Percutaneous transhepatic gallbladder drainage followed by elective laparoscopic cholecystectomy in patients with moderate acute cholecystitis under antithrombotic therapy

• Published in: Journal of hepato-biliary-pancreatic sciences 2014-05, Vol.21 (5), p.335-342
• Main Authors: Shibasaki, Susumu, Takahashi, Norihiko, Toi, Hirofumi, Tsuda, Ichiro, Nakamura, Takahisa, Hase, Taiji, Minagawa, Nozomi, Homma, Shigenori, Kawamura, Hideki, Taketomi, Akinobu
• Format: Article
• Language: English
• Subjects: Acute cholecystitis; Aged; Aged, 80 and over; Antithrombotic therapy; Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis, Acute - surgery; Clinical outcomes; Drainage; Elective Surgical Procedures; Female; Fibrinolytic Agents - administration & dosage; Gallbladder; Gallbladder diseases; Humans; Laparoscopic cholecystectomy; Laparoscopy; Male; Middle Aged; Percutaneous transhepatic gallbladder drainage; Treatment Outcome
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.28

Background Standard treatment for acute cholecystitis (AC) in patients receiving antithrombotic drugs has not been established. We evaluated the safety of percutaneous transhepatic gallbladder drainage (PTGBD) followed by elective laparoscopic cholecystectomy (LC) in patients with moderate AC who were receiving antithrombotics. Methods Seventy‐five patients received PTGBD from January 2006 to March 2013 followed by elective LC for moderate AC. Patients were divided into Group A, which consisted of patients receiving antithrombotic therapy (n = 23), and Group B, which included the remaining patients (n = 52). We analyzed clinical outcomes and perioperative complications between groups. Results No hemorrhagic events occurred during PTGBD insertion regardless of antithrombotic treatment. The open conversion rate was not significantly different between the two groups. Postoperative complications were found in 10 patients (13.3%). The rate of postoperative complications in Group A was slightly higher than that in Group B, but the difference was not significant (21.7% vs. 9.6%; P = 0.15). Complications associated with PTGBD occurred in six patients (8%). There were no significant differences in the incidence of these complications, operation time, intraoperative blood loss, or length of postoperative hospital stay. Conclusions Percutaneous transhepatic gallbladder drainage followed by elective LC may be an effective therapeutic strategy for moderate AC in patients receiving antithrombotic therapy.