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Percutaneous cholecystolithotomy: preliminary experience and technical considerations
1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110.
Insights
Percutaneous cholecystolithotomy offers an effective alternative for high-risk elderly patients with acute calculous cholecystitis. This minimally invasive procedure successfully removed gallbladder stones in all patients, with a manageable complication rate.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Interventional Radiology
Background:
- Elderly patients with acute calculous cholecystitis and comorbidities face high risks with surgical cholecystectomy.
- Limited alternative treatment options exist for these high-risk individuals.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous cholecystolithotomy as a definitive treatment for gallbladder calculi in high-risk elderly patients.
Main Methods:
- Percutaneous cholecystolithotomy was performed in 11 elderly patients with acute calculous cholecystitis and significant comorbidities.
- The procedure involved stone removal from the gallbladder and cystic duct via a percutaneous approach.
- The treatment duration ranged from initial tube placement to final tube removal.
Main Results:
- Complete removal of gallbladder and cystic duct stones was achieved in all 11 patients.
- The mean treatment duration was 21 days (range: 17-40 days).
- One minor complication (local wound infection) and one major complication (bile peritonitis with mortality) occurred.
Conclusions:
- Percutaneous cholecystolithotomy is a viable and effective alternative therapy for acute calculous cholecystitis in elderly, debilitated patients.
- This approach may reduce the morbidity and mortality associated with traditional surgery in this patient population.
Abstract:
Surgical cholecystectomy is associated with a high morbidity and mortality in elderly patients with acute calculous cholecystitis and underlying cardiac or pulmonary disease. Currently there are few alternatives for treating these patients. The authors have used percutaneous cholecystolithotomy in 11 such high-risk patients for definitive treatment of gallbladder calculi. In all 11 patients all stones were successfully removed from the gallbladder and cystic duct. The entire procedure--from initial tube placement to final tube removal--lasted 17-40 days (mean, 21 days). There were two complications: one minor--local wound infection--and one major--bile peritonitis with eventual death. Percutaneous cholecystolithotomy is an effective alternative therapy for acute calculous cholecystitis in elderly, debilitated patients.