Impact of puncture site location in percutaneous transhepatic gallbladder drainage on outcomes of subsequent laparoscopic cholecystectomy: a multicenter retrospective clinical study.

BACKGROUND: Percutaneous transhepatic gallbladder drainage (PTGD) followed by laparoscopic cholecystectomy (LC) is an effective treatment strategy for acute cholecystitis (AC). However, the impact of the PTGD puncture site on subsequent LC outcomes has not been systematically investigated.

METHODS: This retrospective study included patients diagnosed with AC who underwent PTGD followed by LC at the First Affiliated Hospital of Dalian Medical University (January 2018-May 2025) and Yingkou Central Hospital (January 2020-May 2025). PTGD was performed according to the Tokyo Guidelines 2018 (TG18) and individualized clinical judgment. Based on CT imaging, patients were categorized into two groups according to the PTGD puncture site: the fundus group (n = 208), where the puncture was adjacent to the gallbladder fundus, and the neck group (n = 47), where the puncture was adjacent to the gallbladder neck. Clinical parameters compared included baseline characteristics, gallbladder neck stone impaction, post-PTGD hospital stay, LC operative time, difficult gallbladder, intraoperative injuries and hemorrhage, post-LC complications, drainage placement and duration after LC, total hospital stay for LC, post-LC hospital stay, and hospitalization expenses. Multivariable logistic and linear regression analyses were performed to evaluate the independent association between puncture site and perioperative outcomes.

RESULTS: In univariate analyses, no significant differences were observed between the fundus and neck groups regarding intraoperative injuries or major postoperative complications. Compared with the neck group, the fundus group demonstrated significantly shorter LC operative time, a lower incidence of difficult gallbladder, fewer drainage placements and shorter drainage duration after LC, reduced post-LC hospital stay, and lower hospitalization expenses (P < 0.05). In multivariable logistic and linear regression analyses, after adjusting for sex, age, body mass index (BMI), gallbladder neck stone impaction, interval between PTGD and LC, and TG18 severity grade, fundus-adjacent puncture remained independently associated with a lower risk of difficult gallbladder, reduced drainage placements and shorter drainage duration after LC, shorter post-LC and total hospital stays, and lower hospitalization expenses. In addition, fundus-adjacent puncture was associated with a 11.93 min reduction in LC operative time, although the association did not reach statistical significance (95%CI - 24.40 to 0.54; P = 0.061).

CONCLUSIONS: PTGD with puncture site adjacent to the gallbladder fundus is associated with improved surgical efficiency and reduced postoperative burden during subsequent LC. These findings suggest that fundus-adjacent puncture may be a favorable approach in clinical practice for optimizing patient outcomes following PTGD when technically feasible and clinically appropriate.