3409 Safety and usefulness of percutaneous transhepatic cholecystoscopic examination (ptccs) in highrisk surgical patients manifesting acute cholecystitis

Backgrounds: The aim of the present study is to identify the diagnostic and therapeutic usefulness of percutaneous transhepatic cholecystoscopic examination (PTCCS) in high-risk surgical patients manifesting acute cholecystitis. Methods: Between the January 1992 and June 1998, 33 consecutive patients who underwent percutaneous transhepatic cholecystostomy (PC) and subsequent PTCCS for the management of acute cholecystitis and evaluation of gallbladder lesion were included. Results: PC and subsequent PTCCS were successfully accomplished in all of 33 patients. During PTCCS, minor complication (2 of minor bleeding during elctrohydraulic lithotripsy, 2 of tube dislodgement and 1 of bile leakage to peritoneum) occurred in five patients. PTCCS revealed 26 cases of gallstones, 3 cases of sludge ball, 3 cases of gallbladder carcinoma and 1 case of clonorchiasis as associated gallbladder lesion with acute cholecystitis. Three cases of the gallbladder cancer (one case of fundal cancer concealed by stone and two cases of neck cancer) were not predicted radiologically and were incidentally found during PTCCS. For 26 patients with gallstones, PTCCS and concomitant stone removal were successfully carried out in one to four consecutive sessions (mean 2.2 sessions). Gallstones recurred in three (3/22, 14%) patients during the mean follow-up period of 27months. All of them remain asymptomatic. Conclusion: PC and PTCCS may be justified in the management of acute cholecystitis in selected patients of high surgical risk.