PERCUTANEOUS CHOLECYSTOLITHOTOMY - RISKS, BENEFITS, AND LONG-TERM OUTCOME

Background: For symptomatic patients with gallbladder stones and a pat ent cystic duct who wish to retain their 'functioning' gallbladders, p ercutaneous cholecystolithotomy (PCCL) offers an alternative to open o r laparoscopic cholecystectomy. However, there are few data on the ris ks and benefits of this approach or on the long-term outcome. Methods and Results: In 21 patients with symptomatic calcified gallstones, PCC L was successful (gallstone clearance) in 17 (81%). Four to 62 (median , 35) months after clearance 9 of the 17 remained symptom-free and sto ne-free, whereas 4 developed biliary sludge at 7, 30, 32, and 35 month s, 2 of whom subsequently developed gallstones. In four other patients gallstones recurred without evidence of preceding biliary sludge at 9 , 16, 19, and 27 months, corresponding to an actuarial gallstone recur rence rate at 36 months of 53.4 +/- SEM 15.1%, and a combined stone/sl udge recurrence rate of 63.4 +/- 13.5%. Conclusions: PCCL is moderatel y effective but, because of the frequency of complications and sludge/ stone recurrence, is likely to have only a limited residual role in th e era of laparoscopic cholecystectomy.