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 ...