Which is the best timing for performing a cholecystectomy after percutaneous cholecystostomy?

BACKGROUND

Laparoscopic cholecystectomy is the gold standard for managing acute cholecystitis. However, in high-risk surgical patients, percutaneous cholecystostomy is frequently used either as a bridge to surgery or as definitive treatment. When employed as a bridge to surgery, the optimal timing for laparoscopic cholecystectomy after cholecystostomy remains unclear.

METHODS

A critical review of the literature was conducted, focusing particularly on the article published by Spaniolas, et al., presented at SAGES 2024, to evaluate the optimal timing for performing laparoscopic cholecystectomy after a cholecystostomy, according to the available evidence.

RESULTS

The available literature was found to be limited. The timing thresholds vary across studies, preventing a pooled evaluation of the effect size. The study by Spaniolas, et al. has several limitations, including the exclusion of subtotal cholecystectomies from the composite endpoint and the introduction of implausible variables in the logistic regression model.

CONCLUSION

Ideally, the procedure should be performed when it is least technically demanding, minimizing the need for rescue procedures (such as subtotal cholecystectomy, antegrade cholecystectomy, or conversion to open surgery) and reducing complications. This topic is increasingly relevant in clinical practice. However, the current scientific evidence remains limited.