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Abstract
Objectives:
According to the Tokyo Guidelines (TG18), the management of moderate acute cholecystitis (AC) includes either laparoscopic cholecystectomy (LC) or percutaneous cholecystostomy (PC), while for severe AC, straightforward LC is recommended only for selected patients. We aimed to compare the outcomes of emergency cholecystectomy (EC) and bridging PC for patients with moderate and severe AC.
Materials and Methods:
A retrospective analysis was conducted on 328 patients with moderate and severe AC who underwent cholecystectomy at Riga East University Hospital between 2018 and 2023. Patients were categorized by TG18 severity criteria and subdivided into the EC and preoperative PC groups. Outcomes were analyzed and compared.
Results:
For moderate AC (n=296), patients who underwent PC were older (68 vs 77 years, p<0.001), had higher ASA-PS score (50.0% vs 77.3%, p<0.001) compared to the EC group. Furthermore, EC was associated with shorter hospital stay (8 vs 14 days, p<0.001) and fewer postoperative complications (4.8% vs 12.1%, p=0.044). For severe AC (n=32), bridging PC was the preferred treatment (62.5%, p<0.001), moreover no significant difference was found between EC and PC groups regarding hospital stay (p=0.691) and postoperative complications rate (p=1.0). In both moderate and severe AC groups, LC was performed in 86.4% and 70.0% of patients following PC, while incidence of conversion to open cholecystectomy was higher in the EC groups (p<0.001). No deaths were observed after PC, while two (16.7%) patients died in the EC group with severe AC.
Conclusions:
The upfront surgery approach was associated with shorter hospital stay and fewer postoperative complications in moderate AC, but with a higher rate of conversion. Bridging PC appeared to be a safe treatment approach, and could offer time to prepare for LC even high-risk patients. This study highlights the importance of personalized treatment protocols based on AC severity and patient risk factors.
According to the Tokyo Guidelines (TG18), the management of moderate acute cholecystitis (AC) includes either laparoscopic cholecystectomy (LC) or percutaneous cholecystostomy (PC), while for severe AC, straightforward LC is recommended only for selected patients. We aimed to compare the outcomes of emergency cholecystectomy (EC) and bridging PC for patients with moderate and severe AC.
Materials and Methods:
A retrospective analysis was conducted on 328 patients with moderate and severe AC who underwent cholecystectomy at Riga East University Hospital between 2018 and 2023. Patients were categorized by TG18 severity criteria and subdivided into the EC and preoperative PC groups. Outcomes were analyzed and compared.
Results:
For moderate AC (n=296), patients who underwent PC were older (68 vs 77 years, p<0.001), had higher ASA-PS score (50.0% vs 77.3%, p<0.001) compared to the EC group. Furthermore, EC was associated with shorter hospital stay (8 vs 14 days, p<0.001) and fewer postoperative complications (4.8% vs 12.1%, p=0.044). For severe AC (n=32), bridging PC was the preferred treatment (62.5%, p<0.001), moreover no significant difference was found between EC and PC groups regarding hospital stay (p=0.691) and postoperative complications rate (p=1.0). In both moderate and severe AC groups, LC was performed in 86.4% and 70.0% of patients following PC, while incidence of conversion to open cholecystectomy was higher in the EC groups (p<0.001). No deaths were observed after PC, while two (16.7%) patients died in the EC group with severe AC.
Conclusions:
The upfront surgery approach was associated with shorter hospital stay and fewer postoperative complications in moderate AC, but with a higher rate of conversion. Bridging PC appeared to be a safe treatment approach, and could offer time to prepare for LC even high-risk patients. This study highlights the importance of personalized treatment protocols based on AC severity and patient risk factors.
| Original language | English |
|---|---|
| Pages | 434-434 |
| Number of pages | 1 |
| Publication status | Published - Mar 2025 |
| Event | RSU Research Week 2025: Knowledge for Use in Practice - Riga Stradiņš university, Riga, Latvia Duration: 26 Mar 2025 → 28 Mar 2025 https://rw2025.rsu.lv/conferences/knowledge-use-practice |
Conference
| Conference | RSU Research Week 2025: Knowledge for Use in Practice |
|---|---|
| Country/Territory | Latvia |
| City | Riga |
| Period | 26/03/25 → 28/03/25 |
| Other | Infections in the Development of Non-Communicable Diseases |
| Internet address |
Keywords*
- Acute cholecystitis
- Cholecystostomy
- Cholecystectomy, Laparoscopic
Field of Science*
- 3.2 Clinical medicine
Publication Type*
- 3.4. Other publications in conference proceedings (including local)
Fingerprint
Dive into the research topics of 'Emergency Cholecystectomy versus Bridging Cholecystostomy for Moderate and Severe Acute Cholecystitis: Retrospective Cohort Study'. Together they form a unique fingerprint.Research output
- 1 Book
-
Rīga Stradiņš University International Research Conference on Medical and Health Care Sciences “Knowledge for Use in Practice”: Abstracts, 26-28 March, 2025
Rīga Stradiņš University, 2025, Rīga: Rīga Stradiņš University. 478 p.Research output: Book/Report › Book
Open Access
Projects
- 1 Active
-
Evaluation of percutaneous gallbladder drainage and determination of optimal treatment algorithm in high-risk patients with moderate and severe acute cholecystitis
Ptašņuka, M. (Project leader), Plaudis, H. (Supervisor) & Koļesova, O. (Supervisor)
1/10/24 → 29/09/28
Project: PhD projects