Percutaneous cholecystostomy: does transhepatic puncture preclude a transperitoneal catheter route?

Area of Science:

• Interventional Radiology
• Gastroenterology
• Surgical Anatomy

Background:

• Percutaneous cholecystostomy is a common procedure for gallbladder and biliary disorders.
• Optimal catheter placement routes for percutaneous cholecystostomy remain debated.
• The role of the liver's

Purpose of the Study:

• To investigate the predictability of traversing the liver's extraperitoneal fixation plane (bare area) during transhepatic percutaneous cholecystostomy.
• To assess the impact of catheter trajectory on guide-wire stability.

Main Methods:

• Sonographic guidance was used for 21 transhepatic catheterizations (19 cadavers, 2 patients).
• 8-F or 5-F self-retaining catheters were employed.
• Catheter course and puncture sites were evaluated post-procedure.

Main Results:

• 19 (90%) punctures were transhepatic; 2 (10%) were transperitoneal.
• Eight (42%) transhepatic catheters traversed the bare area; 11 (58%) punctured the free gallbladder wall.
• Guide-wire dislodgment occurred in 4 cases, all after free wall puncture; none occurred after bare area traversal.

Conclusions:

• Transhepatic gallbladder puncture can involve the free gallbladder surface.
• The liver and its bare area appear to enhance guide-wire stability during catheter placement.
• This suggests potential benefits for transhepatic approaches in percutaneous cholecystostomy.