Document Detail


Percutaneous stone clearance of the gallbladder through an access cholecystostomy. Laparoscopic-guided technique.
MedLine Citation:
PMID:  2530642     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A laparoscopic-guided technique of percutaneous gallstone fragmentation/removal has been developed in the pig. The procedure entails the creation of a percutaneous access cholecystostomy. The access tract can be safely dilated after 7 days to F16, thereby allowing the introduction of both the Olympus flexible and the Berci-Shore rigid choledochoscopes. Following endoscopic occlusion of the cystic duct by a biliary balloon catheter, stone fragmentation can be conducted under direct visual control. In this particular study, electrohydraulic lithotripsy was performed of human cholesterol and bile-pigment stones inserted into the gallbladder of 16 pigs. The gallstone debris resulting from lithotripsy was then washed out with saline. Larger residual fragments could easily be extracted with the Dormia basket under visual guidance. There was a significant positive correlation between stone size (r = 0.98) and weight (r = 0.96) and the number of pulses needed to achieve satisfactory stone fragmentation. The gross composition of the stones (predominantly cholesterol or pigment) did not influence the number of pulses required. Electrohydraulic lithotripsy caused an explosion effect (the fragments hit the gallbladder wall), causing submucosal haematoma formation. This, however, was not followed by any untoward effect until sacrifice of the animals 10-16 weeks later. Electrohydraulic shocks delivered to the gallbladder wall itself resulted in larger haematoma formation and breach of the gallbladder mucosa with active bleeding into the gallbladder lumen, but again no instance of gallbladder perforation was encountered.(ABSTRACT TRUNCATED AT 250 WORDS)
Authors:
A B Abd el Ghany; M P Holley; A Cuschieri
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Surgical endoscopy     Volume:  3     ISSN:  0930-2794     ISO Abbreviation:  Surg Endosc     Publication Date:  1989  
Date Detail:
Created Date:  1989-12-06     Completed Date:  1989-12-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  GERMANY, WEST    
Other Details:
Languages:  eng     Pagination:  126-30     Citation Subset:  IM    
Affiliation:
Department of Surgery, Ninewells Hospital and Medical School, University of Dundee, UK.
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MeSH Terms
Descriptor/Qualifier:
Animals
Cholecystostomy / adverse effects,  methods*
Cholelithiasis / pathology,  surgery*,  therapy
Gallbladder / pathology
Laparoscopy / methods*
Lithotripsy
Peritonitis / etiology
Postoperative Complications
Swine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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