What is the best management of patients after percutaneous transhepatic gallbladder drainage for acute lithiasic cholecystitis? Comparison of two different strategies

Abstract

Introduction

After percutaneous transhepatic gallbladder drainage (PTGD) in patients with acute lithiasic cholecystitis (ALC), patients are managed on surgical wards. Our aim was to compare two management strategies for these patients.

Material

Consecutive patients (2019–2021) who underwent PTGD were included. In Center A (CHOL− DRAIN+ Clamped): clamping of the drain without systematic cholangiography and discharge with the drain clamped, removal of the drain in consultation; Center B (CHOL+ DRAIN−): cholangiography and removal of the drain during hospitalization. The primary endpoint was the success of PTGD (absence of cholecystectomy or death during hospitalization, absence of readmissions for ALC and/or death from biliary causes within 90 days). Secondary endpoints were PTGD complications, length of hospitalization, unscheduled cholecystectomy, or biliary-associated readmission within 90 days. Analysis was performed in intention-to-treat and per-protocol.

Results

Forty patients were included in Center A (CHOL− DRAIN+ Clamped) and 19 in Center B (CHOL+ DRAIN−). They were comparable. In ITT, the PTGD success rate was comparable between groups (85% vs. 63%, P = 0.097). Drainage complications (15% vs. 53%, P = 0.007) and re-drainage (0% vs. 15.8%, P = 0.03), unscheduled cholecystectomy (2% vs. 26%, P = 0.037), and readmission for biliary causes (10% vs. 32%, P = 0.039) within 90 days were less frequent in Center A. Mortality (7.5% vs. 10.5%, P = 0.7) and length of stay (12 vs. 13 days, P = 0.744) were comparable. Cholangiography enabled a change in strategy for 20.3% of cases. PP management was more frequent in Center A (92.5% vs. 52.6%, P = 0.004).

Conclusion

Drain clamping during hospitalization and removing it during consultation, without systematic cholangiography is a good strategy.