Technical considerations in 113 percutaneous cholecystolithotomies.

Percutaneous cholecystolithotomy (PCCL) was considered appropriate on the basis of clinical and ultrasound criteria in 220 of 283 patients referred with symptomatic cholecystolithiasis. Contraindications to PCCL were a small, shrunken, thick-walled gallbladder or an intrahepatic gallbladder. PCCL was performed in 113 patients (80 women, 33 men; mean age, 56 years). Local anesthesia was used in 10 patients; general anesthesia, in 103 patients. The average procedure time was 1 hour. Complete stone clearance was achieved in 100 patients. PCCL was successful in 107 patients; in 77 of these, it was completed in a single stage. Six technical failures occurred, and seven patients had persistent cystic duct stones. Acute, nonfatal complications occurred in 15 patients and were managed conservatively. In 12 of 13 patients with stones impacted in the Hartmann pouch, patency of the cystic duct was restored. It is concluded that PCCL is a safe, effective procedure for clearing the gallbladder of calculi regardless of their size, composition, or number. It preserves the gallbladder, enables possible restoration of contractility, and can be performed without general anesthesia.