Early Laparoscopic Cholecystectomy after Percutaneous Transhepatic Gallbladder Drainage in Acute Cholecystitis is Appropriate and Safe: An Inverse Probability of Treatment Weighting Analysis

Background: Acute cholecystitis (AC) is a common emergency requiring timely surgical intervention. While laparoscopic cholecystectomy (LC) is the standard treatment, the optimal timing for LC following percutaneous transhepatic gallbladder drainage (PTGBD) remains debated. This study evaluates and compares the safety and efficacy of early LC after PTGBD, immediate LC without PTGBD, and delayed LC following PTGBD. Methods: A retrospective cohort study was conducted at a Level I referral center, analyzing 1436 patients diagnosed with AC and managed surgically between 2010 and 2018. Patients were categorized into three groups: early LC after PTGBD (Early group, n = 18), immediate LC without PTGBD (Immediate group, n = 1243), and delayed LC following PTGBD (Delayed group, n = 175). Patient demographics, clinical characteristics, and surgical outcomes were analyzed using inverse probability of treatment weighting (IPTW) to adjust for baseline differences. Results: Compared to the Immediate group, the Early group had a higher proportion of older patients and multiple comorbidities. After adjustment, adverse event rates were similar between both groups, but major complications were lower in the Early group. Compared to the Delayed group, the Early group demonstrated significantly shorter hospital stays and lower major complication rates. Conclusions: Early LC after PTGBD during the same admission is a viable alternative to delayed LC, reducing hospital stay and complications. Immediate LC remains the preferred approach for eligible patients without prior PTGBD. Further prospective studies are needed to refine the optimal timing of LC following PTGBD.