Korean J Radiol.  2011 Apr;12(2):210-215. 10.3348/kjr.2011.12.2.210.

Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

• Kim YH
• Kim YJ
• Shin TB

• KMID: 1088566
• DOI: http://doi.org/10.3348/kjr.2011.12.2.210

Abstract

OBJECTIVE
To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis.
MATERIALS AND METHODS
Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique.
RESULTS
Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days).
CONCLUSION
Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis.

Keyword

Gallbladder stone; Acute cholecystitis; Percutaneous cholecystolithotomy

MeSH Terms

Aged
Aged, 80 and over
Alloys
Cholecystitis, Acute/radiography/*surgery/ultrasonography
Cholecystostomy/*instrumentation
Conscious Sedation
Equipment Design
Feasibility Studies
Female
Fluoroscopy
Humans
Male
Middle Aged
Polyethylene
Polytetrafluoroethylene
Radiography, Interventional
Treatment Outcome
Ultrasonography, Interventional

Figure

• 

  Fig. 1 Picture of Wittich nitinol basket. Polyethylene portion of shaft (upper, arrow) was peeled off with blade (middle) in order to ease passage of stone basket and guide wire or metallic cannula (lower).

• 

  Fig. 2 83-year-old female with ruptured gallbladder empyema. A. Photograph of snare guide wire technique. B, C. Large stones were fragmented using snare guide wire technique. D. Cholecystogram obtained after stone extraction using Wittich nitinol stone basket showing complete stone clearance.

• 

  Fig. 3 81-year-old male with gallbladder empyema. A. Photograph of metallic cannula (arrow) technique. B. Hard stone being fragmented using metallic cannula (arrow) technique. C. Fragmented stones were extracted through 12-Fr sheath. D. Cholecystogram showing complete stone clearance and patent cystic duct.

• 

  Fig. 4 90-year-old male with acute cholecystitis. A. Cholecystogram showing multiple GB stones. B. Stones were successfully removed, but small stone remained in common bile duct (arrow). C. 12-Fr sheath was placed in common bile duct through cystic duct, and small common bile duct stone was extracted using Wittich stone basket.

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