Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2020; 26(36): 5498-5507
Published online Sep 28, 2020. doi: 10.3748/wjg.v26.i36.5498
Impact of B-mode-ultrasound-guided transhepatic and transperitoneal cholecystostomy tube placement on laparoscopic cholecystectomy
Peng Liu, Che Liu, Yin-Tao Wu, Jian-Yong Zhu, Wen-Chao Zhao, Jing-Bo Li, Hong Zhang, Ying-Xiang Yang
Peng Liu, Che Liu, Yin-Tao Wu, Jian-Yong Zhu, Wen-Chao Zhao, Jing-Bo Li, Hong Zhang, Ying-Xiang Yang, Department of Hepatobiliary Surgery, The Sixth Medical Center of People’s Liberation Army General Hospital, Beijing 100048, China
Author contributions: Liu P performed percutaneous cholecystostomy and laparoscopic cholecystostomy, collected the data, performed the statistical analysis and drafted the manuscript; Yang YX designed the study and revised the manuscript; Liu C, Wu YT, Zhu JY, Zhao WC, Li JB and Zhang H performed percutaneous cholecystostomy and laparoscopic cholecystostomy, collected the data and coordinated the work; All authors read and approved the final paper.
Institutional review board statement: The study was approved by the Ethics Committee of The Sixth Medical Center of People’s Liberation Army General Hospital.
Conflict-of-interest statement: The authors have no conflicts of interest or financial ties to disclose.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
STROBE statement: The guidelines of the STROBE Statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ying-Xiang Yang, MD, Associate Chief Physician, Surgeon, Department of Hepatobiliary Surgery, The Sixth Medical Center of People’s Liberation Army General Hospital, No. 6 Fucheng Road, Beijing 100048, China. yangyx_pla@163.com
Received: June 10, 2020
Peer-review started: June 10, 2020
First decision: July 25, 2020
Revised: August 25, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: September 28, 2020
ARTICLE HIGHLIGHTS
Research background

In elderly or critically ill patients with acute cholecystitis (AC), percutaneous cholecystostomy (PC) can be used as an immediate treatment, and cholecystectomy can be safely performed when the patient’s condition improves. PC can serve as a bridge to cholecystectomy until the inflammatory process has subsided.

Research motivation

There are two access routes for PC: The percutaneous transhepatic gallbladder drainage (PHGD) and the percutaneous transperitoneal gallbladder drainage (PPGD). Each approach has distinct advantages. However, few studies have reported the effects of the two different approaches on laparoscopic cholecystectomy (LC) followed by PC.

Research objectives

This retrospective cohort study was undertaken to compare surgical results after LC followed by PHGD and PPGD to determine the optimal approach for LC after PC in patients with AC.

Research methods

We retrospectively studied 103 patients with acute calculous cholecystitis who underwent scheduled LC after PC between January 2010 and January 2019. Group I included 58 patients who underwent scheduled LC after PHGD. Group II included 45 patients who underwent scheduled LC after PPGD. Clinical outcomes were analyzed according to each group.

Research results

This study showed that there was no significant difference in the conversion rate to laparotomy, rate of subtotal cholecystectomy and rate of complications between the PHGD group and the PPGD group. However, the PHGD group required less operation time and resulted in lower intraoperative blood loss and shorter hospital stay.

Research conclusions

Our results suggest that B-mode ultrasound-guided PHGD is superior to PPGD followed by LC for the treatment of AC. In order to reduce the difficulty of laparoscopic cholecystectomy after PC, we suggest choosing PHGD in the early stage of AC for elderly or critically ill patients.

Research perspectives

In order to reach a more accurate conclusion, prospective randomized controlled trials should be carried out in the future.