OUTCOMES OF PERCUTANEOUS TRANSHEPATIC GALLBLADDER DRAINAGE FOR GRADE II-III ACUTE CALCULOUS CHOLECYSTITIS: A STUDY BASED ON THE TOKYO GUIDELINES 2018
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Abstract
Background: Acute calculous cholecystitis of grade II and III according to the Tokyo Guidelines 2018 is associated with severe inflammation and a high risk of surgical complications. Percutaneous transhepatic gallbladder drainage (PTGBD) is a minimally invasive treatment recommended to control inflammation and stabilize patients during the acute phase. Objectives: To describe the clinical and paraclinical characteristics and to evaluate the clinical outcomes of percutaneous transhepatic gallbladder drainage in patients with grade II-III acute calculous cholecystitis based on the Tokyo Guidelines 2018. Materials and methods: A descriptive study combining retrospective and prospective data was conducted on 27 patients diagnosed with grade II-III acute calculous cholecystitis according to the Tokyo Guidelines 2018 who underwent PTGBD from January 2024 to January 2026 at Can Tho Central General Hospital and Can Tho City General Hospital. Results: The mean age was 76.6 ± 10.4 years; 96.3% of patients were older than 60 years, and 66.7% were male. Grade II acute cholecystitis comprised 66.7% of cases, while grade III accounted for 33.3%. All patients presented with right upper quadrant pain. Murphy’s sign was positive in 96.3%, and leukocytosis was present in 74.1% of cases. Ultrasonography revealed gallstones in 100% of patients, gallbladder distension in 85.2%, gallbladder wall thickening in 66.7%, and pericholecystic fluid in 70.4%. The technical success rate of PTGBD was 100%. Postintervention, 66.7% of patients had no recorded complications, and overall complication rates were low. The mean post-drainage hospital stay was 9.3 ± 6 days. Clinical improvement was achieved in 85.2% of patients. Conclusions: Percutaneous transhepatic gallbladder drainage is a safe and effective therapeutic option for the management of grade II-III acute calculous cholecystitis, particularly in elderly patients and those at high surgical risk.
Keywords
Percutaneous transhepatic gallbladder drainage, acute calculous cholecystitis, Tokyo Guidelines 2018
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