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Systematic review and meta-analysis of early vs late interval laparoscopic cholecystectomy following percutaneous cholecystostomy

Open AccessPublished:April 06, 2022DOI:https://doi.org/10.1016/j.hpb.2022.03.016

      Abstract

      Background

      High risk surgical patients with acute cholecystitis are commonly treated with percutaneous cholecystostomy (PTC) drainage. The optimal timing of subsequent interval laparoscopic cholecystectomy (LC) remains unclear.

      Methods

      Medline, EMBASE, and Scopus were searched to identify studies published between 01/01/2000 and 31/12/2020, reporting on interval LC outcomes in patients initially treated by PTC. Early and late interval LC were defined as <30 and ≥ 30 days respectively. The Methodological Index for Nonrandomized Studies was used for quality assessment. Meta-analysis of proportions was conducted using a random-effects model.

      Results

      A total of 512 studies were screened, 41 met the inclusion criteria. There were 22 studies in both early and late interval LC groups, with 3 included studies reporting both early and late groups. Following quality assessment, 29 studies were included in the meta-analysis. There were no significant differences between early and late interval LC in terms of conversion rates (7.2% vs 8.3%, p = 0.854), 90-day morbidity (12.8% vs 15.9%, p = 0.496), and 90-day mortality (0.25% vs 0.32%, p = 0.704). Heterogeneity was significant (I2>50%) in all groups.

      Conclusion

      Current evidence of interval LC within or beyond 30 days demonstrates no significant impact on outcomes. Patient factors, clinical experience, and hospital facilities may prove more important predictors.

      Introduction

      Acute cholecystitis, an inflammatory condition of the gallbladder, is a common surgical condition that may require hospital admission and subsequent surgical management.
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      • Chen H.-Q.
      • Liao W.-X.
      • Zhou W.-Y.
      • Chen J.-H.
      • Li W.-C.
      • et al.
      Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis.
      ,
      • Portincasa P.
      • Moschetta A.
      • Palasciano G.
      Cholesterol gallstone disease.
      Presentations vary from mild and self-limiting to a life threatening disease with an approximate mortality rate of 0.6%.
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      • Liao W.-X.
      • Zhou W.-Y.
      • Chen J.-H.
      • Li W.-C.
      • et al.
      Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis.
      • Portincasa P.
      • Moschetta A.
      • Palasciano G.
      Cholesterol gallstone disease.
      • El-Gendi A.
      • El-Shafei M.
      • Emara D.
      Emergency versus delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in grade II acute cholecystitis patients.
      Associated complications include empyema, abscess formation, haemorrhagic transformation, or perforation of the gallbladder with peritonitis.
      • Huang S.-Z.
      • Chen H.-Q.
      • Liao W.-X.
      • Zhou W.-Y.
      • Chen J.-H.
      • Li W.-C.
      • et al.
      Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis.
      The 2018 Tokyo Guidelines (TG18) provide clear guidance on the recommended management options.
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      • Suzuki K.
      • Takada T.
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      • Asbun H.J.
      • Endo I.
      • et al.
      Tokyo guidelines 2018: flowchart for the management of acute cholecystitis.
      Early laparoscopic cholecystectomy (LC) is the recommended management option in patients deemed able to withstand surgical treatment.
      • Okamoto K.
      • Suzuki K.
      • Takada T.
      • Strasberg S.M.
      • Asbun H.J.
      • Endo I.
      • et al.
      Tokyo guidelines 2018: flowchart for the management of acute cholecystitis.
      In high-risk surgical patients with moderate and severe acute cholecystitis, the TG18 recommend the use of percutaneous transhepatic gallbladder drainage as the first alternative to surgical intervention.
      • Okamoto K.
      • Suzuki K.
      • Takada T.
      • Strasberg S.M.
      • Asbun H.J.
      • Endo I.
      • et al.
      Tokyo guidelines 2018: flowchart for the management of acute cholecystitis.
      High-risk surgical patients are those individuals presenting with associated organ dysfunction and/or significant frailty or comorbidities.
      • Okamoto K.
      • Suzuki K.
      • Takada T.
      • Strasberg S.M.
      • Asbun H.J.
      • Endo I.
      • et al.
      Tokyo guidelines 2018: flowchart for the management of acute cholecystitis.
      These can be assessed and classified using measures such as the American Society of Anaesthesiologists (ASA) or the Charleston Comorbidity Index (CCI).
      • Okamoto K.
      • Suzuki K.
      • Takada T.
      • Strasberg S.M.
      • Asbun H.J.
      • Endo I.
      • et al.
      Tokyo guidelines 2018: flowchart for the management of acute cholecystitis.
      Previous research has highlighted the positive correlation between gallbladder distension and oedema with conversion rates,
      • Lo C.M.
      • Liu C.L.
      • Fan S.T.
      • Lai E.C.S.
      • Wong J.
      Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.
      ,
      • Kolla S.B.
      • Aggarwal S.
      • Kumar A.
      • Kumar R.
      • Chumber S.
      • Parshad R.
      • et al.
      Early vs delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial.
      as well as operative time and bleeding with postoperative complications.
      • Jia B.
      • Liu K.
      • Tan L.
      • Jin Z.
      • Fu Y.
      • Liu Y.
      Evaluation of the safety and efficacy of percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for treating acute complicated cholecystitis.
      ,
      • Jackson T.D.
      • Wannares J.J.
      • Lancaster R.T.
      • Rattner D.W.
      • Hutter M.M.
      Does speed matter? The impact of operative time on outcome in laparoscopic surgery.
      Percutaneous Cholecystostomy (PTC) acts by providing source control, draining the gallbladder distension, and reducing the associated inflammation and oedema.
      • Huang S.-Z.
      • Chen H.-Q.
      • Liao W.-X.
      • Zhou W.-Y.
      • Chen J.-H.
      • Li W.-C.
      • et al.
      Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis.
      In a meta-analysis of 15 studies, Huang et al. compared early LC with delayed LC following PTC and found shorter operative times, reduced conversion rates, and less intraoperative bleeding in the delayed LC following PTC group.
      • Huang S.-Z.
      • Chen H.-Q.
      • Liao W.-X.
      • Zhou W.-Y.
      • Chen J.-H.
      • Li W.-C.
      • et al.
      Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis.
      In addition, the CHOCOLATE multicentre randomised clinical trial from the Netherlands provided evidence that PTC is not an optimal long term management plan with 44 out of 68 (65%) patients assigned to the PTC without planned interval LC arm experiencing major complications.
      • Loozen C.S.
      • Van Santvoort H.C.
      • Van Duijvendijk P.
      • Besselink M.G.
      • Gouma D.J.
      • Nieuwenhuijzen G.A.
      • et al.
      Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial.
      The reported morbidity and mortality in high risk patients with acute cholecystitis remains high
      • Okamoto K.
      • Suzuki K.
      • Takada T.
      • Strasberg S.M.
      • Asbun H.J.
      • Endo I.
      • et al.
      Tokyo guidelines 2018: flowchart for the management of acute cholecystitis.
      ,
      • Mori Y.
      • Itoi T.
      • Baron T.H.
      • Takada T.
      • Strasberg S.M.
      • Pitt H.A.
      • et al.
      Tokyo guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos).
      despite PTC being the recommended management since the 2013 Tokyo Guidelines (TG13).
      • Okamoto K.
      • Suzuki K.
      • Takada T.
      • Strasberg S.M.
      • Asbun H.J.
      • Endo I.
      • et al.
      Tokyo guidelines 2018: flowchart for the management of acute cholecystitis.
      A question that remains unsolved is whether there is an optimal time period between PTC and interval LC. The TG18 have highlighted and addressed this by currently recommending that physicians need to decide regarding timing on the basis of patient factors, hospital facilities, and clinical experience.
      • Okamoto K.
      • Suzuki K.
      • Takada T.
      • Strasberg S.M.
      • Asbun H.J.
      • Endo I.
      • et al.
      Tokyo guidelines 2018: flowchart for the management of acute cholecystitis.
      This review aims to assess the available evidence on patient outcomes in those that underwent an interval LC following PTC for acute cholecystitis, as well as compare outcomes in those with early interval LC (<30 days) and late interval LC (≥30 days). The primary outcome of interest was conversion rates and secondary outcomes included 90-day morbidity and mortality, operative time, and hospital length of stay.

      Methods

      Protocol and review design

      The protocol was prospectively registered with PROSPERO, CRD42021228685.
      • Kourounis G.
      • Rooke Z.
      • Georgiades F.
      • McGuigan M.
      Optimal timing of interval laparoscopic cholecystectomy following cholecystostomy.
      Ethics approval was not required for this study design. A systematic review was conducted on the published literature between 1 January 2000 and 31 December 2020 using Medline, PubMed, EMBASE, and Scopus. The search strategy for Medline, PubMed and EMBASE (via Ovid) was “laparoscopic cholecystectomy AND (cholecystostomy OR (percutaneous adj4 drain∗))”. The same strategy but without the adj4 function was used on Scopus. The inclusion criteria included studies reporting outcomes on adults with cholecystitis that had a PTC followed by interval LC. Exclusion criteria included studies that did not report conversion rates or did not specify the time interval between PTC and LC. In studies with multiple publications from the same cohort, only the latest publication was used. Case reports, case series and non-English language studies were also excluded from this review.

      Study selection and data extraction

      All identified articles were screened by at least two independent reviewers following removal of duplicates. Discussion with a third author resolved any inclusion conflicts. Full text articles were retrieved for all screened results. Review articles were not included but their references were searched to identify other studies that met the inclusion criteria.
      Data extraction was performed by two independent authors. Study characteristics retrieved included first author, year of publication, country of study, and study design. Cohort data retrieved included number of patients with PTC, mean or median age, percent female ratio, cohort description metric (ie. TG18, TG13, ASA, CCI), timing of interval LC, number of planned LC and open cholecystectomies (OC), conversion rates during interval LC, 90-day morbidity and mortality. Other reported outcomes also recorded included procedure time, hospital length of stay, and blood loss. There is currently no standard definition of early and late interval LC following PTC. For the purpose or this review we defined early interval LC following PTC as <30 days, and late as ≥30 days. Though other time intervals have been described previously, such as <7 and ≥ 7 days,
      • Huang S.-Z.
      • Chen H.-Q.
      • Liao W.-X.
      • Zhou W.-Y.
      • Chen J.-H.
      • Li W.-C.
      • et al.
      Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis.
      this time frame was chosen on the basis of the available evidence to allow as equal a distribution between the two groups.

      Quality assessment

      Assessment of study quality was performed using the Methodological Index for Nonrandomized Studies (MINORS).
      • Slim K.
      • Nini E.
      • Forestier D.
      • Kwiatkowski F.
      • Panis Y.
      • Chipponi J.
      Methodological Index for non-randomized studies (minors): development and validation of a new instrument.
      Where study design precluded assessment of certain criteria, these were marked as not applicable (NA) and removed from the total score for overall assessment. Overall MINORS scores were calculated and classified in quartiles. Studies with a score of less than or equal to the first quartile were excluded from quantitative synthesis.

      Statistical analysis

      Quantitative analysis and synthesis was performed using Statistics Analysis (STATA, version 17.0).
      Conversion rates and morbidity were analysed using a meta-analysis of proportion with a random effects model and Freeman-Tukey double arcsine transformation as described by Nyaga et al.
      • Nyaga V.N.
      • Arbyn M.
      • Aerts M.
      Metaprop: a stata command to perform meta-analysis of binomial data.
      Pooled chi squared test for independence analysis was used to measure difference in mortality. Dates of publication were compared using the Mann–Whitney U test. Statistical significance was defined at p < 0.050. The I2 statistic was used to evaluate heterogeneity among studies, with an I2>50% regarded as significant heterogeneous.

      Results

      Literature review and study selection

      A total of 921 articles were retrieved from the electronic databases. A further 12 articles were identified that complied with the inclusion criteria from the full text articles reviewed. After removal of 416 duplicates, 517 abstracts were reviewed for compliance with the inclusion criteria. Following removal of 408 non relevant abstracts, 109 full text articles were retrieved and assessed. A total of 68 full text articles were excluded with reasoning outlined in Fig. 1. A total of 41 studies were included in the review
      • El-Gendi A.
      • El-Shafei M.
      • Emara D.
      Emergency versus delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in grade II acute cholecystitis patients.
      ,
      • Jia B.
      • Liu K.
      • Tan L.
      • Jin Z.
      • Fu Y.
      • Liu Y.
      Evaluation of the safety and efficacy of percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for treating acute complicated cholecystitis.
      ,
      • Choi J.W.
      • Park S.H.
      • Choi S.Y.
      • Kim H.S.
      • Kim T.H.
      Comparison of clinical result between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis.
      • Han I.W.
      • Jang J.-Y.
      • Kang M.J.
      • Lee K.B.
      • Lee S.E.
      • Kim S.-W.
      Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage.
      • Kim I.-G.
      • Kim J.S.
      • Jeon J.Y.
      • Jung J.P.
      • Chon S.E.
      • Kim H.J.
      • et al.
      • Kim H.O.
      • Ho Son B.
      • Yoo C.H.
      • Ho Shin J.
      Impact of delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis.
      • Kim J.H.
      • Kim J.W.
      • Jeong I.H.
      • Choi T.Y.
      • Yoo B.M.
      • Kim J.H.
      • et al.
      Surgical outcomes of laparoscopic cholecystectomy for severe acute cholecystitis.
      • Akyürek N.
      • Salman B.B.
      • Yüksel O.
      • Tezcaner T.
      • Irkörücü O.
      • Yücel C.
      • et al.
      Management of acute calculous cholecystitis in high-risk patients: percutaneous cholecystotomy followed by early laparoscopic cholecystectomy.
      • Macrì A.
      • Scuderi G.
      • Saladino E.
      • Trimarchi G.
      • Terranova M.
      • Versaci A.
      • et al.
      Acute gallstone cholecystitis in the elderly.
      • Tsumura H.
      • Ichikawa T.
      • Hiyama E.
      • Kagawa T.
      • Nishihara M.
      • Murakami Y.
      • et al.
      An evaluation of laparoscopic cholecystectomy after selective percutaneous transhepatic gallbladder drainage for acute cholecystitis.
      • Chikamori F.
      • Kuniyoshi N.
      • Shibuya S.
      • Takase Y.
      Early scheduled laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for patients with acute cholecystitis.
      • Kim K.H.
      • Sung C.K.
      • Park B.K.
      • Kim W.K.
      • Oh C.W.
      • Kim K.S.
      Percutaneous gallbladder drainage for delayed laparoscopic cholecystectomy in patients with acute cholecystitis.
      • Lyu Y.
      • Li T.
      • Wang B.
      • Cheng Y.
      Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis.
      • Carti E.B.B.
      • Kutluturk K.
      • Kutlutürk K.
      Should percutaneous cholecystostomy Be used in all cases difficult to manage?.
      • Liu P.
      • Liu C.
      • Wu Y.-T.
      • Zhu J.-Y.
      • Zhao W.-C.
      • Li J.-B.
      • et al.
      Impact of B-Mode-Ultrasound-Guided transhepatic and transperitoneal cholecystostomy tube placement on laparoscopic cholecystectomy.
      • Saumoy M.
      • Tyberg A.
      • Brown E.
      • Eachempati S.R.
      • Lieberman M.
      • Afaneh C.
      • et al.
      Successful cholecystectomy after endoscopic ultrasound gallbladder drainage compared with percutaneous cholecystostomy, can it Be done?.
      • Pal K.M.I.
      • Ali A.
      • Bari H.
      Role of percutaneous cholecystostomy tube placement in the management of acute calculus cholecystitis in high risk patients.
      • Kamer E.
      • Cengiz F.
      • Cakir V.
      • Balli O.
      • Acar T.
      • Peskersoy M.
      • et al.
      Percutaneous cholecystostomy for delayed laparoscopic cholecystectomy in patients with acute cholecystitis: analysis of a single-centre experience and literature review.
      • Tolan H.K.
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      • Basak F.
      • Atak I.
      • Ozbagriacik M.
      • Ozpek A.
      • et al.
      Percutaneous cholecystostomy: a curative treatment modality forelderly and high ASA score acute cholecystitis patients.
      • Yu H.
      • Song H.
      • Pan B.
      • Jin X.
      • Jun X.
      • Gao G.
      Is it safe to give laparoscopic cholecystectomy (LC) treatment of acute cholecystitis in senile patients 3 Months after percutaneous transhepatic gallbladder drainage (PTGD)? A case-control study.
      • Hu Y.R.
      • Pan J.H.
      • Tong X.C.
      • Li K.Q.
      • Chen S.R.
      • Huang Y.
      Efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for acute cholecystitis in elderly and high-risk patients.
      • Khasawneh M.A.
      • Shamp A.
      • Heller S.
      • Zielinski M.D.
      • Jenkins D.H.
      • Osborn J.B.
      • et al.
      Successful laparoscopic cholecystectomy after percutaneous cholecystostomy tube placement.
      • Mizrahi I.
      • Mazeh H.
      • Yuval J.B.
      • Almogy G.
      • Bala M.
      • Simanovski N.
      • et al.
      Perioperative outcomes of delayed laparoscopic cholecystectomy for acute calculous cholecystitis with and without percutaneous cholecystostomy.
      • Endo I.
      • Takada T.
      • Hwang T.-L.
      • Akazawa K.
      • Mori R.
      • Miura F.
      • et al.
      Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-taiwan multicenter cohort study.
      • Karakayali F.Y.
      • Akdur A.
      • Kirnap M.
      • Harman A.
      • Ekici Y.
      • Moray G.
      Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis.
      • Costi R.
      • Le Bian A.
      • Cauchy F.
      • Diop P.S.
      • Carloni A.
      • Catherine L.
      • et al.
      Synchronous pyogenic Liver abscess and acute cholecystitis: how to recognize it and what to do (emergency cholecystostomy followed by delayed laparoscopic cholecystectomy).
      • Chok K.S.H.
      • Chu F.S.K.
      • Cheung T.T.
      • Lam V.W.T.
      • Yuen W.K.
      • Ng K.K.C.
      • et al.
      Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis.
      • Koebrugge B.
      • van Leuken M.
      • Ernst M.F.
      • van Munster I.
      • Bosscha K.
      • B K
      • et al.
      Percutaneous cholecystostomy in critically ill patients with a cholecystitis: a safe option.
      • Paran H.
      • Zissin R.
      • Rosenberg E.
      • Griton I.
      • Kots E.
      • Gutman M.
      Prospective evaluation of patients with acute cholecystitis treated with percutaneous cholecystostomy and interval laparoscopic cholecystectomy.
      • Kaura K.
      • Bazerbachi F.
      • Sawas T.
      • Levy M.J.
      • Martin J.A.
      • Storm A.C.
      • et al.
      Surgical outcomes of ERCP-guided transpapillary gallbladder drainage versus percutaneous cholecystostomy as bridging therapies for acute cholecystitis followed by interval cholecystectomy.
      • Lee J.S.
      • Lee S.J.
      • Choi I.S.
      • Moon J.I.
      Optimal timing of percutaneous transhepatic gallbladder drainage and subsequent laparoscopic cholecystectomy according to the severity of acute cholecystitis.
      • Kimura K.
      • Adachi E.
      • Omori S.
      • Toyohara A.
      • Higashi T.
      • Ohgaki K.
      • et al.
      The influence of the interval between percutaneous transhepatic gallbladder drainage and cholecystectomy on perioperative outcomes: a retrospective study.
      • Tomimaru Y.
      • Fukuchi N.
      • Yokoyama S.
      • Mori T.
      • Tanemura M.
      • Sakai K.
      • et al.
      Optimal timing of laparoscopic cholecystectomy after gallbladder drainage for acute cholecystitis: a multi-institutional retrospective study.
      • Han J.W.
      • Choi Y.H.
      • Lee I.S.
      • Chun H.J.
      • Choi H.J.
      • Hong T.H.
      • et al.
      Early laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage is feasible in low-risk patients with acute cholecystitis.
      • Inoue K.
      • Ueno T.
      • Nishina O.
      • Douchi D.
      • Shima K.
      • Goto S.
      • et al.
      Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis.
      • Hung Y.L.
      • Chen H.W.
      • Tsai C.Y.
      • Chen T.C.
      • Wang S.Y.
      • Sung C.M.
      • et al.
      The optimal timing of interval laparoscopic cholecystectomy following percutaneous cholecystostomy based on pathological findings and the incidence of biliary events.
      • Jung B.-H.
      • Park J.-I.
      Impact of scheduled laparoscopic cholecystectomy in patients with acute cholecystitis, following percutaneous transhepatic gallbladder drainage.
      • Jung W.H.
      • Park D.E.
      Timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis.
      • Zeren S.
      • Bayhan Z.
      • Kocak C.
      • Kesici U.
      • Korkmaz M.
      • Ekici M.F.
      • et al.
      Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis: percutaneous cholecystostomy.
      • Yamada K.
      • Yamashita Y.
      • Yamada T.
      • Takeno S.
      • Noritomi T.
      Optimal timing for performing percutaneous transhepatic gallbladder drainage and subsequent cholecystectomy for better management of acute cholecystitis.
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      • Genna M.
      Role of percutaneous cholecystostomy before laparoscopic cholecystectomy in severe acute cholecystitis.
      and are summarised in Table 1.
      Figure 1
      Figure 1PRISMA flow chart of literature review
      Table 1Characteristics of included studies categorised by early and late interval cholecystectomy
      Authors,

      Year
      CountryType of StudyNo. of pts with PTCAge%FTokyo Classification or Comorbidity ScoreTiming of interval LCPlanned LCConversion Rate n (%)Planned OCMortality

      Morbidity n
      Other
      Early Interval Cholecystectomy (<30 days)
      Lee et al.

      2022
      • Lee J.S.
      • Lee S.J.
      • Choi I.S.
      • Moon J.I.
      Optimal timing of percutaneous transhepatic gallbladder drainage and subsequent laparoscopic cholecystectomy according to the severity of acute cholecystitis.
      KoreaRC6956641%ASA ≥3

      34.1%
      Early

      6.2 (SD 5.2)
      69511 (1.6%)04

      78
      Subtotal Cholecystectomy 4

      Mean procedure time 61.8 (SD 27.9) min

      Mean postoperative LOS 3.9 (SD 5.0) days
      Kimura et al.

      2021
      • Kimura K.
      • Adachi E.
      • Omori S.
      • Toyohara A.
      • Higashi T.
      • Ohgaki K.
      • et al.
      The influence of the interval between percutaneous transhepatic gallbladder drainage and cholecystectomy on perioperative outcomes: a retrospective study.
      JapanRC227636%TG18 I/II/III

      36%/55%/9%
      Early

      <14 days
      145 (35.7%)00

      6
      Mean procedure time 117.4 (SD 10.6) min

      Mean postoperative LOS 19.5 (SD 7.2) days
      Lyu et al.

      2021
      • Lyu Y.
      • Li T.
      • Wang B.
      • Cheng Y.
      Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis.
      ChinaRC1006536%TG18 I/II/III

      18%/77%/5%
      Early

      <1 week
      222 (9%)00

      3
      Mean procedure time 92.16 (SD 4.5) mins

      Mean postoperative LOS 5.2 (SD 0.70) days
      6947%TG18 I/II/III

      27%/73%/0%
      Early

      1–4 weeks
      302 (7%)00

      4
      Mean procedure time 89.2 (SD 3.88) mins

      Mean postoperative LOS 5.34 (SD 0.54) days
      Tomimaru et al.

      2020
      • Tomimaru Y.
      • Fukuchi N.
      • Yokoyama S.
      • Mori T.
      • Tanemura M.
      • Sakai K.
      • et al.
      Optimal timing of laparoscopic cholecystectomy after gallbladder drainage for acute cholecystitis: a multi-institutional retrospective study.
      JapanRC856929%TG 18 I/II/III

      8%/53%/39%
      Early

      6 (SD 4) days
      852 (2.4%)00

      6
      Mean procedure time 162 (SD 61) min

      Mean postoperative LOS 10 (SD 8) days
      Jia et al.

      2018
      • Jia B.
      • Liu K.
      • Tan L.
      • Jin Z.
      • Fu Y.
      • Liu Y.
      Evaluation of the safety and efficacy of percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for treating acute complicated cholecystitis.
      ChinaRC656242%ASA 3.5 ± 0.6Early (<5 days)381 (2.6%)00

      2
      Mean procedure time 78 ± 19 min

      Mean postoperative LOS 9 ± 3 days
      Endo et al.

      2017
      • Endo I.
      • Takada T.
      • Hwang T.-L.
      • Akazawa K.
      • Mori R.
      • Miura F.
      • et al.
      Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-taiwan multicenter cohort study.
      JapanRC123968.932.6%TG13 I/II/III

      19%/26%/27%
      Early

      <30 days
      45637 (8.1%)2316

      96
      Mean procedure time 136.7 min
      Inoue et al.

      2017
      • Inoue K.
      • Ueno T.
      • Nishina O.
      • Douchi D.
      • Shima K.
      • Goto S.
      • et al.
      Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis.
      JapanRC677538.8%TG13 I/II/III

      19.4%/62.7%/17.9%
      Early

      <30 days
      549 (16%)130

      9
      25 (37%) Subtotal cholecystectomies
      Jung et al.

      2017
      • Jung B.-H.
      • Park J.-I.
      Impact of scheduled laparoscopic cholecystectomy in patients with acute cholecystitis, following percutaneous transhepatic gallbladder drainage.
      KoreaRC1286539%ASA I/II/III/IV

      17.2%/50.8%/31.3%/0.7%
      Early

      Mean 8 days (Range 2–23)
      12831 (25%)00

      4
      Mean procedure time 82 ± 40 min

      Mean postoperative LOS 7.3 ± 7.3 days
      Zeren et al.

      2017
      • Zeren S.
      • Bayhan Z.
      • Kocak C.
      • Kesici U.
      • Korkmaz M.
      • Ekici M.F.
      • et al.
      Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis: percutaneous cholecystostomy.
      TurkeyRC4075.745%Geriatric cohortEarly (within 72 h)254 (16%)154

      7
      Jung et al.

      2015
      • Jung W.H.
      • Park D.E.
      Timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis.
      KoreaRC746843%ASA 2.3 ± 0.7Early

      <10 days
      3010 (33%)00

      2
      Mean procedure time 103 ± 49 min

      Mean postoperative LOS 7.4 ± 5.3
      Yamada et al.

      2015
      • Yamada K.
      • Yamashita Y.
      • Yamada T.
      • Takeno S.
      • Noritomi T.
      Optimal timing for performing percutaneous transhepatic gallbladder drainage and subsequent cholecystectomy for better management of acute cholecystitis.
      JapanRC466728%TG13 I/II/III

      30.4%/56.6%/13.0%
      Early

      <14 days
      218 (38%)00

      NS
      Median procedure time 180 min (IQR 118–240)
      Borzellino et al.

      2014
      • Borzellino G.
      • Steccanella F.
      • Genna M.
      Role of percutaneous cholecystostomy before laparoscopic cholecystectomy in severe acute cholecystitis.
      ItalyRC407043%NSEarly

      Median 3 days (IQR 2–5)
      396 (15.4%)11

      12
      Median procedure time 105 (IQR 75–120) mins

      Median postoperative LOS 3 (2–6) days
      Choi et al.

      2012
      • Choi J.W.
      • Park S.H.
      • Choi S.Y.
      • Kim H.S.
      • Kim T.H.
      Comparison of clinical result between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis.
      KoreaRC4072.543%Mean ASA 2.4Early

      5 days
      402 (5%)00

      7
      Mean procedure time 85 ± 28 min
      Han et al.

      2011
      • Han I.W.
      • Jang J.-Y.
      • Kang M.J.
      • Lee K.B.
      • Lee S.E.
      • Kim S.-W.
      Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage.
      KoreaRC677029%TG13 I/II/III

      14.3%/76.2%/9.5%
      Early

      <72hr
      210 (0%)00

      4
      Mean procedure time 79.3 ± 25 min

      Mean postoperative LOS 11 ± 5 days
      Kim et al.

      2011
      • Kim I.-G.
      • Kim J.S.
      • Jeon J.Y.
      • Jung J.P.
      • Chon S.E.
      • Kim H.J.
      • et al.
      KoreaRC976652%ASA I/II/III/IV

      8.2%/66%/23.7%/2.1%
      Early

      <14 days
      974 (4.1%)00

      3
      Mean procedure time 120 ± 53 min

      Mean postoperative LOS 7 ± 4 days
      Kim et al.

      2009
      • Kim H.O.
      • Ho Son B.
      • Yoo C.H.
      • Ho Shin J.
      Impact of delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis.
      KoreaRC735840%ASA I/II/III/IV

      11%/60%/26%/3%
      Early

      <7 days
      355 (14%)00

      3
      Mean procedure time 54.7 ± 25.8 min
      Kim et al.

      2008
      • Kim J.H.
      • Kim J.W.
      • Jeong I.H.
      • Choi T.Y.
      • Yoo B.M.
      • Kim J.H.
      • et al.
      Surgical outcomes of laparoscopic cholecystectomy for severe acute cholecystitis.
      KoreaRC3766.865%NSEarly

      7 ± 3.5 days
      371 (2.7%)00

      3
      Mean procedure time 74.86 ± 35.42 min

      Mean postoperative LOS 3.9 ± 2.6 days
      Akyürek et al.

      2005
      • Akyürek N.
      • Salman B.B.
      • Yüksel O.
      • Tezcaner T.
      • Irkörücü O.
      • Yücel C.
      • et al.
      Management of acute calculous cholecystitis in high-risk patients: percutaneous cholecystotomy followed by early laparoscopic cholecystectomy.
      TurkeyPC706267%ASA II/III/IV

      19.3%/45.2%/35.5%
      Early

      <4 days
      312 (6.5%)00

      2
      Macri et al.

      2005
      • Macrì A.
      • Scuderi G.
      • Saladino E.
      • Trimarchi G.
      • Terranova M.
      • Versaci A.
      • et al.
      Acute gallstone cholecystitis in the elderly.
      ItalyRC277681%ASA II/III/IV

      37.1%/55.5%/7.4%
      Early

      <8 days
      255 (20%)01

      6
      Tsumura et al.

      2004
      • Tsumura H.
      • Ichikawa T.
      • Hiyama E.
      • Kagawa T.
      • Nishihara M.
      • Murakami Y.
      • et al.
      An evaluation of laparoscopic cholecystectomy after selective percutaneous transhepatic gallbladder drainage for acute cholecystitis.
      JapanPC606535%Mean ASA 2.4Early

      <30 days (Range 1–26 days)
      602 (3.3%)00

      7
      Mean procedure time 124 (SD 51)

      Mean postoperative LOS 11.8 (SD 7.1) days
      Chikamori et al.

      2002
      • Chikamori F.
      • Kuniyoshi N.
      • Shibuya S.
      • Takase Y.
      Early scheduled laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for patients with acute cholecystitis.
      JapanRC316731%NSEarly

      <7 days
      311 (3%)00

      0
      Mean procedure time 84min

      Mean postoperative LOS 9 ± 4 days
      Kim et al.

      2000
      • Kim K.H.
      • Sung C.K.
      • Park B.K.
      • Kim W.K.
      • Oh C.W.
      • Kim K.S.
      Percutaneous gallbladder drainage for delayed laparoscopic cholecystectomy in patients with acute cholecystitis.
      South KoreaRC275352%NSEarly

      Range 4–26 days
      274 (15%)00

      4
      Mean postoperative LOS 6 days
      Late Interval Cholecystectomy (≥30 days)
      Han et al.

      2021
      • Han J.W.
      • Choi Y.H.
      • Lee I.S.
      • Chun H.J.
      • Choi H.J.
      • Hong T.H.
      • et al.
      Early laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage is feasible in low-risk patients with acute cholecystitis.
      South KoreaRC1797237%CCI ≥6

      28.5%
      Late

      69.5 ± 89.6
      1793 (1.7%)00

      25
      Mean procedure time 53.7 (SD 27.7) min

      Mean postoperative LOS 4.2 (SD 7.8) days
      Hung et al.

      2021
      • Hung Y.L.
      • Chen H.W.
      • Tsai C.Y.
      • Chen T.C.
      • Wang S.Y.
      • Sung C.M.
      • et al.
      The optimal timing of interval laparoscopic cholecystectomy following percutaneous cholecystostomy based on pathological findings and the incidence of biliary events.
      TaiwanRC2216643%TG18 II/III

      88%/12%
      Late

      63 (46–84) days
      22113 (5.9%)00

      68
      Mean postoperative LOS 3.88 ± 3.23 days
      1236845%TG18 II/III

      90%/10%
      Late

      74 (57–97) days
      1233 (2.4%)00

      36
      Mean postoperative LOS 3.16 ± 2.25 days
      Lyu et al.

      2021
      • Lyu Y.
      • Li T.
      • Wang B.
      • Cheng Y.
      Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis.
      ChinaRC1006746%TG18 I/II/III

      17%/79%/4%
      Late

      >4 weeks
      488 (16%)00

      7
      Mean procedure time 99.3 (SD 5.2) mins

      Mean postoperative LOS 4.87 (SD 0.39) days
      Carti et al.

      2020
      • Carti E.B.B.
      • Kutluturk K.
      • Kutlutürk K.
      Should percutaneous cholecystostomy Be used in all cases difficult to manage?.
      TurkeyRC5052.538%TG13 Grade IILate (4–6 weeks)108 (80%)400

      5
      Mean postoperative LOS 2.8 days
      Kaura et al.

      2020
      • Kaura K.
      • Bazerbachi F.
      • Sawas T.
      • Levy M.J.
      • Martin J.A.
      • Storm A.C.
      • et al.
      Surgical outcomes of ERCP-guided transpapillary gallbladder drainage versus percutaneous cholecystostomy as bridging therapies for acute cholecystitis followed by interval cholecystectomy.
      United StatesRC1407229%TG18 I/II/III

      8.6%/28.6%/62.9%
      Late

      Median 72 days (IQR 51–109)
      13122 (16.8%)90

      66
      Liu et al.

      2020
      • Liu P.
      • Liu C.
      • Wu Y.-T.
      • Zhu J.-Y.
      • Zhao W.-C.
      • Li J.-B.
      • et al.
      Impact of B-Mode-Ultrasound-Guided transhepatic and transperitoneal cholecystostomy tube placement on laparoscopic cholecystectomy.
      ChinaRCTranshepatic PTC 5873.847%TG18 I/II/III

      8.6%/79.3%/12.1%
      Late (35 ± 5 days)589 (15.5%)00

      3
      Mean procedure time 118 ± 35 min

      Mean postoperative LOS 14 ± 4 days
      Transperitoneal PTC 4574.847%TG18 I/II/III

      85.2%/82.2%/11.1%
      Late (34 ± 4 days)4511 (24.4%)00

      4
      Mean procedure time 140 ± 37 min

      Mean postoperative LOS 18 ± 5 days
      Tomimaru et al.

      2020
      • Tomimaru Y.
      • Fukuchi N.
      • Yokoyama S.
      • Mori T.
      • Tanemura M.
      • Sakai K.
      • et al.
      Optimal timing of laparoscopic cholecystectomy after gallbladder drainage for acute cholecystitis: a multi-institutional retrospective study.
      JapanRC866835%TG18 I/II/III

      15%/49%/36%
      Late

      53 (SD 11) days
      868 (9.3%)00

      4
      Mean procedure time 160 (SD 92) min

      Mean postoperative LOS 8 (SD 7) days
      867136%TG18 I/II/III

      12%/62%/24%
      Late

      148 (SD 161) days
      862 (2.3%)00

      2
      Mean procedure time 149 (SD 61) min

      Mean postoperative LOS 8 (SD 11) days
      Saumoy et al.

      2019
      • Saumoy M.
      • Tyberg A.
      • Brown E.
      • Eachempati S.R.
      • Lieberman M.
      • Afaneh C.
      • et al.
      Successful cholecystectomy after endoscopic ultrasound gallbladder drainage compared with percutaneous cholecystostomy, can it Be done?.
      InternationalPC216238%Mean CCI 1.80Late (80 ± 31 days)171 (6%)40

      5
      Mean procedure time 138 (SD 46) mins
      Pal et al.

      2018
      • Pal K.M.I.
      • Ali A.
      • Bari H.
      Role of percutaneous cholecystostomy tube placement in the management of acute calculus cholecystitis in high risk patients.
      PakistanRC6558.532%ASA I/II - 36.9%

      ASA III/IV - 63.1%
      Late (6–8 weeks)435 (11%)00

      2
      Mean procedure time 120mins

      Mean postoperative LOS 5 days
      El-Gendi et al.

      2017
      • El-Gendi A.
      • El-Shafei M.
      • Emara D.
      Emergency versus delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in grade II acute cholecystitis patients.
      EgyptPC755060%TG13 Grade IILate (>6 weeks)752 (2.7%)00

      2
      Mean procedure time 38 ± 8 min

      Mean postoperative LOS 11 ± 6 h
      Endo et al.

      2017
      • Endo I.
      • Takada T.
      • Hwang T.-L.
      • Akazawa K.
      • Mori R.
      • Miura F.
      • et al.
      Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-taiwan multicenter cohort study.
      JapanRC123968.932.6%TG13 I/II/III

      19%/26%/27%
      Late

      >31 days
      26321 (8.0%)1332

      45
      Mean procedure time 134 min
      Kamer et al.

      2017
      • Kamer E.
      • Cengiz F.
      • Cakir V.
      • Balli O.
      • Acar T.
      • Peskersoy M.
      • et al.
      Percutaneous cholecystostomy for delayed laparoscopic cholecystectomy in patients with acute cholecystitis: analysis of a single-centre experience and literature review.
      TurkeyPC126033%ASA III/IV

      58%/42%
      Late

      Median 64.5 (Range 56–85)
      122 (17%)00

      3
      Median procedure time 108 (Range 45–115) mins
      Tolan et al.

      2017
      • Tolan H.K.
      • Semiz Oysu A.
      • Basak F.
      • Atak I.
      • Ozbagriacik M.
      • Ozpek A.
      • et al.
      Percutaneous cholecystostomy: a curative treatment modality forelderly and high ASA score acute cholecystitis patients.
      TurkeyRC4070.545%ASA >3Late

      >6 weeks
      163 (18.8%)0NS

      NS
      Yu et al.

      2017
      • Yu H.
      • Song H.
      • Pan B.
      • Jin X.
      • Jun X.
      • Gao G.
      Is it safe to give laparoscopic cholecystectomy (LC) treatment of acute cholecystitis in senile patients 3 Months after percutaneous transhepatic gallbladder drainage (PTGD)? A case-control study.
      ChinaRC3673.855%Geriatric cohortLate

      >3 months
      365 (13.9%)00

      3
      Mean procedure time 78.61 ± 23.87 min

      Mean postoperative LOS 4.83 ± 3 days
      Hu et al.

      2015
      • Hu Y.R.
      • Pan J.H.
      • Tong X.C.
      • Li K.Q.
      • Chen S.R.
      • Huang Y.
      Efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for acute cholecystitis in elderly and high-risk patients.
      ChinaPC356934%Mean ASA 2.2Late (Range 6–8 weeks)353 (8.6%)00

      2
      Mean procedure time 55.6 ± 23 min

      Mean postoperative LOS 3 ± 1.3 days
      Khasawneh et al.

      2015
      • Khasawneh M.A.
      • Shamp A.
      • Heller S.
      • Zielinski M.D.
      • Jenkins D.H.
      • Osborn J.B.
      • et al.
      Successful laparoscopic cholecystectomy after percutaneous cholecystostomy tube placement.
      USARC2457137.5%Median CCI 5 (IQR 4–6)Late

      Mean 55 days (Range 42–75 days)
      6313 (21%)80

      21
      Mean procedure time 96 (73–137 min)

      Mean postoperative LOS 2 (Range 1–5) days
      Mizrahi et al.

      2015
      • Mizrahi I.
      • Mazeh H.
      • Yuval J.B.
      • Almogy G.
      • Bala M.
      • Simanovski N.
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      Perioperative outcomes of delayed laparoscopic cholecystectomy for acute calculous cholecystitis with and without percutaneous cholecystostomy.
      IsraelRC1636444%Median ASA 2Late (84 ± 5 days)16318 (11%)42

      14
      Mean procedure time 142 min
      Karakayali et al.

      2014
      • Karakayali F.Y.
      • Akdur A.
      • Kirnap M.
      • Harman A.
      • Ekici Y.
      • Moray G.
      Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis.
      TurkeyPC436633%ASA I/II

      21%/79%
      Late

      >4 weeks
      438 (19%)00

      4
      Mean procedure time 106 (Range 50–163) mins

      Mean postoperative LOS 3 days
      Costi et al.

      2012
      • Costi R.
      • Le Bian A.
      • Cauchy F.
      • Diop P.S.
      • Carloni A.
      • Catherine L.
      • et al.
      Synchronous pyogenic Liver abscess and acute cholecystitis: how to recognize it and what to do (emergency cholecystostomy followed by delayed laparoscopic cholecystectomy).
      FranceRC127242%NSLate (12 ± 4 weeks)100 (0%)00

      3
      Mean procedure time 91 (Range 55–215) mins

      Mean postoperative LOS 1.7 days
      Chok et al.

      2010
      • Chok K.S.H.
      • Chu F.S.K.
      • Cheung T.T.
      • Lam V.W.T.
      • Yuen W.K.
      • Ng K.K.C.
      • et al.
      Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis.
      ChinaRC238352%ASA II/III/IV

      13%/35%/52%
      Late

      4–6 weeks
      83 (37.5%)0NS

      NS
      Koebrugge et al.

      2010
      • Koebrugge B.
      • van Leuken M.
      • Ernst M.F.
      • van Munster I.
      • Bosscha K.
      • B K
      • et al.
      Percutaneous cholecystostomy in critically ill patients with a cholecystitis: a safe option.
      NetherlandsRC357351%NSLate

      >2 months (Median 66 days)
      122 (17%)13NS

      NS
      Paran et al.

      2006
      • Paran H.
      • Zissin R.
      • Rosenberg E.
      • Griton I.
      • Kots E.
      • Gutman M.
      Prospective evaluation of patients with acute cholecystitis treated with percutaneous cholecystostomy and interval laparoscopic cholecystectomy.
      IsraelPC546156%NSLate

      >6 weeks
      252 (8%)30

      4
      Abbreviations: ASA american society of anaesthesiologists, CCI charleston comorbidity index, IC interval cholecystectomy, IQR interquartile range, LC laparoscopic cholecystectomy, LOS length of stay, NS not specified, OC open cholecystectomy, PC prospective cohort, PTC percutaneous cholecystostomy, RC retrospective cohort, SD standard deviation, TG13 tokyo guidelines 2013, TG18 tokyo guidelines 2018.

      Study characteristics

      Of these, 22 studies reported on outcomes following early interval LC,
      • Jia B.
      • Liu K.
      • Tan L.
      • Jin Z.
      • Fu Y.
      • Liu Y.
      Evaluation of the safety and efficacy of percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for treating acute complicated cholecystitis.
      ,
      • Choi J.W.
      • Park S.H.
      • Choi S.Y.
      • Kim H.S.
      • Kim T.H.
      Comparison of clinical result between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis.
      • Han I.W.
      • Jang J.-Y.
      • Kang M.J.
      • Lee K.B.
      • Lee S.E.
      • Kim S.-W.
      Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage.
      • Kim I.-G.
      • Kim J.S.
      • Jeon J.Y.
      • Jung J.P.
      • Chon S.E.
      • Kim H.J.
      • et al.
      • Kim H.O.
      • Ho Son B.
      • Yoo C.H.
      • Ho Shin J.
      Impact of delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis.
      • Kim J.H.
      • Kim J.W.
      • Jeong I.H.
      • Choi T.Y.
      • Yoo B.M.
      • Kim J.H.
      • et al.
      Surgical outcomes of laparoscopic cholecystectomy for severe acute cholecystitis.
      • Akyürek N.
      • Salman B.B.
      • Yüksel O.
      • Tezcaner T.
      • Irkörücü O.
      • Yücel C.
      • et al.
      Management of acute calculous cholecystitis in high-risk patients: percutaneous cholecystotomy followed by early laparoscopic cholecystectomy.
      • Macrì A.
      • Scuderi G.
      • Saladino E.
      • Trimarchi G.
      • Terranova M.
      • Versaci A.
      • et al.
      Acute gallstone cholecystitis in the elderly.
      • Tsumura H.
      • Ichikawa T.
      • Hiyama E.
      • Kagawa T.
      • Nishihara M.
      • Murakami Y.
      • et al.
      An evaluation of laparoscopic cholecystectomy after selective percutaneous transhepatic gallbladder drainage for acute cholecystitis.
      • Chikamori F.
      • Kuniyoshi N.
      • Shibuya S.
      • Takase Y.
      Early scheduled laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for patients with acute cholecystitis.
      • Kim K.H.
      • Sung C.K.
      • Park B.K.
      • Kim W.K.
      • Oh C.W.
      • Kim K.S.
      Percutaneous gallbladder drainage for delayed laparoscopic cholecystectomy in patients with acute cholecystitis.
      • Lyu Y.
      • Li T.
      • Wang B.
      • Cheng Y.
      Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis.
      ,
      • Endo I.
      • Takada T.
      • Hwang T.-L.
      • Akazawa K.
      • Mori R.
      • Miura F.
      • et al.
      Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-taiwan multicenter cohort study.
      ,
      • Lee J.S.
      • Lee S.J.
      • Choi I.S.
      • Moon J.I.
      Optimal timing of percutaneous transhepatic gallbladder drainage and subsequent laparoscopic cholecystectomy according to the severity of acute cholecystitis.
      • Kimura K.
      • Adachi E.
      • Omori S.
      • Toyohara A.
      • Higashi T.
      • Ohgaki K.
      • et al.
      The influence of the interval between percutaneous transhepatic gallbladder drainage and cholecystectomy on perioperative outcomes: a retrospective study.
      • Tomimaru Y.
      • Fukuchi N.
      • Yokoyama S.
      • Mori T.
      • Tanemura M.
      • Sakai K.
      • et al.
      Optimal timing of laparoscopic cholecystectomy after gallbladder drainage for acute cholecystitis: a multi-institutional retrospective study.
      ,
      • Inoue K.
      • Ueno T.
      • Nishina O.
      • Douchi D.
      • Shima K.
      • Goto S.
      • et al.
      Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis.
      ,
      • Jung B.-H.
      • Park J.-I.
      Impact of scheduled laparoscopic cholecystectomy in patients with acute cholecystitis, following percutaneous transhepatic gallbladder drainage.
      • Jung W.H.
      • Park D.E.
      Timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis.
      • Zeren S.
      • Bayhan Z.
      • Kocak C.
      • Kesici U.
      • Korkmaz M.
      • Ekici M.F.
      • et al.
      Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis: percutaneous cholecystostomy.
      • Yamada K.
      • Yamashita Y.
      • Yamada T.
      • Takeno S.
      • Noritomi T.
      Optimal timing for performing percutaneous transhepatic gallbladder drainage and subsequent cholecystectomy for better management of acute cholecystitis.
      • Borzellino G.
      • Steccanella F.
      • Genna M.
      Role of percutaneous cholecystostomy before laparoscopic cholecystectomy in severe acute cholecystitis.
      and 22 studies following late interval LC.
      • El-Gendi A.
      • El-Shafei M.
      • Emara D.
      Emergency versus delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in grade II acute cholecystitis patients.
      ,
      • Lyu Y.
      • Li T.
      • Wang B.
      • Cheng Y.
      Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis.
      • Carti E.B.B.
      • Kutluturk K.
      • Kutlutürk K.
      Should percutaneous cholecystostomy Be used in all cases difficult to manage?.
      • Liu P.
      • Liu C.
      • Wu Y.-T.
      • Zhu J.-Y.
      • Zhao W.-C.
      • Li J.-B.
      • et al.
      Impact of B-Mode-Ultrasound-Guided transhepatic and transperitoneal cholecystostomy tube placement on laparoscopic cholecystectomy.
      • Saumoy M.
      • Tyberg A.
      • Brown E.
      • Eachempati S.R.
      • Lieberman M.
      • Afaneh C.
      • et al.
      Successful cholecystectomy after endoscopic ultrasound gallbladder drainage compared with percutaneous cholecystostomy, can it Be done?.
      • Pal K.M.I.
      • Ali A.
      • Bari H.
      Role of percutaneous cholecystostomy tube placement in the management of acute calculus cholecystitis in high risk patients.
      • Kamer E.
      • Cengiz F.
      • Cakir V.
      • Balli O.
      • Acar T.
      • Peskersoy M.
      • et al.
      Percutaneous cholecystostomy for delayed laparoscopic cholecystectomy in patients with acute cholecystitis: analysis of a single-centre experience and literature review.
      • Tolan H.K.
      • Semiz Oysu A.
      • Basak F.
      • Atak I.
      • Ozbagriacik M.
      • Ozpek A.
      • et al.
      Percutaneous cholecystostomy: a curative treatment modality forelderly and high ASA score acute cholecystitis patients.
      • Yu H.
      • Song H.
      • Pan B.
      • Jin X.
      • Jun X.
      • Gao G.
      Is it safe to give laparoscopic cholecystectomy (LC) treatment of acute cholecystitis in senile patients 3 Months after percutaneous transhepatic gallbladder drainage (PTGD)? A case-control study.
      • Hu Y.R.
      • Pan J.H.
      • Tong X.C.
      • Li K.Q.
      • Chen S.R.
      • Huang Y.
      Efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for acute cholecystitis in elderly and high-risk patients.
      • Khasawneh M.A.
      • Shamp A.
      • Heller S.
      • Zielinski M.D.
      • Jenkins D.H.
      • Osborn J.B.
      • et al.
      Successful laparoscopic cholecystectomy after percutaneous cholecystostomy tube placement.
      • Mizrahi I.
      • Mazeh H.
      • Yuval J.B.
      • Almogy G.
      • Bala M.
      • Simanovski N.
      • et al.
      Perioperative outcomes of delayed laparoscopic cholecystectomy for acute calculous cholecystitis with and without percutaneous cholecystostomy.
      • Endo I.
      • Takada T.
      • Hwang T.-L.
      • Akazawa K.
      • Mori R.
      • Miura F.
      • et al.
      Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-taiwan multicenter cohort study.
      • Karakayali F.Y.
      • Akdur A.
      • Kirnap M.
      • Harman A.
      • Ekici Y.
      • Moray G.
      Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis.
      • Costi R.
      • Le Bian A.
      • Cauchy F.
      • Diop P.S.
      • Carloni A.
      • Catherine L.
      • et al.
      Synchronous pyogenic Liver abscess and acute cholecystitis: how to recognize it and what to do (emergency cholecystostomy followed by delayed laparoscopic cholecystectomy).
      • Chok K.S.H.
      • Chu F.S.K.
      • Cheung T.T.
      • Lam V.W.T.
      • Yuen W.K.
      • Ng K.K.C.
      • et al.
      Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis.
      • Koebrugge B.
      • van Leuken M.
      • Ernst M.F.
      • van Munster I.
      • Bosscha K.
      • B K
      • et al.
      Percutaneous cholecystostomy in critically ill patients with a cholecystitis: a safe option.
      • Paran H.
      • Zissin R.
      • Rosenberg E.
      • Griton I.
      • Kots E.
      • Gutman M.
      Prospective evaluation of patients with acute cholecystitis treated with percutaneous cholecystostomy and interval laparoscopic cholecystectomy.
      • Kaura K.
      • Bazerbachi F.
      • Sawas T.
      • Levy M.J.
      • Martin J.A.
      • Storm A.C.
      • et al.
      Surgical outcomes of ERCP-guided transpapillary gallbladder drainage versus percutaneous cholecystostomy as bridging therapies for acute cholecystitis followed by interval cholecystectomy.
      ,
      • Tomimaru Y.
      • Fukuchi N.
      • Yokoyama S.
      • Mori T.
      • Tanemura M.
      • Sakai K.
      • et al.
      Optimal timing of laparoscopic cholecystectomy after gallbladder drainage for acute cholecystitis: a multi-institutional retrospective study.
      ,
      • Han J.W.
      • Choi Y.H.
      • Lee I.S.
      • Chun H.J.
      • Choi H.J.
      • Hong T.H.
      • et al.
      Early laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage is feasible in low-risk patients with acute cholecystitis.
      ,
      • Hung Y.L.
      • Chen H.W.
      • Tsai C.Y.
      • Chen T.C.
      • Wang S.Y.
      • Sung C.M.
      • et al.
      The optimal timing of interval laparoscopic cholecystectomy following percutaneous cholecystostomy based on pathological findings and the incidence of biliary events.
      Three studies reported and compared outcomes in both groups.
      • Lyu Y.
      • Li T.
      • Wang B.
      • Cheng Y.
      Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis.
      ,
      • Endo I.
      • Takada T.
      • Hwang T.-L.
      • Akazawa K.
      • Mori R.
      • Miura F.
      • et al.
      Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-taiwan multicenter cohort study.
      ,
      • Tomimaru Y.
      • Fukuchi N.
      • Yokoyama S.
      • Mori T.
      • Tanemura M.
      • Sakai K.
      • et al.
      Optimal timing of laparoscopic cholecystectomy after gallbladder drainage for acute cholecystitis: a multi-institutional retrospective study.
      All included studies were cohort studies, there were no randomized trials. There were 8 prospective cohort (PC) designs and 35 retrospective cohort (RC) designs outlined in Table 1. The proportion of prospective studies was higher in the late interval LC group at 6 out of 22 studies, as opposed to 2 out of 22 studies in the early interval LC group. The year of publication also varied between the two groups. Papers reporting outcomes in late interval LC were significantly more recent, with a median publication year of 2017 (IQR 2014–2020) as opposed to 2015 (IQR 2008–2017) in the early interval LC group, p = 0.039.

      Quality assessment

      Quality assessment using MINORS was variable with scores ranging from 25 to 90%. Full scoring and marking criteria are outlined in Supplementary Table 1. The median MINOR score was 50%. The first quartile score was 42%. Of the 36 included studies, 29 studies had an overall MINORS score of >42%.
      • El-Gendi A.
      • El-Shafei M.
      • Emara D.
      Emergency versus delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in grade II acute cholecystitis patients.
      ,
      • Jia B.
      • Liu K.
      • Tan L.
      • Jin Z.
      • Fu Y.
      • Liu Y.
      Evaluation of the safety and efficacy of percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for treating acute complicated cholecystitis.
      ,
      • Choi J.W.
      • Park S.H.
      • Choi S.Y.
      • Kim H.S.
      • Kim T.H.
      Comparison of clinical result between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis.
      • Han I.W.
      • Jang J.-Y.
      • Kang M.J.
      • Lee K.B.
      • Lee S.E.
      • Kim S.-W.
      Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage.
      • Kim I.-G.
      • Kim J.S.
      • Jeon J.Y.
      • Jung J.P.
      • Chon S.E.
      • Kim H.J.
      • et al.
      • Kim H.O.
      • Ho Son B.
      • Yoo C.H.
      • Ho Shin J.
      Impact of delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis.
      ,
      • Akyürek N.
      • Salman B.B.
      • Yüksel O.
      • Tezcaner T.
      • Irkörücü O.
      • Yücel C.
      • et al.
      Management of acute calculous cholecystitis in high-risk patients: percutaneous cholecystotomy followed by early laparoscopic cholecystectomy.
      ,
      • Tsumura H.
      • Ichikawa T.
      • Hiyama E.
      • Kagawa T.
      • Nishihara M.
      • Murakami Y.
      • et al.
      An evaluation of laparoscopic cholecystectomy after selective percutaneous transhepatic gallbladder drainage for acute cholecystitis.
      ,
      • Lyu Y.
      • Li T.
      • Wang B.
      • Cheng Y.
      Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis.
      ,
      • Liu P.
      • Liu C.
      • Wu Y.-T.
      • Zhu J.-Y.
      • Zhao W.-C.
      • Li J.-B.
      • et al.
      Impact of B-Mode-Ultrasound-Guided transhepatic and transperitoneal cholecystostomy tube placement on laparoscopic cholecystectomy.
      ,
      • Saumoy M.
      • Tyberg A.
      • Brown E.
      • Eachempati S.R.
      • Lieberman M.
      • Afaneh C.
      • et al.
      Successful cholecystectomy after endoscopic ultrasound gallbladder drainage compared with percutaneous cholecystostomy, can it Be done?.
      ,
      • Yu H.
      • Song H.
      • Pan B.
      • Jin X.
      • Jun X.
      • Gao G.
      Is it safe to give laparoscopic cholecystectomy (LC) treatment of acute cholecystitis in senile patients 3 Months after percutaneous transhepatic gallbladder drainage (PTGD)? A case-control study.
      • Hu Y.R.
      • Pan J.H.
      • Tong X.C.
      • Li K.Q.
      • Chen S.R.
      • Huang Y.
      Efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for acute cholecystitis in elderly and high-risk patients.
      • Khasawneh M.A.
      • Shamp A.
      • Heller S.
      • Zielinski M.D.
      • Jenkins D.H.
      • Osborn J.B.
      • et al.
      Successful laparoscopic cholecystectomy after percutaneous cholecystostomy tube placement.
      • Mizrahi I.
      • Mazeh H.
      • Yuval J.B.
      • Almogy G.
      • Bala M.
      • Simanovski N.
      • et al.
      Perioperative outcomes of delayed laparoscopic cholecystectomy for acute calculous cholecystitis with and without percutaneous cholecystostomy.
      • Endo I.
      • Takada T.
      • Hwang T.-L.
      • Akazawa K.
      • Mori R.
      • Miura F.
      • et al.
      Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-taiwan multicenter cohort study.
      • Karakayali F.Y.
      • Akdur A.
      • Kirnap M.
      • Harman A.
      • Ekici Y.
      • Moray G.
      Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis.
      • Costi R.
      • Le Bian A.
      • Cauchy F.
      • Diop P.S.
      • Carloni A.
      • Catherine L.
      • et al.
      Synchronous pyogenic Liver abscess and acute cholecystitis: how to recognize it and what to do (emergency cholecystostomy followed by delayed laparoscopic cholecystectomy).
      ,
      • Paran H.
      • Zissin R.
      • Rosenberg E.
      • Griton I.
      • Kots E.
      • Gutman M.
      Prospective evaluation of patients with acute cholecystitis treated with percutaneous cholecystostomy and interval laparoscopic cholecystectomy.
      ,
      • Lee J.S.
      • Lee S.J.
      • Choi I.S.
      • Moon J.I.
      Optimal timing of percutaneous transhepatic gallbladder drainage and subsequent laparoscopic cholecystectomy according to the severity of acute cholecystitis.
      • Kimura K.
      • Adachi E.
      • Omori S.
      • Toyohara A.
      • Higashi T.
      • Ohgaki K.
      • et al.
      The influence of the interval between percutaneous transhepatic gallbladder drainage and cholecystectomy on perioperative outcomes: a retrospective study.
      • Tomimaru Y.
      • Fukuchi N.
      • Yokoyama S.
      • Mori T.
      • Tanemura M.
      • Sakai K.
      • et al.
      Optimal timing of laparoscopic cholecystectomy after gallbladder drainage for acute cholecystitis: a multi-institutional retrospective study.
      • Han J.W.
      • Choi Y.H.
      • Lee I.S.
      • Chun H.J.
      • Choi H.J.
      • Hong T.H.
      • et al.
      Early laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage is feasible in low-risk patients with acute cholecystitis.
      • Inoue K.
      • Ueno T.
      • Nishina O.
      • Douchi D.
      • Shima K.
      • Goto S.
      • et al.
      Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis.
      • Hung Y.L.
      • Chen H.W.
      • Tsai C.Y.
      • Chen T.C.
      • Wang S.Y.
      • Sung C.M.
      • et al.
      The optimal timing of interval laparoscopic cholecystectomy following percutaneous cholecystostomy based on pathological findings and the incidence of biliary events.
      • Jung B.-H.
      • Park J.-I.
      Impact of scheduled laparoscopic cholecystectomy in patients with acute cholecystitis, following percutaneous transhepatic gallbladder drainage.
      • Jung W.H.
      • Park D.E.
      Timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis.
      ,
      • Yamada K.
      • Yamashita Y.
      • Yamada T.
      • Takeno S.
      • Noritomi T.
      Optimal timing for performing percutaneous transhepatic gallbladder drainage and subsequent cholecystectomy for better management of acute cholecystitis.
      Only these studies were included in subsequent meta-analyses.

      Conversion rates

      All included studies reported conversion rates during interval LC following PTC. The overall conversion rate was 154 out of 2041 (7.6%) patients in the early interval LC group, and 175 out of 1808 (9.7%) patients in the late interval LC group. Fig. 2 outlines the conversion rates in the studies which were meta-analysed following quality assessment. In this subset of papers, conversion rates were 133 out of 1857 (7.2%) patients in the early interval LC group, and 132 out of 1588 (8.3%) patients in the late interval LC group. The random effects meta-analysis of proportions confirmed no statistically significant difference in conversion rates between the two groups, p = 0.854. Heterogeneity among the studies within and between subgroups was significant (Early interval LC group I2 = 89.1%, Late interval LC group I2 = 76.0%, Between groups I2 = 84.9%).
      Figure 2
      Figure 2Forrest plot of conversion rates during early and late interval laparoscopic cholecystectomy following percutaneous cholecystostomy

      Morbidity and mortality

      There were 4 studies that did not report any morbidity outcomes.
      • Tolan H.K.
      • Semiz Oysu A.
      • Basak F.
      • Atak I.
      • Ozbagriacik M.
      • Ozpek A.
      • et al.
      Percutaneous cholecystostomy: a curative treatment modality forelderly and high ASA score acute cholecystitis patients.
      ,
      • Chok K.S.H.
      • Chu F.S.K.
      • Cheung T.T.
      • Lam V.W.T.
      • Yuen W.K.
      • Ng K.K.C.
      • et al.
      Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis.
      ,
      • Koebrugge B.
      • van Leuken M.
      • Ernst M.F.
      • van Munster I.
      • Bosscha K.
      • B K
      • et al.
      Percutaneous cholecystostomy in critically ill patients with a cholecystitis: a safe option.
      ,
      • Yamada K.
      • Yamashita Y.
      • Yamada T.
      • Takeno S.
      • Noritomi T.
      Optimal timing for performing percutaneous transhepatic gallbladder drainage and subsequent cholecystectomy for better management of acute cholecystitis.
      In the remaining 37 studies, the overall reported 90-day morbidity was 268 out of 2028 (13.2%) patients in the early interval LC group and 236 out of 1772 (18.4%) patients in the late interval LC group. Fig. 3 outlines morbidity rates as proportions in the studies which were meta-analysed following quality assessment. In this subset of papers, the reported 90-day morbidity was 236 out of 1844 (12.8%) patients in the early interval LC group, and 253 out of 1588 (15.9%) patients in the late interval LC group. The random effects meta-analysis of proportions confirmed no statistically significant difference in the morbidity rates of the two groups, p = 0.496. There was significant heterogeneity among the studies within and between subgroups (Early interval LC group I2 = 78.5%, Late interval LC group I2 = 89.5%, Between groups I2 = 85.4%).
      Figure 3
      Figure 3Forrest plot of reported 90-day morbidity rates following early and late interval laparoscopic cholecystectomy following percutaneous cholecystostomy
      There were 3 studies that did not report any mortality outcomes.
      • Tolan H.K.
      • Semiz Oysu A.
      • Basak F.
      • Atak I.
      • Ozbagriacik M.
      • Ozpek A.
      • et al.
      Percutaneous cholecystostomy: a curative treatment modality forelderly and high ASA score acute cholecystitis patients.
      ,
      • Chok K.S.H.
      • Chu F.S.K.
      • Cheung T.T.
      • Lam V.W.T.
      • Yuen W.K.
      • Ng K.K.C.
      • et al.
      Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis.
      ,
      • Koebrugge B.
      • van Leuken M.
      • Ernst M.F.
      • van Munster I.
      • Bosscha K.
      • B K
      • et al.
      Percutaneous cholecystostomy in critically ill patients with a cholecystitis: a safe option.
      In the remaining 33 studies, the overall reported 90-day mortality was 12 out of 2049 (0.59%) patients in the early interval LC group and 4 out of 1772 (0.23%) in the late interval LC group. The difference in mortality reduced following removal of studies with low quality assessment scores. In the subset of studies included for meta-analysis the mortality rates were 6 out of 1865 (0.32%) patients in the early interval LC group, and 4 out of 1588 (0.25%) patients in the late interval LC group. Due to most studies showing 0 frequencies, a pooled chi squared test for independence analysis was used and confirmed no significant difference between the early and later interval LC groups, p = 0.704.

      Discussion

      In this review and meta-analysis, we aimed to identify the optimal time interval for interval LC following PTC in adult patients with acute cholecystitis. Time intervals were separated into early (<30 days) and late (≥30 days) based on the intervals reported in the included literature. The current available evidence demonstrates that timing of an interval LC following PTC within or beyond 30 days does not have an impact on conversion rates as well as postoperative morbidity and mortality.
      These findings are in keeping with the management guidelines published by Okamoto et al. in the TG18. They state that there is currently no consensus on the optimal timing of LC following interval PTC, and that the responsible clinician needs to make a decision based on patient factors.
      • Okamoto K.
      • Suzuki K.
      • Takada T.
      • Strasberg S.M.
      • Asbun H.J.
      • Endo I.
      • et al.
      Tokyo guidelines 2018: flowchart for the management of acute cholecystitis.
      Our meta-analysis supports that the timing of interval LC following PTC for acute cholecystitis does not seem to be a significant determinant of outcomes. Instead, patient factors, clinical experience, and hospital facilities are likely to play a bigger role.
      Huang et al., in 2020, compared outcomes in those with early LC alone and those with interval LC following PTC.
      • Huang S.-Z.
      • Chen H.-Q.
      • Liao W.-X.
      • Zhou W.-Y.
      • Chen J.-H.
      • Li W.-C.
      • et al.
      Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis.
      They noted decreased intraoperative bleeding, operative times, conversion rates in the group with interval LC following PTC. The authors also divided the interval LC following PTC studies into two groups based on the time interval to LC (<7 days vs ≥ 7 days). They then compared these two subgroups with the LC without PTC studies. This showed the same results as with the overall comparison, however the ≥7 days group showed a greater difference in those outcomes. Outcomes between the <7 days and ≥7 days studies were not directly compared.
      A significant limitation of the evidence base on this topic is the lack of comparative studies and randomized control trials (RCT). Only 2 of the included studies reported non-randomized cohort comparisons.
      • Lyu Y.
      • Li T.
      • Wang B.
      • Cheng Y.
      Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis.
      ,
      • Endo I.
      • Takada T.
      • Hwang T.-L.
      • Akazawa K.
      • Mori R.
      • Miura F.
      • et al.
      Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-taiwan multicenter cohort study.
      In addition, of the 36 included studies, 28 were retrospective. Patient characteristics such as their comorbidities and severity of acute cholecystitis were not uniformly reported, introducing bias that could not be controlled for. Other sources of heterogeneity include the type of PTC method used (transhepatic vs transperitoneal PTC), clinical experience of surgical teams, and variability in the hospital facilities available. The definition of early and late interval LC is also variable. There is no current consensus, with studies using cut offs at 3 days, 7 days, and 30 days. The use of the 30-day cut off in this review was used to allow for an equal distribution and comparison of the available literature.
      Of note, the current review cannot comment on other timings of interval LC, such as in the use of shorter time intervals like 3 or 7 days. There are studies that have found a significant improvement in outcomes in those with interval LC at ≥3 days after PTC.
      • Choi J.W.
      • Park S.H.
      • Choi S.Y.
      • Kim H.S.
      • Kim T.H.
      Comparison of clinical result between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis.
      ,
      • Han I.W.
      • Jang J.-Y.
      • Kang M.J.
      • Lee K.B.
      • Lee S.E.
      • Kim S.-W.
      Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage.
      These findings could represent the need for a longer time interval required to alleviate inflammation and gallbladder oedema to allow for a less complicated LC.
      • Huang S.-Z.
      • Chen H.-Q.
      • Liao W.-X.
      • Zhou W.-Y.
      • Chen J.-H.
      • Li W.-C.
      • et al.
      Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis.
      Furthermore, we have found that studies reporting on late interval LC are significantly more likely to be more recent compared to the early interval LC studies. This could represent empirical clinical observations that favour late interval LC with increasing numbers of clinicians choosing this approach. However, this approach may be associated with additional complications and costs due to the prolonged presence of the PTC catheter, which is susceptible to mechanical blockage and/or dislocation.
      This meta-analysis is the first to directly compare the impact of timing between PTC and LC. Strengths of the study include the large number of included studies as well as the implementation of the MINORS quality assessment tool to refine the studies included into the meta-analysis. The use of the methodology described by Nyaga et al.
      • Nyaga V.N.
      • Arbyn M.
      • Aerts M.
      Metaprop: a stata command to perform meta-analysis of binomial data.
      allowing for the meta-analysis of proportions was vital in synthesizing these groups of mostly retrospective non-comparative cohort studies.
      A RCT comparing different interval LC times would be ideal, though potentially not the most pragmatic. Patients that are deemed sufficiently high risk to undergo PTC rather than LC are currently the minority of acute cholecystitis presentations. With current evidence suggesting a limited and non-significant difference in outcomes between the early and late interval LC groups, a sufficiently powered RCT would require very large sample sizes. A potentially more pragmatic and feasible method of future comparison could be the creation of a prospectively collected multicentre database of patients that had PTC followed by interval LC. The collected information should include patient characteristics, measures of frailty and comorbidity, method of PTC insertion, time to interval LC, intraoperative and postoperative outcomes, clinical experience of performing physicians, and relevant available hospital facilities.

      Funding

      FG is funded by the National Institute of Health Research (NIHR) in partnership with NHS Blood and Transplant (NHSBT) as an Academic Clinical Fellow. No specific funding was received to assist with the preparation of this manuscript.

      Author's contributions

      Conceptualisation/protocol development: GK, FG, Data Collection: MM, ZR, GK, Data Analysis: GK, FG, Manuscript writing/editing: GK, ZR, MM, FG.

      Conflicts of interest

      None to declare.

      Appendix A. Supplementary data

      The following is/are the supplementary data to this article:

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