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KMID : 0371320070730040329
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Journal of the Korean Surgical Society
2007 Volume.73 No. 4 p.329 ~ p.333
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Comparison of Early Versus Delayed Laparoscopic Cholecystectomy after Percutaneous Transhepatic Gallbladder Drainage (PTGBD) for Patient with Complicated Acute Cholecystitis
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Kim Heung-Dae
Kim Hyung-Ook
Shin Jun-Ho
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Abstract
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Purpose: This study was to evaluate the safety and conversion rate of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) in patients with a complicated acute cholecystitis (GB empyema, gangrenous cholecystitis and pericholecystic abscess) according to the timing of LC.
Methods: One hundred and four patients, who underwent a laparoscopic cholecystectomy after PTGBD between March 2004 and December 2006, were analyzed. Thirty-four patients underwent LC within 7 days after PTGBD (early group, n=34) and 38 patients underwent LC between 14 and 39 days after PTGBD (delayed group, n=38). Thirty-two patients were excluded because of gallbladder cancer (n=2), simple acute cholecystitis (n=12), a history of previous abdominal surgery (n=5), and LC between 8 and 13 days after PTGBD (n=13).
Results: There was no significant difference in age (early group, 58.4±11.2; delayed group, 61.0±12.1), diagnosis, duration of symptoms, WBC counts, interval of admission and PTGBD, improvement of symptoms after PTGBD, American Society of Anesthesiologists (ASA) score, prior medical history, post-PTGBD and postoperative complications, and operation time. The rate of conversion to an open laparotomy was 14.7% (5/34) in the early group and 2.6% (1/38) in the delayed group (statistically not significant).
Conclusion: The timing of LC after PTGBD for a complicated acute cholecystitis does not influence the rate of conversion to an open laparotomy, surgery time and complication. However, a delayed LC after PTGBD tends to decrease the rate of conversion to an open laparotomy
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KEYWORD
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Laparoscopic cholecystectomy, Percutaneous transhepatic gallbladder drainage (PTGBD), Acute cholecystitis
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