title: Optimal timing for performing percutaneous transhepatic gallbladder drainage and subsequent cholecystectomy for better management of acute cholecystitis.
abstract: BACKGROUND
  We aimed to clarify the appropriate timing for performing percutaneous transhepatic gallbladder drainage (PTGBD) and cholecystectomy, and the effect of PTGBD on surgical difficulty in acute cholecystitis patients.
  
  
  METHODS
  We retrospectively examined 46 patients who underwent laparoscopic cholecystectomy (LC) after PTGBD for acute cholecystitis. We evaluated the duration from acute cholecystitis onset to PTGBD and the appropriate interval from PTGBD to elective LC. Intraoperative blood loss, operating time, rate of conversion to open surgery, and rate of severe adhesion were the objective and subjective measures.
  
  
  RESULTS
  Based on the cut-off value calculated using the Youden index, the group with a duration from acute cholecystitis onset to PTGBD of ≤73.5 h had a significantly shorter operating time (127.5 min vs. 180.0 min, P = 0.007), lower rate of severe adhesion (3/20 vs. 14/26, P = 0.007), and lower rate of conversion to open surgery (2/20 vs. 13/26, P = 0.004); moreover, the interval from PTGBD to elective LC did not significantly differ between these groups.
  
  
  CONCLUSIONS
  The most important predictor of successful LC following PTGBD for acute cholecystitis was a duration from acute cholecystitis onset to PTGBD of ≤73.5 h. Hence, PTGBD should be performed immediately in cases where early cholecystectomy is not indicated.
authors.affiliation: Department of Gastroenterological Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0133, Japan. kazunosukefukudai@yahoo.co.jp.
authors.forename: Kazunosuke
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Gastroenterological Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0133, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Department of Gastroenterological Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0133, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Gastroenterological Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0133, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Takeno
authors.affiliation: Department of Gastroenterological Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0133, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Noritomi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D017734:Bile Ducts, Extrahepatic / Q000473:pathology*; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male
keywords: Acute cholecystitis; Laparoscopic cholecystectomy; Percutaneous transhepatic gallbladder aspiration; Percutaneous transhepatic gallbladder drainage; Tokyo Guidelines 2013