Percutaneous subhepatic cholecystostomy with removable anchor.

Percutaneous subhepatic cholecystostomy is preferable to the transhepatic technique because it spares the liver from unnecessary trauma and possible sepsis. In order to prevent gallbladder wall invagination and intraperitoneal bile leakage, the fundus is first secured to the abdominal wall with a removable anchoring device that is introduced through a 17-gauge needle system under sonographic and fluoroscopic control. With this technique, the gallbladder was drained in seven patients with possible empyema, and stones were extracted from the gallbladder in three patients who were poor risks for cholecystectomy. None of the patients had hypotension, bile leakage, peritonitis, or bleeding. Subhepatic cholecystostomy was done safely in 10 patients after temporarily anchoring the fundus to the abdominal wall.