Early laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage is feasible in low-risk patients with acute cholecystitis

Background: Laparoscopic cholecystectomy (Lap-C) is generally performed following percutaneous transhepatic gallbladder drainage (PTGBD) in patients with acute cholecystitis (AC). However, the timing of Lap-C and risk factors for postoperative complications following PTGBD are still unclear. Methods: We analyzed 331 patients with AC who underwent Lap-C following PTGBD. Univariate and multivariate logistic regression analyses were used for identifying risk factors associated with poor surgical outcomes, including postoperative complications in the total group and the early Lap-C subgroup (n = 152). Based on the Tokyo guideline 2013 (TG 13), all patients were divided into two groups according to the period (2009–2013, pre-TG 13 group; 2014–2020, post-TG 13 group), and each analysis was performed in those subgroups. Results: We found that early Lap-C (≤ 42 days after PTGBD) was associated with postoperative complications (OR 2.04, P =.022). Importantly, subgroup analyses revealed that Charlson comorbidity index (CCI) (OR 6.15, P <.001) and cholecystitis severity grade (OR 2.93, P =.014) were independent risk factors of postoperative complications in the early Lap-C group. Among the early Lap-C group, high CCI was also an independent risk factor for surgical complications in both pre-TG 13 (OR 14.87, P =.003) and post-TG 13 (OR 3.23, P =.046) groups. Interestingly, we found that the incidence of postoperative complications in the low-risk early Lap-C group was not different from the delayed group, even in the cases of very early surgery (≤ 1 week following PTGBD). Conclusions: These findings suggest that early Lap-C is feasible following PTGBD, especially in low-risk patients, although future prospective large-scale studies are needed.