Analysis Of The Timing Of Laparoscopic Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage For Acute Cholecystitis And The Factors Affecting The Difficulty Of Cholecystectomy

Objective:To investigate the timing of laparoscopic cholecystectomy(LC)after percutaneous transhepatic gallbladder drainage(PTGBD)for acute cholecystitis and the factors affecting the technical difficulty of cholecystectomy.Methods: Sixty-three patients who underwent PTGBD for acute cholecystitis with second-stage LC at the Fourth Hospital of China Medical University from January 2016to December 2021 were selected.Patients were grouped according to the interval between PTGBD and elective LC,when the interval was ≤14 days for the early LC group(ELC group,n=19)and >14 days for the delayed LC group(DLC group,n=44).The differences in operative time,intraoperative bleeding,difficult gallbladder rate,intermediate open rate,postoperative drainage tube use time,postoperative venting time,postoperative complications,postoperative hospitalization time,and total hospitalization time were compared between the two groups.Factors that may affect the technical difficulty of laparoscopic cholecystectomy were subjected to univariate and multifactorial logistic regression analysis to obtain independent risk factors affecting the surgical difficulty of laparoscopic cholecystectomy and further investigate their effects on LC.Results: There were no significant differences between patients in the ELC and DLC groups in terms of operative time,intraoperative bleeding,difficult gallbladder rate,intermediate open rate,postoperative drainage tube use time,postoperative venting time,postoperative complications,and postoperative hospital stay.the total hospital stay of patients in the ELC group was significantly less than that in the DLC group(15.2 ± 1.3 d vs.23.2 ± 1.2 d,P < 0.0001),and their PTGBD catheter-related complication rate was significantly lower(0% vs.20.5%,P = 0.047).Timing of PTGBD was an independent risk factor for the technical difficulty of cholecystectomy,and when the interval between PTGBD performed in AC was ≤ 90.8 h,the operative time(84.0 ± 7.2 h vs.104.3 ± 5.9 h,P = 0.038),intraoperative bleeding(36.9 ± 7.4 ml vs.67.4 ± 9.3 ml,P= 0.012)and difficult gallbladder occurrence(28.1% vs.71.9%,P < 0.0001)were significantly lower,but there was no statistical difference in postoperative drainage tube use time,postoperative venting time,intermediate open rate,postoperative complications,postoperative hospital stay,and total postoperative hospital stay.Conclusion: Early LC after PTGBD is safe and effective and can reduce the incidence of PTGBD catheter-related complications and the total length of stay of patients.Patients with AC should undergo PTGBD as early as possible after it is clear that there is no chance of emergency surgery;the timing of gallbladder drainage affects the difficulty of cholecystectomy.