SCHEDULED LAPAROSCOPIC CHOLECYSTECTOMY FOLLOWING PERCUTANEOUS TRANSHEPATIC CHOLECYSTOSTOMY VERSUS EARLY LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT PTHC IN ACUTE CALCULOUS CHOLECYSTITIS: A PROSPECTIVE COMPARATIVE STUDY

Abstract

Backgrounds/Aims: Acute cholecystitis is one of the common conditions we encounter in our daily practice. Emergency laparoscopic cholecystectomy (LC) is the first line treatment of choice. Percutaneous transhepatic cholecystostomy (PTHC) can be a better option for high-risk patients who are not fit for surgery. In this study, we compare and evaluate the outcomes of scheduled  Laparoscopic  cholecystectomy following  PTHC  and early Laparoscopic cholecystectomy without PTHC. Methods: A prospective observational, comparative study done between January 2024 and December 2025. 80 patients, age >50yrs, with acute cholecystitis, who had undergone LC, were studied. Patients were divided into two groups Non-PTHC group included 40 patients who underwent early LC without PTHC. The other group, PTHC group, included 40 patients who underwent scheduled LC after PTHC. Clinical outcomes were analysed according to each group. Results: Non-PTHC group and PTHC group had a significant difference in patients with cardiovascular diseases with 27.5 % and 50% respectively (P-value- 0.039). Re-intervention (radiological) in 5% of patients, Unplanned admissions in 17.5% of patients in the PTHC group. Non-PTHC group had almost equal ASA class I and class II patients (23 and 17 respectively). PTHC group had more ASA class III (30) patients than ASA class II(10patients).Operation time was more in PTHC group (median = 85min) than Non-PTHC group (median =60 min)Difficulty in dissection in 25% of Non-PTHC group and 40% of PTHC group(P-value 0.152).Intraoperative adhesions, both moderate and severe together more in PTHC, 36 patients(90%) than Non-PTHC ,22 patients (55%),P-value- 0.002 and also PTHC group had more subtotal cholecystectomy (12/40) than Non-PTHC group (4/40) P-value-0.048.Blood loss was higher in Non-PTHC and PTHC group (67.77±6.76 ml and 32.13±9.47, respectively). 2patients in PTHC group had bile leak post LC from PTHC entry site in the liver. Significant difference in total duration of antibiotic usage ( Median value 7 in Non PTHC and 14 in PTHC), length of hospital stay (Median of 5 days in Non-PTHC and Median of 12 in PTHC group), no. of days of returning to normal activity (Median of 56 days  in PTHC group and 11days in Non PTHC group) and cost of treatment,(P-value being <0.001 in all).Mortality(In-hospital and 30 days) is 0% in both groups. Conclusions: Doing direct LC was easier, lesser operation time, cost-effective, requires less hospital stay and can return to their normal activities earlier than those who had PTHC, but blood loss is more intra-operatively. Among high-risk patients who are unfit for emergency surgery, delayed LC is a better option. To reduce active inflammation, PTHC can be done as a bridging procedure. But intra-operative adhesions and the chance of subtotal cholecystectomy is higher in scheduled LC after PTHC compared to early LC.