Abstract
Aim: The aim of this study is the preoperative prediction of the surgical difficulty in the cholecystectomy and the optimal period of PTGBD and surgery.
Method: The 941 cases of laparoscopic cholecystectomy (LC) for gallbladder stones were divided into the low-difficulty group (Group L; n=832) and high-difficulty group (Group H: n=109) according to operation time, blood loss, and open conversion.
Result: It was considered that three factors (gallbladder wall thickness in CT, cystic duct occlusion, and PTGBD) were significant by the multivariate analysis. When the positive numbers of these three factors were a total of 0, 1, 2, and 3, the rate of Group H was 6%, 13%, 33%, and 59%. Progress of inflammation was prevented in the patients who started antibacterial medicine or PTGBD within one day after the onset of acute cholecystitis. The case of high difficulty decreased gradually as the period from PTGBD to LC became longer. It was about 20% in more than four weeks.
Conclusion: In the prediction of surgical difficulty for cholecystectomy, the above three factors were useful. In acute cholecystitis, it is desirable to start the medical treatment and keep more than four weeks from PTGBD to surgery.
