Is it safe to give laparoscopic cholecystectomy (LC) treatment of acute cholecystitis in senile patients 3 months after percutaneous transhepatic gallbladder drainage (PTGD)? A case-control study

Background: PTGD combined with delay LC has been widely applied to elderly patients. Nevertheless, there are only few data available on delay LC after PTGD. We present a case-control study to evaluate the safety and efficacy of delay LC after PTGD 3 months later for acute cholecystitis. Methods: Data of elderly patients underwent LC for cholecystitis were prospectively collected in our hospital. From July 2014 to January 2016, 36 patients who underwent PTGD combined delay LC (group I) were compared with a prospective cohort of 50 patients who underwent emergency LC (group II) during the same period. The general condition, operative time, rate of common bile duct injury, intraoperative blood loss, rate of conversion to open surgery, postoperative anal exhaust time, postoperative hospital stay, and postoperative complications of patients were compared in the two groups. Results: The operative time of group I was significantly longer than that of group II (78.61 +/- 23.87 min vs 67.70 +/- 18.63 min P = 0.021), the conversion rate of group I was significantly higher than that of group II (P = 0.033). Intraoperative bleeding of the patients in group I was significantly higher than that in group II (P = 0.029). And the postoperative anal exhaust time and postoperative hospital stay of group I were significantly shorter than those of group II (14.02 +/- 4.36 hours vs 16.44 +/- 4.78 hours, P = 0.020; 4.83 +/- 3.07 days vs 6.12 +/- 2.56 days, P = 0.039). The postoperative complication rate of group I was significantly lower than that of group II (3 cases vs 14 cases, P = 0.024). Conclusion: Our study suggests delay LC after PTGD (3 months later) reduced postoperative hospital stay and the occurrence of postoperative complications, but increased the difficulties of operation.