Emergency Versus Delayed Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage in Grade II Acute Cholecystitis Patients

El-Gendi, Ahmed; Elshafei, Mohamed; Emara, Doaa M.

doi:10.1007/s11605-016-3304-y

Cited by 47 publications

(39 citation statements)

References 52 publications

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“…That said, one study reported that the differences were not substantial between the two approaches . Furthermore, two studies comparing surgery after PTGBD to early surgery without PTGBD (one randomized controlled trial and one cohort study ) both reported good outcomes when Lap‐C was performed after waiting 4–6 weeks after PTGBD for the factors bleeding volume, operating times, percentage of patients switched to open surgery, and incidence of complications. These results suggest that risks may be increased further when Lap‐C is performed at a relatively early stage after PTGBD in high‐risk patients.…”

Section: Introductionmentioning

confidence: 99%

Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

Okamoto

Suzuki

Takada

et al. 2017

J Hepato Biliary Pancreat

601

471

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We propose a new flowchart for the treatment of acute cholecystitis (AC) in the Tokyo Guidelines 2018 (TG18). Grade III AC was not indicated for straightforward laparoscopic cholecystectomy (Lap-C). Following analysis of subsequent clinical investigations and drawing on Big Data in particular, TG18 proposes that some Grade III AC can be treated by Lap-C when performed at advanced centers with specialized surgeons experienced in this procedure and for patients that satisfy certain strict criteria. For Grade I, TG18 recommends early Lap-C if the patients meet the criteria of Charlson comorbidity index (CCI) ≤5 and American Society of Anesthesiologists physical status classification (ASA-PS) ≤2. For Grade II AC, if patients meet the criteria of CCI ≤5 and ASA-PS ≤2, TG18 recommends early Lap-C performed by experienced surgeons; and if not, after medical treatment and/or gallbladder drainage, Lap-C would be indicated. TG18 proposes that Lap-C is indicated in Grade III patients with strict criteria. These are that the patients have favorable organ system failure, and negative predictive factors, who meet the criteria of CCI ≤3 and ASA-PS ≤2 and who are being treated at an advanced center (where experienced surgeons practice). If the patient is not considered suitable for early surgery, TG18 recommends early/urgent biliary drainage followed by delayed Lap-C once the patient's overall condition has improved. Free full articles and mobile app of TG18 are available at:

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Section: Introductionmentioning

confidence: 99%

Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

Okamoto

Suzuki

Takada

et al. 2017

J Hepato Biliary Pancreat

601

471

View full text Add to dashboard Cite

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“…AC patients may present with a wide spectrum of disease severities linked to the operative difficulty, leading to the possibility of bile duct injury when AC patients undergo LC [2][3][4]. Several studies have also endorsed the usefulness of PTGBD for AC with a high success rate of efficacious drainage and a low complication rate, making it is a suitable treatment for AC patients [29,30,36].…”

Section: Discussionmentioning

confidence: 99%

“…Among these 25 articles, 10 were excluded because of a lack of a control group (n = 7) and necessary data (n = 3). Finally, 15 articles were included in this meta-analysis [3,4,6,10,[15][16][17][28][29][30][31][32][33][34][35].…”

Section: Literature Retrieval and Study Selectionmentioning

confidence: 99%

“…Acute cholecystitis (AC), an inflammatory condition of the gallbladder, is also a common disease that involves hospitalization and surgical treatment [1]. Patients with AC may present with a wide spectrum of inflammation, which may progress to empyema, perforation, and abscess formation, with an overall mortality rate of approximately 0.6% [2][3][4]. Since the first cholecystectomy was performed with the use of an operative laparoscope 30 years ago [5], laparoscopic cholecystectomy (LC) is currently recognized as a standard treatment for AC.…”

Section: Introductionmentioning

confidence: 99%

“…Percutaneous transhepatic gallbladder drainage (PTGBD), which was first applied by Radder in 1980 [11], is a minimally invasive operation performed to relieve gallbladder tension through external drainage under ultrasound or CT guidance [3]. According to the 2018 Tokyo guidelines for drainage management of AC, PTGBD can alleviate inflammation caused by edema of the gallbladder wall and pericholecystic adhesions, and it has the advantage of a lower risk of adverse events compared with cholecystectomy, which is an alternative to surgical treatment in highrisk AC patients [6,12,13].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis

et al. 2020

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Laparoscopic cholecystectomy and percutaneous transhepatic gallbladder drainage (PTGBD) are common treatments for patients with acute cholecystitis. However, the safety and efficacy of emergency laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) after PTGBD in patients with acute cholecystitis remain unclear. The PubMed, EMBASE, and Cochrane Library databases were searched through October 2019. The quality of the included nonrandomized studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS). The meta-analysis was performed using STATA version 14.2. A random-effects model was used to calculate the outcomes. A total of fifteen studies involving 1780 patients with acute cholecystitis were included in the meta-analysis. DLC after PTGBD was associated with a shorter operative time (SMD − 0.51; 95% CI − 0.89 to − 0.13; P = 0.008), a lower conversion rate (RR 0.43; 95% CI 0.26 to 0.69; P = 0.001), less intraoperative blood loss (SMD − 0.59; 95% CI − 0.96 to − 0.22; P = 0.002) and longer time of total hospital stay compared to ELC (SMD 0.91; 95% CI 0.57–1.24; P < 0.001). There was no difference in the postoperative complications (RR 0.68; 95% CI 0.48–0.97; P = 0.035), biliary leakage (RR 0.65; 95% CI 0.34–1.22; P = 0.175) or mortality (RR 1.04; 95% CI 0.39–2.80; P = 0.933). Compared to ELC, DLC after PTGBD had the advantages of a shorter operative time, a lower conversion rate and less intraoperative blood loss.

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Optimal timing of laparoscopic cholecystectomy after gallbladder drainage for acute cholecystitis: A multi‐institutional retrospective study

Tomimaru

Fukuchi

Yokoyama

et al. 2020

J Hepato Biliary Pancreat

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BackgroundThere is no consensus on the optimal timing of laparoscopic cholecystectomy (LC) after gallbladder drainage for acute cholecystitis (AC). To obtain evidence for a consensus, we investigated surgical outcomes of LC after gallbladder drainage with respect to the time elapsed from gallbladder drainage to surgery in a multi‐institutional retrospective study.MethodsThis study enrolled 347 patients who underwent LC after gallbladder drainage for AC at 15 institutions. Surgical outcome of LC was investigated in the cases based on the interval from gallbladder drainage to surgery.ResultsThe median interval from gallbladder drainage to surgery of the patients was 34 days, with a mean ± standard deviation of 58 ± 99 days. Patients were divided into four groups based on quartiles of the interval: Group A, cases with an interval of 1‐12 days; Group B, cases with an interval of 13‐34 days; Group C, cases with an interval of 35‐73 days; and Group D, cases with an interval of ≥74 days. Surgical outcomes, which were evaluated with respect to intraoperative blood loss, operation time, postoperative hospital stay, rate of intraoperative accident, conversion from laparoscopic to open surgery, and postoperative complication, were worse in Group B than in the other groups. The finding was verified by propensity score‐matched analysis.ConclusionsSurgical outcome of LC after gallbladder drainage for AC was inferior in Group B compared with the other groups. This finding could be useful for determining the optimal timing of LC after gallbladder drainage for AC.

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Emergency Versus Delayed Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage in Grade II Acute Cholecystitis Patients

Abstract: PTGBD and ELC are highly efficient in resolving cholecystitis sepsis. Delayed cholecystectomy after PTGBD produces better outcomes with a lower conversion rate, fewer procedure-related complications, and a shorter hospital stay than emergency cholecystectomy.

Cited by 47 publications

References 52 publications

Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis

Optimal timing of laparoscopic cholecystectomy after gallbladder drainage for acute cholecystitis: A multi‐institutional retrospective study

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