elective treatment strategy may be a useful alternative option in the treatment of AC.
authors.affiliation: Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Tadashi
authors.initials: T
authors.lastname: Tsukamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iwasaki
authors.forename: Akihiro
authors.initials: A
authors.lastname: Toyokawa
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Shinobu
authors.initials: S
authors.lastname: Tsuchida
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takahashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takebe
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Wakahara
authors.forename: Akihiko
authors.initials: A
authors.lastname: Watanabe
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sugahara
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Mukai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000628:therapy*; D019468:Disease Management; D004322:Drainage / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005704:Gallbladder / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: acute cholecystitis; cholecystectomy; percutaneous transhepatic gallbladder aspiration; percutaneous transhepatic gallbladder drainage; treatment outcome