Minimally invasive cholecystostomy in the dog: evaluation of placement techniques and use in extrahepatic biliary obstruction.
OBJECTIVE
To evaluate 4 methods of cholecystostomy catheter placement and to report on laparoscopic (Lap) cholecystostomy for the management of extrahepatic biliary obstruction (EHBO) in 3 dogs.


METHODS
Experimental study and clinical report.


METHODS
Cadaveric dogs (n=20); 2 canine and 1 feline patient.


METHODS
Pigtail cholecystostomy catheters were inserted in 20 canine cadavers using ultrasound (US) or Lap guidance. Insertion routes were either transperitoneal or transhepatic. Methods studied included Lap-transperitoneal, US-transperitoneal, US-transhepatic, and US-Seldinger (n=5 dogs/group). Insertion success, pleural penetration, and insertion site leakage (Lap-transperitoneal group) were evaluated. Three clinical EHBO cases were treated by Lap-transperitoneal technique.


RESULTS
Insertion success was 100% by Lap-transperitoneal but 0% with US-transperitoneal and US-Seldinger methods. US-transhepatic yielded 3 of 5 successful placements. The pleura was penetrated in all US-transhepatic and US-Seldinger insertions. Leakage pressure for Lap-transperitoneal catheters averaged 75 cm H2O (+/-20 cm H2O). Lap-transperitoneal cholecystostomy resulted in marked improvement in 2 dogs, but the catheter became obstructed in the cat. One dog spontaneously regained common bile duct patency and the remaining 2 animals had successful cholecystoenterostomy.


CONCLUSIONS
In cadaver testing, the Lap-transperitoneal cholecystostomy method was superior based on high insertion success with no pleural penetration. In 2 clinical cases, Lap-transperitoneal placement successfully provided biliary drainage for patient stabilization.


CONCLUSIONS
The role for temporary cholecystostomy has yet to be established, but may aid patient stabilization and mortality reduction in EHBO.
Murphy
Sean M
SM
Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53705, USA.
Rodríguez
Julian D
JD
McAnulty
Jonathan F
JF
D000818:Animals; D017734:Bile Ducts, Extrahepatic / Q000601:surgery; D002102:Cadaver; D002371:Cat Diseases / Q000601:surgery*; D002404:Catheterization / Q000379:methods / Q000662:veterinary*; D002415:Cats; D002767:Cholecystostomy / Q000379:methods / Q000662:veterinary*; D001651:Cholestasis, Extrahepatic / Q000601:surgery / Q000662:veterinary*; D004283:Dog Diseases / Q000601:surgery*; D004285:Dogs; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000662:veterinary; D016896:Treatment Outcome