한국간담췌외과학회지 (Annals of Hepato-Biliary-Pancreatic Surgery)

  • 제26권2호
  • /
  • Pages.159-167
  • /
  • 2022
  • /
  • 2508-5778(pISSN)
  • /
  • 2508-5859(eISSN)
한국간담췌외과학회 (The Korean Association of Hepato-Biliary-Pancreatic Surgery)
권호 표지
DOI QR코드

DOI QR Code

Optimal timing of percutaneous transhepatic gallbladder drainage and subsequent laparoscopic cholecystectomy according to the severity of acute cholecystitis

  • Jung Suk Lee (Department of Surgery, Konyang University Hospital, Konyang University College of Medicine) ;
  • Seung Jae Lee (Department of Surgery, Konyang University Hospital, Konyang University College of Medicine) ;
  • In Seok Choi (Department of Surgery, Konyang University Hospital, Konyang University College of Medicine) ;
  • Ju Ik Moon (Department of Surgery, Konyang University Hospital, Konyang University College of Medicine)
  • 투고 : 2021.09.08
  • 심사 : 2021.10.29
  • 발행 : 2022.05.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Backgrounds/Aims: The optimal timing of percutaneous transhepatic gallbladder drainage (PTGBD) and subsequent laparoscopic cholecystectomy (LC) according to the severity of acute cholecystitis (AC) has not been established yet. Methods: This single-center, retrospective study included 695 patients with grade I or II AC without common bile duct stones who underwent PTGBD and subsequent LC between January 2010 and December 2019. Difficult surgery (DS) (open conversion, subtotal cholecystectomy, adjacent organ injury, transfusion, operation time ≥ 90 minutes, or estimated blood loss ≥ 100 mL) and poor postoperative outcome (PPO) (postoperative hospital stay ≥ 7 days or Clavien-Dindo grade ≥ II postoperative complication) were defined to comprehensively evaluate intraoperative and postoperative outcomes, respectively. Results: Of 695 patients, 403 had grade I AC and 292 had grade II AC. According to the receiver operating characteristic curve and multivariate logistic regression analyses, an interval from symptom onset to PTGBD of > 3.5 days and an interval from PTGBD to LC of > 7.5 days were significant predictors of DS and PPO, respectively, in grade I AC. In grade II AC, the timing of PTGBD and subsequent LC were not statistically related to DS or PPO. Conclusions: In grade I AC, performing PTGBD within 3.5 days after symptom onset can reduce surgical difficulties and subsequently performing LC within 7.5 days after PTGBD can improve postoperative outcomes. In grade II AC, early PTGBD cannot improve the surgical difficulty. In addition, the timing of subsequent LC is not correlated with surgical difficulties or postoperative outcomes.

키워드

참고문헌

  1. Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci 2018;25:55-72.
  2. Radder RW. Ultrasonically guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging 1980;49:330-333.
  3. Horn T, Christensen SD, Kirkegard J, Larsen LP, Knudsen AR, Mortensen FV. Percutaneous cholecystostomy is an effective treatment option for acute calculous cholecystitis: a 10-year experience. HPB (Oxford) 2015;17:326-331.
  4. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018;25:41-54.
  5. Habib FA, Kolachalam RB, Khilnani R, Preventza O, Mittal VK. Role of laparoscopic cholecystectomy in the management of gangrenous cholecystitis. Am J Surg 2001;181:71-75.
  6. Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status - historical perspectives and modern developments. Anaesthesia 2019;74:373-379.
  7. Wakabayashi G, Iwashita Y, Hibi T, Takada T, Strasberg SM, Asbun HJ, et al. Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018;25:73-86.
  8. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187-196.
  9. Han IW, Jang JY, Kang MJ, Lee KB, Lee SE, Kim SW. Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage. J Hepatobiliary Pancreat Sci 2012;19:187-193.
  10. Choi JW, Park SH, Choi SY, Kim HS, Kim TH. Comparison of clinical result between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis. Korean J Hepatobiliary Pancreat Surg 2012;16:147-153.
  11. Sakamoto T, Fujiogi M, Matsui H, Fushimi K, Yasunaga H. Timing of cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis: a nationwide inpatient database study. HPB (Oxford) 2020;22:920-926.
  12. Inoue K, Ueno T, Nishina O, Douchi D, Shima K, Goto S, et al. Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis. BMC Gastroenterol 2017;17:71.
  13. Yamada K, Yamashita Y, Yamada T, Takeno S, Noritomi T. Optimal timing for performing percutaneous transhepatic gallbladder drainage and subsequent cholecystectomy for better management of acute cholecystitis. J Hepatobiliary Pancreat Sci 2015;22:855-861.
  14. Iwashita Y, Ohyama T, Honda G, Hibi T, Yoshida M, Miura F, et al. What are the appropriate indicators of surgical difficulty during laparoscopic cholecystectomy? Results from a Japan-Korea-Taiwan multinational survey. J Hepatobiliary Pancreat Sci 2016;23:533-547.
  15. Schrenk P, Woisetschlager R, Rieger R, Wayand WU. A diagnostic score to predict the difficulty of a laparoscopic cholecystectomy from preoperative variables. Surg Endosc 1998;12:148-150.
  16. Sakuramoto S, Sato S, Okuri T, Sato K, Hiki Y, Kakita A. Preoperative evaluation to predict technical difficulties of laparoscopic cholecystectomy on the basis of histological inflammation findings on resected gallbladder. Am J Surg 2000;179:114-121.
  17. Simopoulos C, Botaitis S, Polychronidis A, Tripsianis G, Karayiannakis AJ. Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Surg Endosc 2005;19:905-909.
  18. Lipman JM, Claridge JA, Haridas M, Martin MD, Yao DC, Grimes KL, et al. Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery 2007;142:556-563; discussion 563-565.
  19. Abraham S, Toth I, Benko R, Matuz M, Kovacs G, Morvay Z, et al. Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: ten years' experience at a tertiary care centre. Surg Endosc 2021. https://doi.org/10.1007/s00464-021-08573-0 [in press]