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A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
Published on: September 13, 2022
"Is percutaneous extraction of gallstones safe and effective in high-risk patients? Evidence from a systematic
Ejaz Ahmed Latif1, Inamullah1, Hijran Mahdi1
1Department of Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar.
Insights
Percutaneous cholecystolithotomy offers a safe and effective option for gallstone removal in high-risk patients unable to undergo surgery. This minimally invasive procedure demonstrates a high success rate with acceptable complication rates.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Gallstone disease management in high-risk patients is challenging due to comorbidities limiting surgical options.
- Percutaneous gallstone removal presents an alternative, but evidence on its safety and efficacy is limited.
Approach:
- A systematic review and literature search were conducted following PRISMA guidelines.
- The review assessed outcomes of percutaneous gallstone removal in high-risk patient populations.
Key Points:
- Twelve studies involving 435 patients were analyzed.
- Percutaneous cholecystolithotomy achieved a 91% success rate.
- Overall complication rate was 28%, with a 0.7% procedure-related mortality and 7% recurrence rate.
Conclusions:
- Percutaneous cholecystolithotomy is a safe and effective treatment for gallstones in patients unsuitable for laparoscopic cholecystectomy.
- It serves as a viable alternative when standard surgical treatment is contraindicated due to patient comorbidities.
Abstract:
Gallstone disease in high-risk patients presents a management dilemma as cholecystectomy is often not performed due to their co-morbidities. Alternatively, such patients can be managed by percutaneous removal of gallstones. To date, there is paucity of high-quality evidence addressing the safety and efficacy of percutaneous cholecystolithotomy in high-risk patients. We aimed to conduct a systematic review on the feasibility of percutaneous gallstone removal in high-risk patients.
Methods:
A literature review was conducted using the Cochrane review and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines without setting the time limits to assess the outcomes of percutaneous gallstone removal in high-risk patients.
Results:
Twelve studies were identified. A total of 435 patients underwent percutaneous gallstone removal. Success rate was 91%. Overall complications (including minor and major) were 28%. The mean length of stay was 7 days (range, 1-80). Procedure related mortality was 0.7%. The recurrence rate was 7%.
Conclusion:
Percutaneous cholecystolithotomy is a safe and effective technique. Although, it cannot substitute the current standard treatment for gallstones i.e., laparoscopic cholecystectomy. However, it may be considered for the patients who cannot undergo laparoscopic cholecystectomy due to their comorbid conditions.
