The influence of Percutaneous Cholecystostomy Duration on Optimizing Surgical Outcomes and Timing of Interval Cholecystectomy in ASA II patients with grade II-III Acute Calculous Cholecystitis

Objective: Despite substantial medical advancements in recent decades, the optimal management of Grade II-III acute calculous cholecystitis in patients with an ASA II classification remains a subject of ongoing debate, even with laparoscopic cholecystectomy established as the standard of care. Background: The optimal timing of cholecystectomy (early vs. delayed) remains debated regarding morbidity, risk-benefit balance, and cost. While percutaneous cholecystostomy is supported as definitive management for ASA III/IV patients, its efficacy as a bridge to cholecystectomy in ASA II medically refractory grade II-III acute cholecystitis is unclear. Moreover, the optimal interval between percutaneous cholecystostomy and interval laparoscopic cholecystectomy in this specific group is not well-established. Methods: This retrospective cohort study aimed to elucidate the impact of percutaneous cholecystostomy, performed as an initial intervention, on the subsequent elective cholecystectomy in patients classified as ASA II and diagnosed with Grade II-III acute calculous cholecystitis. Specifically, the study evaluated the influence of prior percutaneous cholecystostomy on the timing, duration, and type of the subsequent elective cholecystectomy procedure. Of the 186 patients managed with percutaneous cholecystostomy for severe acute calculous cholecystitis, 97 patients, classified as ASA II, who subsequently underwent interval elective cholecystectomy at our institution, constituted the study cohort. Results: 77% experienced prolonged laparoscopic cholecystectomy, defined as being longer than 60 minutes, when operated after 8 weeks of cholecystostomy placement. The complexity and the difficulty of surgery were significantly increased in this group. Conclusion: Liberal use of percutaneous cholecystostomy for grade II-III acute calculous cholecystitis is discouraged. Early laparoscopic cholecystectomy is preferred for most ASA II acute cholecystitis cases, reserving percutaneous cholecystostomy for intractable cases or those with contraindications to immediate surgery.