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.
The position for a gallbladder operation, as described in Plate 95, is used. With local anesthesia this is modified if the patient is uncomfortable.
The skin is prepared in the routine manner.
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 are encountered, the procedure is carried out through the usual upper right rectus or infracostal incision. The adhesions are not dissected from the undersurface ...