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11.08.2023 | 2023 SAGES Oral

What is the ideal timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis?

verfasst von: Spyridon Giannopoulos, Keith Makhecha, Sathvik Madduri, Felix Garcia, Timothy C. Baumgartner, Dimitrios Stefanidis

Erschienen in: Surgical Endoscopy | Ausgabe 11/2023

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Abstract

Background

Acute cholecystitis (AC) is one of the most prevalent diseases in clinical practice. Poor surgical candidates may benefit from early percutaneous cholecystostomy (PC) drainage followed by interval cholecystectomy (IC), which is the definitive treatment. The optimal timing between the PC drainage and the IC has not been identified. This study aimed to investigate how the duration between PC and IC affects perioperative outcomes and identify the optimal IC timing to minimize complications.

Methods

This retrospective cohort study included all adult patients diagnosed with AC who underwent PC followed by IC at a single institution center between 2014 and 2022. Patients with a history of hepatobiliary surgery, stones in the common bile duct, cirrhosis, active malignancy, or prolonged immunosuppression were excluded. The analysis did not include cases with major concurrent procedures during cholecystectomy, previously aborted cholecystectomies, or failure of the PC drain to control the inflammation. Linear and logistic regression models were used to analyze the impact of the interval between PC and IC on intra- and perioperative outcomes.

Results

One hundred thirty-two patients (62.1% male) with a mean age of 64.4 ± 15 (mean ± SD) years were diagnosed with AC (25% mild, 47.7% moderate, 27.3% severe). All patients underwent PC followed by IC after a median of 64 [48–91] days. Longer ICU stay was associated with longer time intervals between PC and IC (Coef 105.98, p < 0.001). No significant variations were detected in the intraoperative and perioperative outcomes between patients undergoing IC within versus after 8 weeks from PC placement. However, a higher percentage of patients with delayed IC (after 8 weeks) were discharged home (96.4% vs. 83.7%; p = 0.019).

Conclusions

Patients may benefit from undergoing IC after the 8-week cutoff after PC. However, very long periods between PC and IC procedures may increase the risk of longer ICU stay.

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Titel: What is the ideal timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis?
verfasst von: Spyridon Giannopoulos
Keith Makhecha
Sathvik Madduri
Felix Garcia
Timothy C. Baumgartner
Dimitrios Stefanidis
Publikationsdatum: 11.08.2023
Verlag: Springer US
Erschienen in: Surgical Endoscopy / Ausgabe 11/2023
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-023-10332-2

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What is the ideal timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis?