New Scoring System for Prediction of Surgical Difficulty During Laparoscopic Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage. Issue 2 (27th October 2021)

• Record Type: Journal Article
• Authors: Matsumoto, Michinori; Abe, Kyohei; Futagawa, Yasuro; Furukawa, Kenei; Haruki, Koichiro; Onda, Shinji; Kurogochi, Takanori; Takeuchi, Nana; Okamoto, Tomoyoshi; Ikegami, Toru
• Is Part Of: Annals of gastroenterological surgery. Volume 6:Issue 2(2022)
• Page Start: 296
• Page End: 306
• Publication Date: 2021-10-27
• Subjects: bile duct injury -- laparoscopic cholecystectomy -- percutaneous transhepatic gallbladder drainage -- receiver operating characteristic -- scoring system; Digestive organs -- Surgery -- Periodicals; 617.43
• DOI: 10.1002/ags3.12522
• Languages: English
• ISSNs: 2475-0328

Abstract

Abstract: Background: The surgical difficulty of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) remains unknown. This study aimed to establish a scoring system (SS) to predict the necessity of a bailout procedure during LC after PTGBD and to evaluate the relationship between SS and perioperative complications. Methods: We retrospectively studied 70 patients who underwent LC after PTGBD. Preoperative factors potentially predictive of the need for the bailout procedure were analyzed. The SS included significantly predictive factors, with their cutoff values determined by receiver operating characteristic curves. Patients were assigned a score of 1 when exhibiting only one of these abnormalities. We compared the perioperative factors between three groups with scores of 0, 1, or 2. The SS was applied to another series of 65 patients for validation. We compared the score‐2 patient perioperative factors between LC with the bailout procedure and open cholecystectomy from the beginning (OC). Results: Independent predictors were time until PTGBD after symptom onset and the maximal wall gallbladder thickness (cutoff values: 3 days and 10 mm, respectively). The high‐score group was significantly associated with bile duct injury (BDI). The sensitivity and specificity of our SS were 75.0% and 98.1% in validation, respectively. The score‐2 OC and laparoscopic subtotal cholecystectomy (LSC) groups had no BDI. Conclusions: The SS using time until PTGBD after symptom onset and gallbladder wall thickness for predicting the need for the bailout procedure correctly predicted the need. The scores might be associated with the risk of BDI, and LSC or OC might be a better choice for score‐2 patients. Abstract : We propose a new scoring system to predict the necessity of a bailout procedure during LC after PTGBD, using significant predictors of time until PTGBD after symptom onset and the maximal wall thickness of GB. Our scoring system for the necessity of the bailout procedure seems to provide a precise prediction and might be associated with the risk of BDI. It might be better to select flexibly laparoscopic subtotal cholecystectomy or open cholecystectomy from the beginning for patients with a score of 2 after PTGBD.