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

Abstract

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.

Ultimate outcomes of three modalities for non-surgical gallbladder drainage in acute cholecystitis with or without concomitant common bile duct stones

“…In our study, 51 patients (59.3%) with ETGS and 13 patients (37.1%) with PC further underwent cholecystectomy without surgical complications, with a median time from gallbladder drainage to cholecystectomy of 130 days and 72 days, respectively. In a multi-center retrospective study of laparoscopic cholecystectomy after PC and endoscopic naso gallbladder drainage for acute cholecystitis (n = 347) reported by Tomimaru et al [ 25 ], the time for cholecystectomy in their series were within 2 weeks and after 1 month, respectively, with good surgical outcomes. In a study of cholecystectomy after EUGS (n = 13) and PC (n = 21) reported by Saumoy et al [ 26 ], all patients had technically successful with the mean time from gallbladder drainage to cholecystectomy of 156 days and 80 days, respectively.…”

Efficacy of superb microvascular imaging of ultrasound for diagnosis of gallbladder lesion

“…The diagnosis and treatment of GB lesions have been well discussed. [15][16][17][18][19][20][21] In particular, the differentiation between benign lesions and malignant lesions is a major issue of concern. Various approaches have been attempted for the accurate diagnosis of GB lesions including analysis of the enhancement pattern on contrast-enhanced US (CE-US) or contrast-enhanced EUS (CE-EUS).…”

“…The diagnosis and treatment of GB lesions have been well discussed 15‐21 . In particular, the differentiation between benign lesions and malignant lesions is a major issue of concern.…”

Vascular disorders of the gallbladder and bile ducts: Imaging findings

“…A sound knowledge of vascular anatomy and potential variants is important to avoid vascular injury in both open surgery as well as laparoscopic surgery. Laparoscopic cholecystectomy is the standard treatment for benign gallbladder disease 6,7 and there is emerging evidence that supports laparoscopic cholecystectomy for the treatment of early gallbladder cancer. 6,8 At laparoscopy, vascular injury may occur either during creation of pneumoperitoneum or during dissection within Calot's triangle.…”