The optimal timing of interval laparoscopic cholecystectomy following percutaneous cholecystostomy based on pathological findings and the incidence of biliary events. (23rd July 2021)

• Record Type: Journal Article
• Authors: Hung, Yu‐Liang; Chen, Huan‐Wu; Tsai, Chun‐Yi; Chen, Tse‐Ching; Wang, Shang‐Yu; Sung, Chang‐Mu; Hsu, Jun‐Te; Yeh, Ta‐Sen; Yeh, Chun‐Nan; Jan, Yi‐Yin
• Is Part Of: Journal of hepato-biliary-pancreatic sciences. Volume 28:Number 9(2021)
• Page Start: 751
• Page End: 759
• Publication Date: 2021-07-23
• Subjects: cholecystectomy -- cholecystitis -- cholecystolithiasis -- cholecystostomy -- pathological processes; Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 617.556
• DOI: 10.1002/jhbp.1012
• Languages: English
• ISSNs: 1868-6974

Abstract

Abstract: Background: The incidence of biliary events (BE) following percutaneous cholecystostomy (PC) in acute cholecystitis (AC) patients is high. Therefore, definitive laparoscopic cholecystectomy (LC) is recommended. We aimed to investigate the optimal timing of LC following PC with regard to the clinical course and pathological findings. Methods: All 744 AC patients with PC were included. The incidence and median number of BE were investigated with the concept of competing risks. The 344 patients with interval LC were divided into two groups based on the pathological findings of resected gallbladders: the acute/acute‐and‐chronic group (AANC group) (n = 221) and the chronic group (n = 123). A comparative analysis of the demographic data and perioperative outcomes was performed. Results: Among the 744 AC patients with PC, 142 patients experienced recurrent BE. The cumulative incidence of BE was 26.6%, and the median time to recurrence was 67.5 days. The PC‐to‐LC days of the chronic group were longer than those of the AANC group (73.51 vs 63.00, P < .001). The multivariate analysis indicated that the operation time was longer in the AANC group than in the chronic group ( P = .040). Conclusion: In terms of the clinical course and sequential pathological changes in the gallbladder, a 9‐ to 10‐week interval after PC is the optimal timing for LC. Abstract : Highlight Hung and colleagues performed a retrospective study to determine the optimal timing of laparoscopic cholecystectomy following percutaneous cholecystostomy placement for acute cholecystitis. Based on the sequential pathological changes to the gallbladder and the risk of recurrent biliary events, 9‐10 weeks after percutaneous cholecystostomy was considered the optimal timing.