title: Ultrasound-guided double-tract percutaneous cholecystostomy combined with a choledochoscope for performing cholecystolithotomies in high-risk surgical patients.
abstract: BACKGROUND
  Cholecystolithiasis is the most common disease treated by general surgery, with an incidence of about 0.15-0.22%. The most common therapies are open cholecystectomy (OC) or laparoscopic cholecystectomy (LC). However, with a greater understanding of the function of the cholecyst, more and more patients and surgeons are aware that preserving the functional cholecyst is important for young patients, as well as patients who would not tolerate anesthesia associated with either OC or LC. Based on these considerations, we have introduced a notable, minimally invasive treatment for cholecystolithotomy.
  
  
  METHODS
  We performed a retrospective review of patients with cholecystolithiasis who were unable to tolerate surgery or who insisted on preserving the functional cholecyst. Our particular approach can be simply described as ultrasound-guided percutaneous cholecystostomy combined with a choledochoscope for performing a cholecystolithotomy under local anesthesia.
  
  
  RESULTS
  Ten patients with cholecystolithiasis were treated via this approach. All except one patient had their gallbladder stones totally removed under local anesthesia, without the aggressive procedures associated with OC or LC. The maximum number of gallbladder stones removed was 16, and the maximum diameter was 13 mm without lithotripsy. After the minimally invasive surgery, the cholecyst contractile functions of all patients were normal, confirmed via ultrasound after a high-fat diet. Complications such as bile duct injury, biliary fistula, and bleeding occurred significantly less often than with OC and LC. The recurrence rates for each of 2 post-operative years were about 11.11% (1/9, excluding a failure case) with uncertainty surrounding recurrence or residue, and 22.22% (2/9, including one non-recurrence patient with follow-up time of 22 months), respectively.
  
  
  CONCLUSIONS
  Ultrasound-guided percutaneous cholecystostomy combined with choledochoscope is a safe, efficient, and minimally invasive cholecystolithotomy method. We recommend this technique for the management of small stones (less than 15 mm) in high-risk surgical patients.
authors.affiliation: General Surgery Center, Chengdu Military General Hospital, Chengdu, 610083, Sichuan, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.forename: Tao
authors.initials: T
authors.lastname: Chen
authors.forename: Shu
authors.initials: S
authors.lastname: Zou
authors.forename: Ning
authors.initials: N
authors.lastname: Lin
authors.forename: Hong-yin
authors.initials: HY
authors.lastname: Liang
authors.forename: Hong-tao
authors.initials: HT
authors.lastname: Yan
authors.forename: Nan-lin
authors.initials: NL
authors.lastname: Li
authors.forename: Li-ye
authors.initials: LY
authors.lastname: Liu
authors.forename: Hao
authors.initials: H
authors.lastname: Luo
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.forename: Wei-hui
authors.initials: WH
authors.lastname: Liu
authors.forename: Li-jun
authors.initials: LJ
authors.lastname: Tang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D002404:Catheterization; D002763:Cholecystectomy / Q000379:methods*; D002767:Cholecystostomy / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional