Combined surgical and radiologic intervention for complicated cholelithiasis in high-risk patients.

Ultrasound-guided surgical cholecystostomy with local infiltration anesthesia was combined with radiologic removal of gallstones in 36 elderly patients with acute calculous gallbladder disease who were considered to be at high risk due to multiple coexisting diseases. At cholecystostomy, the fundus of the gallbladder was sutured to the anterior abdominal wall resulting in a short surgical track to the gallbladder. This permitted early percutaneous stone removal through the cholecystostomy track under fluoroscopic guidance. All gallstones were removed in 31 of 36 patients, for an overall success rate of 86%. The success rate was 97% for gallbladder stones, 86% for cystic duct stones, and 63% for common bile duct stones that were removed by traversing the cystic duct. The treatment in the five patients in whom radiologic stone removal was incomplete or unsuccessful consisted of elective cholecystectomy in three, with common bile duct exploration in two of these; endoscopic sphincterotomy and stone extraction in one; and expectant management in one. There were no deaths or serious complications. This technique has thus proved safe and effective in these 36 high-risk patients.