Clinical compare between ultrasound-guided double tract percutaneous cholecystostomy combined with a choledochoscope for performing cholecystolithotomies and laparoscopic-choledochoscopy-assisted cholecystolithotomy after cholecystostomy in high-risk surgical patients

Background and Aims: We compared the clinical outcomes between double tract cholecystostomy combined with choledochoscope for cholecystolithotomy and laparoscopic-choledochoscopy-assisted removal of cholecystolithotomy (LRCL) after cholecystostomy in high risk patient. Methods: 19 cases of cholecystolithotomy and 20 cases of LRCL were collected in Chengdu Military General Hospital from January 2011 to november 2012. The therapeutic effect such as surgery time, bleeding volume, hospital stay, hospitalization cost and the quality of life were retrospectively analyzed. The follow-up time was ranged from 6-24 months after discharge, respectively. Results: All the cholecystostomy were performed successfully. Gallbladder stones of 19 patients in cholecystolithotomy group were completely and successfully removed without any complications such as bleeding, biliary leakage. In LRCL group, 20 patients successfully underwent laparoscopy combined with choledochoscopy and cholelithotomy. In this group, biliary fistula was detected in two patients, and one of which showed signs of bleeding. The incidence rate of gastrointestinal adverse reaction was higher than that of double-channel cholelithotomy. Conclusions: The effect of double-channel cholelithotomy was better and showed fewer complications than LRCL method. Thus, doublechannel cholelithotomy can be used as the preferred strategy to treat critical cholecystolithiasis in elderly patients.