Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitisReportar como inadecuado




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BMC Gastroenterology

, 17:71

Hepatobiliary and pancreatic disorders

Abstract

BackgroundThe Tokyo guideline for acute cholecystitis recommended percutaneous transhepatic gallbladder drainage followed by cholecystectomy for severe acute cholecystitis, but the optimal timing for the subsequent cholecystectomy remains controversial.

MethodsSixty-seven patients who underwent either laparoscopic or open cholecystectomy after percutaneous transhepatic gallbladder drainage for severe acute cholecystitis were enrolled and divided into difficult cholecystectomy group A and non-difficult cholecystectomy group B. Patients who had one of these conditions were placed in group A: 1 conversion from laparoscopic to open cholecystectomy; 2 subtotal cholecystectomy and-or mucoclasis; 3 necrotizing cholecystitis or pericholecystic abscess formation; 4 tight adhesions around the gallbladder neck; and 5 unsuccessfully treated using PTGBD. Preoperative characteristics and postoperative outcomes were analyzed.

ResultsThe interval between percutaneous transhepatic gallbladder drainage and cholecystectomy in Group B was longer than that in Group A 631 h vs. 325 h; p = 0.031. Postoperative complications occurred more frequently when the interval was less than 216 h compared to when it was more than 216 h 35.7 vs. 7.6%; p = 0.006.

ConclusionsCholecystectomy for severe acute cholecystitis was technically difficult when performed within 216 h after percutaneous transhepatic gallbladder drainage.

KeywordsCholecystitis Percutaneous transhepatic gallbladder drainage Cholecystectomy AbbreviationsACAcute cholecystitis

LCLaparoscopic cholecystectomy

LILong interval

PTGBDPercutaneous transhepatic gallbladder drainage

ROCReceiver operating characteristic

SEMStandard error mean

SIShort interval

TG13Tokyo Guidelines 2013

Electronic supplementary materialThe online version of this article doi:10.1186-s12876-017-0631-8 contains supplementary material, which is available to authorized users.





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