The Use of Laser Lithotripsy Status Post Cholecystostomy Tube Placement Without Interval Cholecystectomy for Calculous Cholecystitis in a Patient Unfit for General Anesthesia

Abstract

Acute cholecystitis in patients unfit for general anesthesia often initially requires cholecystectomy tube placement without cholecystectomy. The best way to definitively manage those patients with irreversible medical conditions, leaving them unable to undergo cholecystectomy, has yet to be defined. Laser lithotripsy is currently used in the management of stones of the genitourinary system. Extracorporeal shock wave cholelithotripsy has been extensively evaluated in Munich, Germany and since then, has been abandoned as an alternative treatment of cholelithiasis. This report discusses a novel approach using established cholecystocutaneous fistula tracts and laser lithotripsy to definitively treat this group of patients.

Cholecystocutaneous fistula incidence, Etiology, Clinical Manifestations, Diagnosis and treatment. A literature review

“… During the surgery Open cholecystectomy Pol et al [ 21 ] 70 F Gallstones Discharging sinus in the right hypochondriac region CT fistulogram Laparoscopic cholecystectomy Kassi et al [ 6 ] 46 _ Gallstones Painful, fluctuating, epigastric swelling of 15 days' duration. CT Open cholecystectomy Bermúdeza et al [ 30 ] 30 F Gallstones pain in the right hypochondrium of years evolution X-Ray Fistulogram Open cholecystectomy Dixon et al [ 28 ] 94 F Gallstones wound discharge and non-healing wound CT conservative management Polite et al [ 29 ] 70 F Gallstones acute on chronic midepigastric abdominal pain, associated with nausea and vomiting Hepatobiliary iminodiacetic acid Open cholecystectomy Ozdemir et al [ 24 ] 89 F Gallstones right upper abdominal pain and icterus CT Open cholecystectomy Gordon et al [ 33 ] 83 F Gallstones mild, intermittent right upper quadrant pain …”

“…Hepatobiliary iminodiacetic acid scan was used in two cases; it failed to demonstrate the fistula in one case (4) and showed obstruction in biliary tracks in the second one [ 29 ].…”