title: Risk factors for gallbladder contractility after cholecystolithotomy in elderly high-risk surgical patients.
abstract: OBJECTIVE
  Cholecystolithiasis is a common disease in the elderly patient. The routine therapy is open or laparoscopic cholecystectomy. In the previous study, we designed a minimally invasive cholecystolithotomy based on percutaneous cholecystostomy combined with a choledochoscope (PCCLC) under local anesthesia.
  
  
  METHODS
  To investigate the effect of PCCLC on the gallbladder contractility function, PCCLC and laparoscope combined with a choledochoscope were compared in this study.
  
  
  RESULTS
  The preoperational age and American Society of Anesthesiologists (ASA) scores, as well as postoperational lithotrity rate and common biliary duct stone rate in the PCCLC group, were significantly higher than the choledochoscope group. However, the pre- and postoperational gallbladder ejection fraction was not significantly different. Univariable and multivariable logistic regression analyses indicated that the preoperational thickness of gallbladder wall (odds ratio [OR]: 0.540; 95% confidence interval [CI]: 0.317-0.920;P=0.023) and lithotrity (OR: 0.150; 95% CI: 0.023-0.965;P=0.046) were risk factors for postoperational gallbladder ejection fraction. The area under receiver operating characteristics curve was 0.714 (P=0.016; 95% CI: 0.553-0.854).
  
  
  CONCLUSIONS
  PCCLC strategy should be carried out cautiously. First, restricted by the diameter of the drainage tube, the PCCLC should be used only for small gallstones in high-risk surgical patients. Second, the usage of lithotrity should be strictly limited to avoid undermining the gallbladder contractility and increasing the risk of secondary common bile duct stones.
authors.affiliation: General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan, People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.affiliation: General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan, People's Republic of China.
authors.forename: Hao
authors.initials: H
authors.lastname: Luo
authors.affiliation: General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan, People's Republic of China.
authors.forename: Hong-Tao
authors.initials: HT
authors.lastname: Yan
authors.affiliation: General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan, People's Republic of China.
authors.forename: Guo-Hu
authors.initials: GH
authors.lastname: Zhang
authors.affiliation: General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan, People's Republic of China.
authors.forename: Wei-Hui
authors.initials: WH
authors.lastname: Liu
authors.affiliation: General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan, People's Republic of China.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Tang
mesh_terms: D000328:Adult; D000367:Age Factors; D002767:Cholecystostomy / Q000379:methods*; D005260:Female; D005704:Gallbladder / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011184:Postoperative Period; D012307:Risk Factors
keywords: GBEF; cholecystolithotomy; gallbladder motility; lithotrity; thickness of gallbladder wall