Early laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage is feasible in low-risk patients with acute cholecystitis.
BACKGROUND
Laparoscopic cholecystectomy (Lap-C) is generally performed following percutaneous transhepatic gallbladder drainage (PTGBD) in patients with acute cholecystitis (AC). However, the timing of Lap-C and risk factors for postoperative complications following PTGBD are still unclear.


METHODS
We analyzed 331 patients with AC who underwent Lap-C following PTGBD. Univariate and multivariate logistic regression analyses were used for identifying risk factors associated with poor surgical outcomes, including postoperative complications in the total group and the early Lap-C subgroup (n = 152). Based on the Tokyo guideline 2013 (TG 13), all patients were divided into two groups according to the period (2009-2013, pre-TG 13 group; 2014-2020, post-TG 13 group), and each analysis was performed in those subgroups.


RESULTS
We found that early Lap-C (≤ 42 days after PTGBD) was associated with postoperative complications (OR 2.04, P = .022). Importantly, subgroup analyses revealed that Charlson comorbidity index (CCI) (OR 6.15, P < .001) and cholecystitis severity grade (OR 2.93, P = .014) were independent risk factors of postoperative complications in the early Lap-C group. Among the early Lap-C group, high CCI was also an independent risk factor for surgical complications in both pre-TG 13 (OR 14.87, P = .003) and post-TG 13 (OR 3.23, P = .046) groups. Interestingly, we found that the incidence of postoperative complications in the low-risk early Lap-C group was not different from the delayed group, even in the cases of very early surgery (≤ 1 week following PTGBD).


CONCLUSIONS
These findings suggest that early Lap-C is feasible following PTGBD, especially in low-risk patients, although future prospective large-scale studies are needed.
['Han|Ji Won|JW|', 'Choi|Young Hoon|YH|https://orcid.org/0000-0002-2633-1401', 'Lee|In Seok|IS|', 'Chun|Ho Jong|HJ|', 'Choi|Ho Joong|HJ|', 'Hong|Tae Ho|TH|https://orcid.org/0000-0003-3864-8104', 'You|Young Kyoung|YK|']
D017081:Cholecystectomy, Laparoscopic D002764:Cholecystitis D041881:Cholecystitis, Acute D004322:Drainage D005704:Gallbladder D006801:Humans D012189:Retrospective Studies
laparoscopic cholecystectomy percutaneous transhepatic gallbladder drainage acute cholecystitis cholecystitis severity grade Charlson comorbidity score