Clinical efficacy of laparoscopic cholecystectomy combined with percutaneous transhepatic gallbladder drainage in severe acute cholecystitis: an analysis of prognostic risk factors

TL;DR

Combining laparoscopic cholecystectomy with drainage improves recovery in severe gallbladder inflammation but increases costs.

Contribution

Demonstrates the clinical benefits and cost trade-offs of combining two procedures for severe acute cholecystitis.

Findings

Combined surgery reduced operation time and blood loss compared to laparoscopic cholecystectomy alone.

Patients with combined surgery had faster recovery and lower inflammation markers post-surgery.

The combined approach was linked to higher medical costs and specific risk factors for complications.

Abstract

To analyze the clinical efficacy of laparoscopic cholecystectomy (LC) combined with percutaneous transhepatic gallbladder drainage (PTGBD) in patients with acute critical cholecystitis.

One hundred patients diagnosed with severe acute cholecystitis were retrospectively selected and categorized into two groups based on the surgical approach: the joint group (n = 49, underwent LC combined with PTGBD) and the LC group (n = 51, underwent LC alone).

The joint group demonstrated a significantly shorter surgery duration and lower intraoperative blood loss compared to the LC group (P < 0.05). On the third postoperative day, patients in the joint group exhibited lower levels of WBC and CRP than those in the LC group (P < 0.05). The joint group showed faster recovery of bowel function, earlier ambulation, and shorter time to resume oral intake compared to the LC group (P < 0.05). Additionally, the joint group reported higher satisfaction than the LC group (P < 0.05). However, the joint group incurred higher surgical costs, total hospitalization costs, and medication costs than the LC group (P < 0.05). The independent risk factors for postoperative complications in patients with severe acute cholecystitis included a disease onset longer than 72 h, a surgical approach of LC alone, surgery duration longer than 2 h, intraoperative blood loss >100 ml, and age ≥65 years (P < 0.05).

Compared with LC alone, LC combined with PTGBD is more effective in reducing surgical trauma in patients with severe acute cholecystitis, improving postoperative inflammatory markers, and accelerating recovery. However, this combined approach is associated with significantly higher direct medical costs during hospitalization.

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