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Choi, Park, Choi, Kim, and Kim: Comparison of clinical result between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis
Original Article
Korean Journal of Hepato-Biliary-Pancreatic Surgery

Korean Journal of Hepato-Biliary-Pancreatic Surgery 2012; 16(4): 147-153.

Published online: 30 November 2012

DOI: https://doi.org/10.0000/kjhbps.2012.16.4.147

Comparison of clinical result between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis

Jae Woo Choi, Sin Hui Park, Sang Yong Choi, Haeng Soo Kim, Taeg Hyun Kim

Department of Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea.

Corresponding author: Taeg Hyun Kim. Department of Surgery, Gwangmyeong Sungae Hospital, Chulsan 3-dong, Gwangmyeong 423-711, Korea. Tel: +82-2-2680-7211, Fax: +82-2-2680-7755, taeghyun@gmail.com

Received 28 September 2012       Revised 5 October 2012       Accepted 15 October 2012

Copyright © 2012 Korean Association of HBP Surgery

Abstract

Backgrounds/Aims

In the treatment of complicated cholecystitis, laparoscopic cholecystectomy (LC) has limited efficacy due to its substantial post-operative complications. In addition, the clinical characteristics of complicated cholecystitis (CC) patients were suspected as advanced age with highly risky comorbidity. Percutaneous transhepatic gall bladder (PTGBD) drainage could be an alternative option for successful LC. Hence, this study evaluated the outcome of PTGBD for CC within and after 5 days.

Methods

The medical records of 109 consecutive CC patients who had undergone an LC between January 2007 and December 2011 were retrospectively reviewed and compared with the medical records of CC patients who had undergone an LC within 72 hours of (group I, n=63) or 5 days after PTGBD (group II, n=40). In addition, group I was divided into group Ia (n=46) and group Ib (n=17), according to the patients' development of open-conversion or post-operative complications. The clinical outcomes of the four groups were analyzed.

Results

There was a significantly higher reference to age, the ASA score grading, and predominant comorbidities in group II than in group I. The peri-operative results of group II showed lower blood loss and relatively shorter operating times than those of group I. In the cases of early LC within 72 hours (group Ia vs. group Ib), the difference was statistically insignificant.

Conclusions

The delayed LC after PTGBD for complicated cholecystitis with high clinical risk had better results in this study, although it prolonged the patient's hospital stay.

Keywords: Complicated cholecystitis, Percutaneous transhepatic gallbladder drainage, Early laparoscopic cholecystectomy, Delayed laparoscopic cholecystectomy

Figures and Tables

Fig. 1
Axial (A, B) and coronal (C, D) CT images of empyema of the gallbladder in an 82 year-old female patient. (A, C) Computed tomography scan shows a markedly dilated and gallbladder with ascites collection at perihepatic space. (B, D) Follow up CT image obtained 14 days after percutaneous transhepatic gallbladder drainage shows marked resolution of the abscess with drainage tube.
kjhbps-16-147-g001
Table 1
Pre-operative characteristics of complicated cholecystitis
kjhbps-16-147-i001

Group I, laparoscopic cholecystectomy underwent within 72 hours; Group II, preoperative percutaneous transhepatic gallbladder drainageand subsequent laparoscopic cholecystectomy underwent after 5 days; ASA, American Society of Anesthesiologists score; WBC, white blood cell; CRP, C-reactive protein

Table 2
Comparison of outcome during operation of complicated cholecystitis
kjhbps-16-147-i002

Open conversion, converted from laparoscopic cholecystectomy to open cholecystectomy

Table 3
Postoperative results of complicated cholecystitis
kjhbps-16-147-i003

*Worsen existing disease or hypotension or arrhythmia; †Including stress gastritis, ileus, diarrhea

Table 4
Comparison on development of perioperative difficulty or postoperative complication between early laparoscopic cholecystectomy of complicated cholecystitis
kjhbps-16-147-i004

Surgery-related complications included bile leakage and subhepatic abscess formation. Cardiovascular complications included worsen existing disease, hypotension or arrhythmia. Respiratory complications included pneumonia and pulmonary embolism

Group Ia, no development of any complication with early laparoscopic cholecystectomy undergoing within 72 hours; Group Ib, development of some complications or open conversion with early laparoscopic cholecystectomy

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