Urgent laparoscopic cholecystectomy or percutaneous cholecystostomy for grade II–III acute calculous cholecystitis: selection criteria and outcomes of a comparative cohort study

Introduction. The choice between urgent laparoscopic cholecystectomy (LC) and percutaneous cholecystostomy (PC) in grade II–III acute calculous cholecystitis remains controversial, especially in high-risk surgical patients.
The aim of the study: to compare the early results of urgent LC and primary PC with analysis of the 90-day treatment pathway.
Materials and methods. This single-centre retrospective cohort study included 166 patients: 71 underwent PC and 95 underwent urgent LC. Baseline clinical and laboratory characteristics, imaging findings, timing of intervention, hospital stay, operative parameters, complications, repeated interventions, readmissions and the primary composite endpoint were analysed.
Results. Patients in the PC group were older, had a higher comorbidity burden and higher C-reactive protein levels: 161,2 [96,9; 240,0] versus 40,3 [7,8; 148,9] mg/L, p<0,001. The primary composite endpoint occurred in 34/71 (47,9 %) and 10/95 (10,5 %) patients, respectively, p<0,001. Repeated interventions were more frequent after PC: 42,3 % versus 6,3 %, p<0,001. Delayed cholecystectomy after PC was associated with longer operative time, higher conversion rate and more complications: 24,0 % versus 7,4 %, p=0,028.
Conclusion. PC is effective for initial stabilization but does not always complete the treatment pathway. In potentially operable patients, PC should be considered the first treatment stage followed by reassessment of cholecystectomy feasibility.

1. Yokoe M., Hata J., Takada T., Strasberg S.M., Asbun H.J., Wakabayashi G., et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis. J Hepatobiliary Pancreat Sci., 2018, no 25(1), pp. 41–54. https://doi.org/10.1002/jhbp.515

2. 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. J Hepatobiliary Pancreat Sci., 2018, no 25(1), рр. 55–72. https://doi.org/10.1002/jhbp.516

3. Wakabayashi G., Iwashita Y., Hibi T., Takada T., Strasberg S.M., Asbun H.J., et al. Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis. J Hepatobiliary Pancreat Sci., 2018, no 25(1), рр. 73–86. https://doi.org/10.1002/jhbp.517

4. Pisano M., Allievi N., Gurusamy K., Borzellino G., Cimbanassi S., Boerna D., et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg., 2020, no 15, рр. 61. https://doi.org/10.1186/s13017-020-00336-x

5. Revishvili A.Sh., Olovyanny V.E., Markov P.V., Gurmikov B.N., Kuznetsov A.V. Potentially preventable causes of mortality in acute calculous cholecystitis: a population-based study. Pirogov Russian Journal of Surgery, 2024, no 7, рр. 5–15. (In Russ.) https://doi.org/10.17116/hirurgia20240715

6. Ministry of Health of the Russian Federation. Acute cholecystitis. Clinical guidelines. 2021/2023. Available at: cr.minzdrav.gov.ru/schema/324_2. (In Russ.)

7. Ministry of Health of the Russian Federation. Cholelithiasis. Adults. Clinical guidelines. 2024. Available at: cr.minzdrav.gov.ru/schema/580_2. (In Russ.)

8. Brunt L.M., Deziel D.J., Telem D.A., Strasberg S.M., Aggarwal R., Asbun H., et al. Safe Cholecystectomy Multi-Society Practice Guideline and State-of-the-Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy. Surg Endosc., 2020, no 34, рр. 2827–2855. https://doi.org/10.1007/s00464-020-07568-7

9. 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 randomized clinical trial. BMJ, 2018, no 363. https://doi.org/10.1136/bmj.k3965

10. Cirocchi R., Amato L., Ungania S., Buononato M., Tebala G.D., Cirillo B., et al. Management of acute cholecystitis in high-risk patients: percutaneous gallbladder drainage as a definitive treatment versus emergency cholecystectomy – systematic review and meta-analysis. J Clin Med., 2023, no 12(15), рр. 4903. https://doi.org/10.3390/jcm12154903

11. Fanciulli G., Favara G., Maugeri A., et al. Comparing percutaneous treatment and cholecystectomy outcomes in acute cholecystitis patients: a systematic review and meta-analysis. World J Emerg Surg., 2025, no 20, рр. 50. https://doi.org/10.1186/s13017-025-00622-6

12. Pesce A., Ramírez-Giraldo C., Arkoudis N.A., Ramsay G., Popivanov G., Gurusamy K., et al. Management of high-surgicalrisk patients with acute cholecystitis following percutaneous cholecystostomy: results of an international Delphi consensus study. Int J Surg., 2025, no 111(5), рр. 3185–3192. https://doi.org/10.1097/JS9.0000000000002325

13. Cheo F.Y., Sin E.I. Outcomes of early compared to late interval cholecystectomy post-percutaneous cholecystostomy in patients diagnosed with acute cholecystitis: a systematic review and meta-analysis. World J Surg., 2026, no 50(6), рр. 1528–1544. https://doi.org/10.1002/wjs.70375

14. Madni T.D., Leshikar D.E., Minshall C.T., Nakonezny P.A., Cornelius C.C., Imran J.B., et al. The Parkland grading scale for cholecystitis. Am J Surg., 2018, no 215(4), рр. 625–630. https://doi.org/10.1016/j.amjsurg.2017.05.017

15. Griffiths E.A., Hodson J., Vohra R.S., Marriott P., Katbeh T., Zino S., et al. Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy. Surg Endosc., 2019, no 33(1), рр. 110–121. https://doi.org/10.1007/s00464-018-6281-2