Timing of Cholecystectomy after Percutaneous Cholecystostomy for Acute Cholecystitis

Woohyun Jung; Dong-Eun Park

doi:10.4166/kjg.2015.66.4.209

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Jung and Park: Timing of Cholecystectomy after Percutaneous Cholecystostomy for Acute Cholecystitis

Original Article

Korean J Gastroenterol 2015;66(4):209-214.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.66.4.209

Timing of Cholecystectomy after Percutaneous Cholecystostomy for Acute Cholecystitis

Woohyun Jung, Dong-Eun Park

Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea

Correspondence to: Dong-Eun Park, Department of Surgery, Wonkwang University School of Medicine, 460 Iksan-daero, Iksan 54538, Korea. Tel: +82-63-859-1490, Fax: +82-63-855-2386, E-mail: knife@wonkwang.ac.kr

Received 10 July 2015 Revised 11 September 2015 Accepted 13 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Laparoscopic cholecystectomy is the standard treatment for acute cholecystitis. Percutaneous cholecystostomy is an alternative treatment to resolve acute inflammation in patients with severe comorbidities. The purpose of this study is to determine the optimal timing of laparoscopic cholecystectomy after percutaneous cholecystostomy for the patients with acute cholecystitis.

Methods

This retrospective study was conducted in patients who underwent cholecystectomy after percutaneous cholecystostomy from January 2010 through November 2014. Seventy-four patients were included in this study. The patients were divided into two groups by the operation timing. Group I patients underwent cholecystectomy within 10 days after percutaneous cholecystostomy (n=30) and group II patients underwent cholecystectomy at more than 10 days after percutaneous cholecystostomy (n=44).

Results

There was no significant difference between groups in conversion rate to open surgery, operation time, perioperative complications rate, and days of hospital stay after operation. However, complications related to cholecystostomy such as catheter dislodgement occurred significantly more often in group II than group I (group I:group II=0%:18.2%; p=0.013).

Conclusions

Timing of laparoscopic cholecystectomy after percutaneous cholecystostomy did not influence postoperative outcomes. However, late surgery caused more complications related to cholecystostomy than early surgery. Therefore, early laparoscopic cholecystectomy should be considered over late surgery after percutaneous cholecystostomy insertion.

Keywords: Acute cholecystitis, Laparoscopic cholecystectomy, Cholecystostomy

References

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Table 1.

Clinical Characteristics

Characteristic	Group I (n=30)	Group II (n=44)	p-value
Age (yr)	67.9±16.4	69.17±11.4	0.703
Sex (male:female)	17:13	27:17	0.686
WBC count on admission (/mm³)	14,696±5,207	14,090±465	0.670
Gallbladder stone	27 (90.0)	37 (84.1)	0.465
ASA score			0.825
I	3 (10.0)	5 (11.4)
II	15 (50.0)	23 (52.3)
III	12 (40.0)	15 (34.1)
IV	0 (0)	1 (2.3)
Comorbid disease			0.482
None	5 (16.7)	4 (9.1)
Hypertension	18 (60.0)	23 (52.3)
Diabetes mellitus	10 (33.3)	8 (18.2)
Congestive heart failure	1 (3.3)	2 (4.5)
Ischemic heart disease	3 (10.0)	6 (13.6)
Malignant disease	4 (13.3)	4 (9.1)
Liver cirrhosis	1 (3.3)	0 (0)
Others	7 (23.3)	9 (20.5)
Taking anticoagulants	22 (73.3)	28 (63.6)	0.454
Severity criteria ^a			0.949
Mild	18 (60.0)	27 (61.4)
Moderate	11 (36.7)	15 (34.1)
Severe	1 (3.3)	2 (4.5)

Values are presented as mean±SD or n (%).

Group I, patients underwent cholecystectomy within 10 days after percutaneous cholecystostomy insertion; group II, patients underwent cholecystectomy at more than 10 days after percutaneous cholecystostomy insertion.

WBC, white blood cell; ASA, American Society of Anesthesiologist.

^a Updated Tokyo Guidelines for the Management of Acute Cholangitis and Cholecystitis (TG13) severity grading for acute cholecystitis.

Table 2.

Complications Associated with Percutaneous Cholecystostomy

Group I (n=30)	Group II (n=44)	p-value
0 (0%)	8 (18.2%)	0.013
	Tube obstruction, 1 Bleeding, 1 Bile leakage, 1 Tube dislodgement, 5

Table 3.

Postoperative Outcomes

	Group I (n=30)	Group II (n=44)	p-value
Operation time (min)	102.6±49.0	94.9±39.9	0.459
Hospital stay after operation (day)	7.4±5.3	7.6±6.8	0.910
Open conversion	10 (33.3)	11 (25.0)	0.435
Severe inflammation	8	10
Severe bleeding	3	2
Bile duct injury	1	0
Postoperative complications ^a	2 (6.7)	6 (13.6)	0.343
Grade I	1	0
Grade II	0	2
Grade III	1	4

Values are presented as mean±SD or n (%).

^a Clavien-Dindo classification of surgical complications.

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