Department of Surgery, Okinawa Chubu Hospital, Okinawa, Japan; Department of Surgery, University of Southern California, Los Angeles, CA, United States.
Department of Surgery, University of Southern California, Los Angeles, CA, United States.
J Gastrointest Surg. 2024 Nov;28(11):1912-1914. doi: 10.1016/j.gassur.2024.08.002. Epub 2024 Aug 24.
Gallbladder drainage procedures are often considered for acute cholecystitis (AC) patients with significant peri-operative risks. While percutaneous transhepatic gallbladder drainage (PTGBD) has been evaluated in previous studies, there is scarce data on the feasibility and efficacy of endoscopic transpapillary gallbladder stenting (ETGBS) in patients with AC. This study aimed to compare the characteristics of interval cholecystectomy following ETGBS and PTGBD.
This retrospective descriptive study included patients who underwent ETGBS and/or PTGBD for AC and subsequently underwent interval cholecystectomy between 2018 and 2023. Demographics, operative technique, and postoperative complications of patients with ETGBS and PTGBD were compared.
A total of 59 patients were included (14 ETGBS and 45 PTGBD). The median days between ETGBS and cholecystectomy were significantly longer than the PTGBD group (64 [45-150] days vs. 16 [10-42] days, p=0.045). The median operation time was significantly longer in the ETGBS group. Among 33 patients who underwent subtotal cholecystectomy, the ERGBS group more frequently required closure of the gallbladder stump due to the difficulty in ligating the cystic duct compared to the PTGBD group (75.0% vs. 28.0%, p=0.035). Similarly, the fundus-first approach was more commonly selected in the ERGBS group (62.5% vs. 28.0%, p=0.01). No significant differences in the incidence of postoperative complications were observed between the two groups.
Interval cholecystectomy following ETGBS is more technically demanding compared to PTGBD. Laparoscopic subtotal cholecystectomy following ETGBS could be a potential treatment option for patients who are unfit for early surgery, with the recognition of the difficulty in ligating the cystic duct.
对于伴有明显围手术期风险的急性胆囊炎（AC）患者，常考虑进行胆囊引流术。虽然经皮经肝胆囊引流术（PTGBD）在之前的研究中已得到评估，但有关 AC 患者内镜经乳头胆囊支架置入术（ETGBS）的可行性和疗效的数据却很少。本研究旨在比较 ETGBS 和 PTGBD 后行间隔期胆囊切除术的特征。
本回顾性描述性研究纳入了 2018 年至 2023 年间因 AC 而行 ETGBS 和/或 PTGBD 治疗，并随后行间隔期胆囊切除术的患者。比较了 ETGBS 和 PTGBD 患者的人口统计学、手术技术和术后并发症。
共纳入 59 例患者（14 例行 ETGBS，45 例行 PTGBD）。ETGBS 与胆囊切除术之间的中位天数明显长于 PTGBD 组（64[45-150]天 vs. 16[10-42]天，p=0.045）。ETGBS 组的中位手术时间明显更长。在 33 例行次全胆囊切除术的患者中，与 PTGBD 组相比，ETGBS 组因难以结扎胆囊管而更频繁地需要关闭胆囊残端（75.0% vs. 28.0%，p=0.035）。同样，在 ETGBS 组中更常选择先处理胆囊底部（62.5% vs. 28.0%，p=0.01）。两组术后并发症的发生率无显著差异。
与 PTGBD 相比，ETGBS 后行间隔期胆囊切除术技术要求更高。对于不适合早期手术的患者，ETGBS 后行腹腔镜次全胆囊切除术可能是一种潜在的治疗选择，需要认识到结扎胆囊管的难度。
