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Interventional Radiology of the Gallbladder - Percutaneous Cholecystostomy (Paperback, Softcover reprint of the original 1st ed. 1990)
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Interventional Radiology of the Gallbladder - Percutaneous Cholecystostomy (Paperback, Softcover reprint of the original 1st ed. 1990)
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Interventional Radiology has as its main goal the performance of
surgical techniques using a percutaneous approach to simplify
patient care. Percutaneous cholecystostomy now has many advocates;
still, it is practised in comparatively few centers. Over many
years it was used as a last resort at failed transhepatic
cholangiography to provide images of the bile ducts in biliary
obstruction. Transhepatic cholecystostomy is reputed to be safer
than transperito- neal puncture, since bile leaks do not enter the
peritoneum. The advo- cates of percutaneous cholecystolithotomy,
almost without exception, fa- vour subcostal cholecystostomy and
puncture of the fundus of the gall- bladder. There is no evidence
of bile peritonitis after successfully making a track to the
gallbladder 18 F in diameter or larger for stone removal. After 1-7
days a postlithotomy drain is removed from the gallbladder and the
patient is allowed home. Transhepatic cholecystostomy for gallstone
lysis, in contrast, requires only a 5-F track to the hepatic
surface of the gallbladder. Loss of the gallbladder is not as great
a fear with this technique as it is during dilata- tion of a
subcostal track for cholecystolithotomy. During the latter pro-
cedure this may result in laparotomy to avoid bile peritonitis,
while in the former, if the gallbladder is still visualised, the
procedure may be re- commenced immediately. Catheter dislodgement
is a fear when prolon- ged catheterisation is considered.
General
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