Surgical outcomes of percutaneous transhepatic gallbladder drainage for high-risk patients with moderate and severe acute cholecystitis: an experience at a tertiary centre

Introduction. Acute cholecystitis (AC) poses a life-threatening challenge for patients with serious comorbidities. We aimed to evaluate the effectiveness of percutaneous transhepatic gallbladder drainage (PTHGD) treatment for moderate and severe AC in high-risk patients and compare the benefits between early (EC) and delayed cholecystectomy (DC) after PTHGD.
Materials. A retrospective analysis included 117 patients with grade II and grade III AC, and who had an ASA grading of ≥3, undergoing PTHGD at Riga East Clinical University Hospital between January 2020 and May 2023. Patients who received surgical treatment after PTHGD within one week following the admission were assigned to the early group, while the patients who were operated after one week or admitted in the second visit were assigned to the delayed group.
Results. The median age of the patients was 81 (IQR 74-86) years. According to the Tokyo guidelines, 90 (76.9%) patients were presented with grade II, while 27 (23.1%) presented with grade III AC. Furthermore, 27 (23.1%) patients met criteria for sepsis, and 16 of them had severe sepsis. Among entire cohort, 10 (8.5%) patients developed
catheter-related complications, of them 4 patients required surgery. 72 (61.5%) patients had PTHGD as definitive intervention, while 20 (17.1%) had EC and 25 (21.4%) had DC following PTHGD for AC. The differences in rate of readmissions and reinterventions between drainage and cholecystectomy groups were not statistically significant (29.2% vs 20.0%, p=0.28, and 16.7% vs 11.1%, p=0.59). No significant differences in operative time, conversion rate, postoperative complications, or length of stay between EC and DC were observed (p>0.05). Open surgery was the preferred option in DC group, p=0.04.
Conclusion. PTHGD could be an effective alternative treatment for high-risk patients with moderate and severe AC. EC after PTHGD is feasible for patients upon improvement of their physical condition without significant postoperative
events.