Published online Sep 28, 2020. doi: 10.3748/wjg.v26.i36.5498
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
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.
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.
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.
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.
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.
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.
In order to reach a more accurate conclusion, prospective randomized controlled trials should be carried out in the future.