Percutaneous cholecystolithotomy

Percutaneous laparoscopic cholecystolithotomy describes a transperitoneal, laparoscopic approach to the removal of gallstones

• patient is sedated or placed under general anaesthesia
• laparoscope is directed to the fundus of the gallbladder by ultrasound and fluoroscopic guidance
• viscus is punctured, a cholecystogram performed, and a guidewire inserted
• guidewire is then used to channel metal dilators in order to widen the aperture of the perforation. Once suitably wide, a rigid endoscope is inserted into the gallbladder and stones are removed either with suction or with forceps. Large stones may be fragmented firstly using laser or ultrasound implements.

After radiology has confirmed that there are no remaining stones, a Foley catheter is sited into the gallbladder for drainage. The catheter is removed after around 10 days; the patient is discharged after 1-2 days.

Almost 80% of patients with symptomatic gallstones are suitable for treatment. Patients with thick-walled gallbladders are unsuitable as perforation is difficult.

Up to 10% of patients have recurrences of stones after percutaneous cholecystolithotomy.

Reference:

• Cheslyn-Curtis, S. General Surgery. In: Minimal access medicine and surgery: principles and techniques. Ed. Rosin, D. (1993), Radcliffe Medical Press.