Timing of LC after PTGD in high-risk acute cholecystitis and influencing factors of delayed operation

ObjectiveTo investigate the optimal interval of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in high-risk patients with acute cholecystitis, and to explore the risk factors of delayed surgery.

MethodsCase data of 89 patients with high-risk acute cholecystitis were collected and categorized according to the different intervals of LC after PTGD: group A (time ≤4 weeks), group B (4 weeks < time ≤8 weeks), and group C (8 weeks < time ≤12 weeks).Patients in group A and group B with low incidence of PTGD puncture tube detachment, bleeding, puncture related infection and other complications were combined into group AB (catheter duration ≤8 weeks), which were compared again with group C (8 weeks < catheter duration ≤12 weeks) with high incidence of complications.Based on the clinical data collected after admission, the optimal time for LC after PTGD was analyzed, and the risk factors affecting the delay of surgery after PTGD were discussed.

ResultsThere was no statistically significant difference in the first time of getting out of bed between group A, group B and group C (P>0.05).The time of first feeding fluid, discharge time and exhaust time after operation were shorter in group B (P < 0.05), the time of operation in group B and group C was shorter (P < 0.05), the postoperative complications in group A and group C were higher (P < 0.05), the proportion of patients who switched to laparotomy in group C was higher (P < 0.05), and the proportion of puncture tube shedding, bleeding and puncture tube-related infection in group C was higher (P < 0.05).The single factor results showed that the proportion of gallbladder wall thickness, abdominal operation history, calculi, age, history of hypertension, history of coronary heart disease and history of diabetes in group C were higher than those in group AB (P < 0.05).The results of multi-factor analysis showed that: preoperative gallbladder wall thickness ≥ 6 mm, previous history of abdominal surgery and age were the risk factors for delaying surgery for PTGD (OR>1).

ConclusionsThe optimal surgical interval for LC after PTGD is 4-8 weeks.Preoperative gallbladder wall thickness ≥ 6 mm, history of abdominal surgery, and advanced age may be risk factors for prolonged surgical interval.