title: Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath in high-risk surgical patients with acute cholecystitis.
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.
  
  
  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).
  
  
  CONCLUSIONS
  Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis.
authors: Department of Radiology, Keimyung University, College of Medicine, Daegu 700-712, Korea. yhkim68@dsmc.or.kr
authors: Young Hwan
authors: YH
authors: Kim
authors: Yong Joo
authors: YJ
authors: Kim
authors: Tae Beom
authors: TB
authors: Shin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging / Q000601:surgery*; D002767:Cholecystostomy / Q000295:instrumentation*; D016292:Procedural Sedation; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020959:Polyethylene; D011138:Polytetrafluoroethylene; D015641:Radiography, Interventional; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000497:Alloys; C013616:nitinol; D011138:Polytetrafluoroethylene; D020959:Polyethylene