The Role of Series Cholecystectomy in High Risk Acute Cholecystitis Patients Who Underwent Gallbladder Drainage

Abstract

Background: Cholecystectomy (CCY) is the only definitive therapy for acute cholecystitis. We conducted this study to evaluate which patients may not benefit from further CCY after percutaneous transhepatic gallbladder drainage (PTGBD) has been performed in acute cholecystitis patients.Methods: Acute cholecystitis patients with PTGBD treatment were selected from one million random samples from the National Health Insurance Research Database obtained between January 2004 and December 2010. Recurrent biliary events (RBEs), RBE-related medical costs, RBE-related mortality rate and an RBE-free survival curve were compared in patients who accepted CCY within 2 months and patients without CCY within 2 months after the index admission.Results: Three hundred and sixty-five acute cholecystitis patients underwent PTGBD at the index admission. A total of 190 patients underwent further CCY within 2 months after the index admission. The other 175 patients did not accept further CCY within 2 months after the index admission. RBE-free survival was significantly better in the CCY within 2 months group (60 vs. 42%, p < 0.001). The RBE-free survival of the CCY within 2 months group was similar to that of the no CCY within 2 months group in patients ≥ 80 years old and patients with a Charlson Comorbidity Index (CCI) score ≥ 9.Conclusions: We confirmed CCY after PTGBD reduced RBEs, RBE-related medical expenses, and the RBE-related mortality rate in patients with acute cholecystitis. In patients who accepted PTGBD, the RBE and survival benefits of subsequent CCY within 2 months became insignificant in patients ≥ 80 years old or with a CCI score ≥ 9.

Percutaneous cholecystostomy in acute complicated versus uncomplicated cholecystitis; is there a difference in outcomes? A single-center experience

“…Long-term data or even larger pooled data is, however, lacking; from our perspective, we feel that larger studies comparing drains that have been internalized versus those that remain external would be of clinical interest to interventional radiologists. Internalization may also prove to be a better long-term option for cost mitigation as the management of recurrent biliary events in patients with long-term drains in situ has been described to be associated with higher costs (17).…”

Assessment of Gallbladder Drainage Methods in the Treatment of Acute Cholecystitis: A Literature Review

“…Whether to perform the postprocedural cholecystectomy mainly depends on the patient's clinical condition after the acute inflammation withdrawal. If the patient is fit for surgery, the majority of authors support interval cholecystectomy due to the high risk of recurrent biliary events usually caused by cystic duct obstruction or bile stasis and, consequently, high medical expenses [17,47,48].…”