Comparision between percutaneous transhepatic gallbladder drainage and early laparoscopic cholecystectomy for acute cholecystitis in patients over 80 years Old: a propensity score-matched analysis

To retrospectively analyze perioperative differences between percutaneous transhepatic gallbladder drainage (PTGBD) and early laparoscopic cholecystectomy (ELC) in patients aged ≥ 80 years with acute cholecystitis. Clinical data of patients aged ≥ 80 years with acute calculous cholecystitis who underwent PTGBD or ELC at Zhejiang Hospital from July 2018 to June 2025 were collected. Patients were divided into PTGBD group (53 cases) and LC group (121 cases). Propensity score matching (PSM) at 1:1 ratio balanced baseline characteristics, with sensitivity analysis verifying result stability. All patients completed surgery successfully. After PSM, no significant differences in baseline data were noted between groups (p > 0.05). PTGBD group had significantly shorter postoperative ambulation time [0(0,1)d], flatus time [0(0,1)d], fasting time [0(0,1)d], hospital stay [7.5[6.0,9.0]d] and postoperative day 1 pain score( 2.7 ± 1.4) than ELC group [1(0,1)d, 1(0,1)d, 1[1.0,2.0]d, 9(7.75,10)d, 3.5 ± 1.5] (all p < 0.05). Postoperative CRP and WBC decreased significantly in both groups (p < 0.05), with a more marked reduction in ELC group. Long-term follow-up showed 47.2% (25/53) of PTGBD patients had long-term catheterization, with 5.6% (3/53) catheter-related complications and 5.6% (3/53) cholecystitis recurrence; ELC group had 3.3% (4/121) long-term complication rate. ELC is superior in inflammation control and long-term prognosis, while PTGBD is better in short-term gastrointestinal recovery and early ambulation. Clinical decisions should be individualized based on patients’ conditions, surgical tolerance and long-term needs.