Preoperative Treatment for Acute Cholecystitis Assuming Standby Laparoscopic Cholecystectomy

Abstract

Introduction: Early cholecystectomy is recommended for acute cholecystitis, but standby cholecystectomy is often required. In this study, we investigated the influence of and appropriate preoperative treatment for laparoscopic cholecystectomy (LC). Methods: We retrospectively evaluated the data of 76 patients who underwent standby LC for acute cholecystitis between June 2014 and June 2023 at our hospital. Patients were classified by preoperative treatment into antimicrobial, antimicrobial ＋ percutaneous transhepatic gallbladder drainage (PTGBD), and antimicrobial ＋ percutaneous transhepatic gallbladder aspiration (PTGBA) groups, and the preoperative outcomes, surgical difficulty, and surgical outcomes were compared among the three groups. We also compared the period from treatment to normalization of the leukocyte count and serum CRP levels among patients with mild and moderate/severe disease. Results: In patients with mild disease, the period duration to normalization of the leukocyte count/serum CRP was 3/7 days in the antimicrobial group, 4.5/10.5 days in the PTGBD group, and 3.5/8.5 days in the PTGBA group, with no significant differences among the groups. However, in patients with moderate/severe disease, the period to normalization of the leukocyte count/serum CRP was significantly longer in the antimicrobial group: 8/16 days in the PTGBD group, 4/11 days in the PTGBD group, and 4.5/11 days in the PTGBA group. Conclusion: When preoperative treatment for acute cholecystitis is undertaken assuming standby LC, early biliary drainage should be considered in patients with moderate/severe disease.