The most appropriate timing for selective laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute severe cholecystitis aged above 60 years

Objective To investigate the clinical effect of selective laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of elderly patients with acute severe cholecystitis, as well as the most appropriate timing for selective operation.Methods A total of 90 patients with acute severe cholecystitis aged above 60 years who were admitted to Department of Hepatobiliary Surgery in The First Hospital of Jilin University from January 2015 to June 2016 were enrolled, and according to the time of selective LC, they were divided into group A (with 2 months) , group B (2-4 months) , and group C (>4 months) , with 30 patients in each group.The clinical effects of PTGD and selective LC were observed.The t-test was used for comparison of continuous data between two groups, an analysis of variance was used for comparison between three groups, and LSD-t test was used for comparison between any two groups; the chi-square test was used for comparison of categorical data between groups.Results All the patients underwent successful PTGD, and the time to abdominal pain remission was 2.52 ± 0.76 hours.Body temperature returned to normal with 24-72 hours after surgery, and there were significant improvements in laboratory markers (white blood cell count, neutrophil count, and liver function) (all P<0.05) .No patient experienced complications such as bile leakage, hematobilia, pneumothorax, and colon perforation caused by puncture, and there was no case of PTGD after the tube was detached.There were significant differences between the three groups in gallbladder wall thickness before LC (F=8.029, P<0.001) , time of operation (F=24.674, P<0.001) , intraoperative blood loss (F=12.864, P<0.001) , length of hospital stay (F=22.844, P<0.001) , rate of conversion to laparotomy (χ2=12.345, P=0.002) , and incidence rate of complications (χ2=8.750, P=0.013) .Compared with group A, groups B and C had significantly lower gallbladder wall thickness before LC, intraoperative blood loss, length of hospital stay, rate of conversion to laparotomy, and incidence rate of complications (all P<0.05) , and group B had significantly lower time of operation, intraoperative blood loss, and length of hospital stay than group C (all P<0.05) .Conclusion Selective LC with 2-4 months after PTGD has a marked clinical effect and high safety in the treatment of elderly patients with acute severe cholecystitis.