Plate 102

Indications

Cholecystostomy, while not recognized as routine treatment for cholelithiasis, may be a lifesaving procedure. Today cholecystostomy is usually placed under image guidance by a percutaneous technique. Surgical cholecystostomy may be needed in some situations. It is the operation of choice in some elderly patients with acute cholecystitis, in poor surgical risks who present a well-defined mass, in seriously ill patients in whom minimum surgery is desirable when a large abscess surrounds the gallbladder, and when technical difficulties make cholecystectomy hazardous. If there is obstruction of the common duct with long-standing jaundice and a tendency toward hemorrhage that cannot be controlled by vitamin K and transfusions or percutaneous transhepatic biliary tube drainage, preliminary cholecystostomy for decompression may be the procedure of choice.

Preoperative Preparation

See Plate 95.

Anesthesia

See Plate 95.

Position

The position for a gallbladder operation, as described in Plate 95, is used. With local anesthesia this is modified if the patient is uncomfortable.

Operative Preparation

The skin is prepared in the routine manner.

Incision and Exposure

A small incision is made with its midportion directly over the maximum point of tenderness in the right upper quadrant. Occasionally, when unsuspected technical difficulties or inflammation more severe than anticipated ...