scholarly journals Laparoscopic subtotal cholecystectomy after percutaneous transhepatic gallbladder drainage for grade II or III acute cholecystitis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masafumi Ie ◽  
Morihiro Katsura ◽  
Yukihiro Kanda ◽  
Takashi Kato ◽  
Kazuya Sunagawa ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Acute Cholecystitis ◽  
Gallbladder Drainage ◽  
Open Conversion ◽  
Subtotal Cholecystectomy ◽  
Conversion Rates ◽  
Significant Difference ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Grade Ii

Abstract Background Severe adhesions and fibrosis between the posterior wall of the gallbladder and liver bed often render total cholecystectomy after percutaneous transhepatic gallbladder drainage (PTGBD) difficult, leading to high open conversion rates. Since the publication of Tokyo Guidelines 2018 (TG18), our policy has shifted from open conversion to subtotal cholecystectomy (SC) when total laparoscopic cholecystectomy for difficult cases of cholecystitis is not feasible. Recently, SC has been frequently applied as bailout surgery for complicated cholecystitis. Nonetheless, the efficacy and validity of laparoscopic SC after PTGBD remain unclear. This study aimed to evaluate the safety and feasibility of laparoscopic SC after PTGBD for grade II or III acute cholecystitis (AC) by comparing two periods of altered surgical strategies. Methods This retrospective cohort study was conducted between January 2013 and December 2020. A total of 44 eligible patients with grade II or III AC were divided according to the time of cholecystitis onset into the pre-TG18 group (2013–2017, n = 17) and post-TG18 group (2018–2020, n = 27). Patients’ background demographics, surgical method, surgical results, and postoperative complications were compared. Results The interval between PTGBD and surgery was significantly longer in the post-TG18 group than in the pre-TG18 group (15 [interquartile range: 9–42] days vs. 8 [4–11] days; P = 0.010). The frequency of laparoscopic cholecystectomy significantly increased from 52.9% in the pre-TG18 group to 88.9% in the post-TG18 group (P = 0.007), whereas the frequency of SC was 23.5% and 40.7%, respectively, which showed no statistically significant difference (P = 0.241). However, the rate of laparoscopic SC significantly increased from 0 to 90.9% among 15 SC cases, whereas the rate of open SC significantly plummeted from 100 to 9.1% (P = 0.001). Significant differences in the operative time, amount of intraoperative bleeding, and incidence of postoperative complications (wound infection and subhepatic abscess) were not observed. Mortality, bile leakage, and bile duct injury did not occur in either group. Conclusions For grade II or III AC after PTGBD, aggressive adoption of SC increased the completion rate of laparoscopic surgery. Laparoscopic SC is a safe and feasible treatment option.

Percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy for acute cholecystitis

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Minh Hai Pham ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Medical Center ◽  
Case Series ◽  
Morbidity Rate ◽  
Safe Procedure ◽  
Gallbladder Drainage ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Grade Ii ◽  
Grade Iii

Abstract Introduction: Laparoscopic cholecystectomy (LC) has been considered as main treatment for acute cholecystitis due to gallstones. However, LC is not entirely safe for patients with severe comorbidities, high risk of surgery. In such circumstances, two-stage treatment including percutaneous transhepatic gallbladder drainage (PTGBD) first and then LC is an appropriate choice. PTGBD followed by LC or LC after PTGBD might be technically difficult. This article was written to evaluate the feasibility and the safety of PTGBD followed by LC (PTGBD + LC). Materials and Methods: This case series report was conducted on patients who underwent PTGBD + LC in University Medical Center, Ho Chi Minh City, Vietnam, from June 2018 to June 2020. We applied TG 2018 criteria for diagnosis and severity grading of cholecystitis in all patients. The comorbidities were evaluted according to Charlson comorbidity index (CCI) and American Society of Anesthesiologists physical status (ASA-PS) classification. Indications for PTGBD were grade II or grade III acute cholecystitis and the presence of a severe comorbidities (CCI > 6 and/or ASA > III). Results: From June 2018 to June 2020, there were 13 cases performed PTGBD + LC. There were 84,6% of grade II cholecystitis cases and 15,4% of grade III cholecystitis cases according to Tokyo guidelines 2018 criteria with comorbidities (30,8% of cases with CCI > 6, 100% of cases with ASA > III). Mean operative time: 126 minutes; one case needed transfusion due to bleeding from gallbladder inflammatory; no conversion to open surgery; morbidity rate was 23,1% (1 bile leakage successfully treated with preservation, 1 surgical site infection, 1 pneumoniae); mean hospital stay was 5,25 days; no mortality was observed in this series. Conclusions: PTGBD followed up by LC is feasible and safe procedure for acute cholecystitis in selected patients.

scholarly journals Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yunxiao Lyu ◽  
Ting Li ◽  
Bin Wang ◽  
Yunxiao Cheng
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Medical Costs ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Group Ii

AbstractThere is no consensus on the optimal timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute cholecystitis (AC). We retrospectively evaluated patients who underwent LC after PTGBD between 1 February 2016 and 1 February 2020. We divided patients into three groups according to the interval time between PTGBD and LC as follows: Group I (within 1 week), (Group II, 1 week to 1 month), and Group III (> 1 month) and analyzed patients’ perioperative outcomes. We enrolled 100 patients in this study (Group I, n = 22; Group II, n = 30; Group III, n = 48). We found no significant difference between the groups regarding patients’ baseline characteristics and no significant difference regarding operation time and estimated blood loss (p = 0.69, p = 0.26, respectively). The incidence of conversion to open cholecystectomy was similar in the three groups (p = 0.37), and we found no significant difference regarding postoperative complications (p = 0.987). Group I had shorter total hospital stays and medical costs (p = 0.005, p < 0.001, respectively) vs Group II and Group III. Early LC within 1 week after PTGBD is safe and effective, with comparable intraoperative outcomes, postoperative complications, and conversion rates to open cholecystectomy. Furthermore, early LC could decrease postoperative length of hospital stay and medical costs.

scholarly journals Operative and Postoperative Complications of Laparoscopic Cholecystectomy: Experience from a Tertiary Care Hospital of Bangladesh

2017 ◽  
Vol 5 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Tapash Kumar Maitra ◽  
Mahmud Ekram Ullah ◽  
Faruquzzaman ◽  
Samiran Kumar Mondol
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Invasive Technique ◽  
Favorable Result ◽  
Age Group ◽  
Open Conversion ◽  
Female Patients ◽  
Complications Of Laparoscopic Cholecystectomy

Background: The technique of laparoscopic surgery has rapidly become popular because of its several advantages over conventional open surgery. The reduction of postoperative pain provided positive human impact, and the reduction of length of hospital stay as well as the earlier return to work generated a positive socioeconomic impact. However, in spite of being a minimally invasive technique, this procedure has different peroperative and postoperative complications which cannot be disregarded.Objective: To evaluate the complications of laparoscopic cholecystectomy in symptomatic and asymptomatic cholelithiasis and other benign gall bladder diseases.Methodology: 172 patients who underwent laparoscopic cholecystectomy were included in this prospective study on the basis of non-randomized convenient sampling from a period of September 30, 2014 to September 30, 2016 in BIRDEM General Hospital, Dhaka, Bangladesh. Data of the patients regarding outcomes and complications were analyzed.Result: Results of this study suggests that 35.5% cases were male and 64.5% patients were female. In male group, most of the patients (18.0%) were in 41-50 years of age group followed by 9.9% in 51-60 years age group, whereas among the female patients these were 33.1% and 15.7% respectively. Mean±SD of age were46±1.7 and 42±1.3 years in case of male and female patients respectively.In 119 (69.2%) out of total 172 cases, laparoscopic cholecystectomy was done for chronic cholecystitis and in 18.6% (32 out of total 172) cases, it was performed for acute cholecystitis. Intra-operative bile leak(11.0%) was found to be the most frequent complications during laparoscopic cholecystectomy. The incidence rates of perforation of gall bladder, stone spillage were 9.3% and 5.2% respectively. Trocar site, vascular, and hepatic bed hemorrhages were 7.0%, 4.7% and 4.0% respectively. Open conversion was done in 17 cases (9.9%). Port site infection and post cholecystectomy syndrome developed in 5.2% and 4.7% cases respectively. The overall mortality was approximately 1.1%. Serious complications likebowel injury and bile duct injury were recorded in 0.6% and 1.2% cases respectively.The results of this study suggest that gender, age, co-morbidities, previous abdominal surgery, acute cholecystitis, obesity, thickened gall bladder wall on ultrasound, history of preoperative ERCPare probablyimportant and clinically significant relevant factors for open conversion of laparoscopic cholecystectomy.Conclusion: In our study, complications of laparoscopic cholecystectomy were similar to those of different centres in western countries. We found laparoscopic cholecystectomy as a safe and effective procedure in almost all patients with cholelithiasis. Proper preoperative work up, awareness of possible complications and adequate training on laparoscopic technique make this operation a safe procedure with favorable result and lesser complications.Bangladesh Crit Care J March 2017; 5(1): 11-16

scholarly journals Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Prospective, Randomized Study

2014 ◽  
Vol 99 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Alper Bilal Özkardeş ◽  
Mehmet Tokaç ◽  
Ersin Gürkan Dumlu ◽  
Birkan Bozkurt ◽  
Ahmet Burak Çiftçi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Operation Time ◽  
Early Laparoscopic Cholecystectomy ◽  
Laparoscopic Cholecystectomy Group ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy

Abstract We aimed to compare the clinical outcome and cost of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Sixty patients with acute cholecystitis were randomized into early (within 24 hours of admission) or delayed (after 6–8 weeks of conservative treatment) laparoscopic cholecystectomy groups. There was no significant difference between study groups in terms of operation time and rates for conversion to open cholecystectomy. On the other hand, total hospital stay was longer (5.2 ± 1.40 versus 7.8 ± 1.65 days; P = 0.04) and total costs were higher (2500.97 ± 755.265 versus 3713.47 ± 517.331 Turkish Lira; P = 0.03) in the delayed laparoscopic cholecystectomy group. Intraoperative and postoperative complications were recorded in 8 patients in the early laparoscopic cholecystectomy group, whereas no complications occurred in the delayed laparoscopic cholecystectomy group (P = 0.002). Despite intraoperative and postoperative complications being associated more with early laparoscopic cholecystectomy compared with delayed intervention, early laparoscopic cholecystectomy should be preferred for treatment of acute cholecystitis because of its advantages of shorter hospital stay and lower cost.

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