Timing of percutaneous transhepatic gallbladder drainage in elective laparoscopic cholecystectomy for acute cholecystitis

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Introduction: The Tokyo Guidelines 2018 (TG18) developed from TG13 provides a simple criteria and management strategy for acute cholecystitis. The influence of the timing of percutaneous transhepatic gallbladder drainage (PTGBD) in elective laparoscopic cholecystectomy (LC) for acute cholecystitis on surgical outcome has not been clarified. Methods: 45 patients who underwent PTGBD followed by LC for moderate to severe acute cholecystitis were enrolled in this study. Patients were divided into two groups according to the timing of PTGBD. Group I patients underwent PTGBD within 72 hours of symptoms (n = 28), whereas group II patients underwent PTGBD at more than 72 hours of symptoms (n = 17). Results: Operation time was longer in group II (median 112 versus 146 min) (P = 0.04). The rate of postoperative complica-tions was significantly higher in group II (0 versus 3 cases) (P = 0.05). Conclusions: Patients underwent PTBD at more than 72 hours of symptoms showed higher difficulty in LC. We recommend that PTBD within 72 hours of symptoms for the elective LC is performed in patients with acute cholecystitis.