Available online 27 December 2022
Author links open overlay panelHighlights•Laparoscopic cholecystectomy is still burdened by a certain risk of biliary injury.
•An alternative strategy to manage acute cholecystitis is the cholecystostomy.
•Lower complications in the drainage before laparoscopic cholecystectomy group.
•Secondary outcomes are in favour of the drainage before the cholecystectomy.
•Cholecystostomy before cholecystectomy is recommended in severe cholecystitis.
AbstractBackgroundAcute cholecystitis is one of the most common causes of acute abdomen. Early laparoscopic cholecystectomy is the gold standard treatment, still burdened by a risk of intraoperative biliary duct injury. An alternative strategy to manage patients with severe acute cholecystitis is the percutaneous gallbladder drainage (PGBD).
MethodsThe Italian Society of Emergency Surgery and Trauma performed a systematic review and meta-analysis with the aim to clarify controversies about the preoperative use of PGBD. We extracted 32 studies: 9 Randomized Control Trial Studies (RCTs) and 23 no RCTs.
Results of critical outcomesThe incidence of post-operative complications was lower in the PGBD associated at LC than in the LC alone (RCTs: RR 0.28, 95% CI 0.14 to 0.56, I2 = 63%). The incidence of the post-operative biliary leakage was higher in late PGBD’ group (RCTs: RR 0.18, 95% CI 0.04 to 0.80).
Results of other outcomesThe incidence of intraabdominal abscess, blood loss, conversion to open, subtotal cholecystectomy, operative time and wound infection was lower in PGBD’ group. The total hospital stay was the same.
ConclusionA strong recommendation is performed to the use of the PGBD + LC than upfront LC to reduce biliary leakage (recommendation “strong positive”) in high risk acute cholecystitis especially in patients with higher perioperative risks or longstanding acute cholecystitis. For post-operative complications a recommendation “positive weak” suggests that PGBD + LC could be used than upfront LC to reduce the rate of post-operative complications.
KeywordsAcute cholecystitis
Percutaneous drainage
Post-operative complications
Bile duct injury
AbbreviationsPGBDpercutaneous gallbladder drainage
RCTsControl Trial Studies
LClaparoscopic cholecystectomy
ASAAmerican Society of Anesthesiology
ITUintensive therapy unit
ELCemergency laparoscopic cholecystectomy
View full text© 2022 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.
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