AIM: To investigate the clinical value of early (≤7 days) versus delayed (>6 weeks) laparoscopic cholecystectomy (LC) after ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGBD) in high-risk acute cholecystitis (AC), with PTGBD serving as a bridging intervention.

METHODS: A retrospective analysis was performed on 110 high-risk AC patients admitted between August 2021 and January 2025. Patients were divided into an early LC group (52 cases) and a delayed LC group (58 cases). Surgical indicators, inflammatory response control, hospitalization duration, treatment costs, quality of life, and postoperative complications were compared between the two groups.

RESULTS: The early LC group demonstrated significantly superior outcomes in operative time (22.51 ± 4.32 vs. 65.28 ± 15.12 minutes, p < 0.001), intraoperative blood loss (12.16 ± 2.13 vs. 52.47 ± 6.11 mL, p < 0.001), length of hospital stay (7.12 ± 0.58 vs. 10.11 ± 1.62 days, p < 0.001), and total treatment costs (2.36 ± 0.32 vs. 3.80 ± 0.52 ten thousand yuan, p < 0.001, 1 dollar = 6.91 yuan). The incidence of moderate to severe adhesions was significantly lower in the early LC group (28.85% vs. 56.90%, p = 0.003). However, the delayed LC group exhibited lower postoperative C-reactive protein levels (12.45 ± 2.23 vs. 15.32 ± 2.78 mg/L, p < 0.001) and procalcitonin levels (0.25 ± 0.06 vs. 0.38 ± 0.05 ng/mL, p < 0.001), as well as significantly higher quality-of-life scores at 3 months postoperatively (all p < 0.001). No statistically significant differences were observed in complication rates (9.62% vs. 15.52%) or conversion-to-laparotomy rates (3.85% vs. 10.34%) between groups (p > 0.05).

CONCLUSIONS: Early LC following PTGBD effectively shortens overall treatment duration, reduces healthcare costs, and lowers surgical complexity. However, careful consideration should be given to the potential influence of residual inflammation on long-term quality of life. Further multi-center prospective studies are warranted to validate long-term safety and to optimize individualized treatment strategies.