Combined surgical and radiologic intervention for complicated cholelithiasis in high-risk patients.

Abstract

Ultrasound-guided surgical cholecystostomy with local infiltration anesthesia was combined with radiologic removal of gallstones in 36 elderly patients with acute calculous gallbladder disease who were considered to be at high risk due to multiple coexisting diseases. At cholecystostomy, the fundus of the gallbladder was sutured to the anterior abdominal wall resulting in a short surgical track to the gallbladder. This permitted early percutaneous stone removal through the cholecystostomy track under fluoroscopic guidance. All gallstones were removed in 31 of 36 patients, for an overall success rate of 86%. The success rate was 97% for gallbladder stones, 86% for cystic duct stones, and 63% for common bile duct stones that were removed by traversing the cystic duct. The treatment in the five patients in whom radiologic stone removal was incomplete or unsuccessful consisted of elective cholecystectomy in three, with common bile duct exploration in two of these; endoscopic sphincterotomy and stone extraction in one; and expectant management in one. There were no deaths or serious complications. This technique has thus proved safe and effective in these 36 high-risk patients.

Chemical Ablation of the Gallbladder with Acetic Acid

“…In such cases, conservative measures such as performing a percutaneous cholecystostomy, which permits an interval cholecystectomy or cholecystolithotomy, can be considered as an alternative to minimize surgical and anesthetic trauma (1). However, these procedures allow only temporary alleviation of symptoms and are associated with a high rate of recurrence (1,4,5).…”

Percutaneous Rotational Lithotripsy of Gallbladder Stones

“…After the procedure the drainage catheters must remain in place for up to 6 weeks (6). A combined surgical and radiologic interventional procedure for complicated cholelithiasis in high-risk patients has been described by GIBNEY et al (10). It involves the combination of minilaparotomy with cholecystostomy with local anesthesia followed by stone extraction under fluoroscopy.…”

Percutaneous Techniques for the Management of Symptomatic Gallbladder Stones

“…Ultrasound-guided surgical cholecystostomy, under sedation and local anaesthesia, has been described in 36 elderly high-risk patients with acute cholecystitis or severe biliary colic [37], Stone extraction was performed, on the 7th to 1 Oth postoperative day, using radiolog ical techniques via the 24-French cholecystostomy tract. Ninety-seven percent (35 of 36) of gallbladder, 86% (6 of 7) of cystic duct, and 63% (5 of 8) of bile duct stones were success fully extracted through the short surgical tract.…”