Outcomes of acute moderate cholecystitis management techniques: percutaneous transhepatic gallbladder drainage and early laparoscopic cholecystectomy

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BACKGROUND: Acute cholecystitis (AC) is a common hepatobiliary condition that requires surgical intervention. The Tokyo Guidelines 2018 (TG18) recommend early laparoscopic cholecystectomy (LC) for moderate AC (Grade II) and percutaneous transhepatic gallbladder drainage (PTGBD) for high-risk patients. However, the optimal timing for LC following PTGBD remains controversial. METHODS: This retrospective study analyzed data from 432 patients with Grade II AC treated at a high-volume center between January 2022 and February 2024. Patients were divided into two groups: early LC (n=131) and delayed LC following PTGBD (n=43). Clinical outcomes, postoperative complications, and length of hospital stay were compared using statistical analyses, including linear regression modeling. RESULTS: No significant differences were observed between the groups in conversion to open surgery (4.7% vs. 9.9%, p=0.27), postoperative bleeding (6.9% vs. 1.5%, p=0.006), or biliary tract complications (4.7% vs. 3%, p=0.638). However, postoperative systemic inflammatory response syndrome (SIRS) occurred significantly more frequently in the PTGBD group (23.3% vs. 6.9%, p=0.003). Linear regression analysis identified conversion to open surgery, postoperative SIRS, and biliary complications as independent predictors of prolonged hospital stay, whereas PTGBD itself was not associated with increased hospitalization duration (p=0.304). CONCLUSION: Early LC is a feasible approach for most patients with Grade II AC, with outcomes comparable to those of PTGBD followed by delayed LC. PTGBD remains a valuable alternative for high-risk patients. Further large-scale prospective studies are needed to refine treatment strategies and determine the optimal timing for LC following PTGBD.

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