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Optimal Waiting Period for Cholecystectomy after Percutaneous Transhepatic Biliary Drainage Based on Surgical Difficulty

Purpose: There is no consensus on the optimal waiting period between percutaneous transhepatic gallbladder drainage (PTGBD) and cholecystectomy for acute cholecystitis. We evaluated the relationship of waiting period with surgical difficulty, and examined the optimal waiting period. Materials and Methods: Associations of surgical difficulty with waiting period and other factors were retrospectively evaluated in 85 patients who underwent cholecystectomy after PTGBD in our hospital. For endpoints that suggested involvement of the waiting period, cutoff values for the waiting period were set between 2 and 8 weeks, and the detection power was evaluated with ROC curves. Factors associated with the selected waiting periods were examined. Results: The waiting period was significantly longer in patients with automatic suture closure or reconstitution of the gallbladder neck, intraoperative perforation of the gallbladder, an intraoperative finding of mass formation in the gallbladder neck, and an operation time ≥120 min. An cutoff of a waiting period of 3 weeks was identified for the optimal predictive power of these four factors. Patients with a waiting period >3 weeks had more severe cholecystitis, more residual inflammation of the gallbladder, and more frequent mass formation in the gallbladder neck. Conclusion: Many cases of severe cholecystitis require a waiting period. Careful surgical manipulation and postoperative management are still required after this period because the surgical difficulty is likely to remain high.