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otential risks of cholecystostomy: Do you know what accidents may happen
Cholecystostomy, or cholecystotomy, is an important medical procedure used primarily to treat gallbladder diseases, especially acute cholecystitis. This procedure allows the doctor to create an opening in the gallbladder through the skin to facilitate the drainage of bile. However, like any other medical procedure, this procedure is associated with a number of risks and complications, which may become a potential concern for patients.
Indications for cholecystostomy
Cholecystostomy is usually performed when a person has severe cholecystitis and is not a good candidate for traditional surgery.
This surgery is indicated in certain situations, including:
- Critically unstable patients cannot tolerate surgery
- Patients who cannot tolerate anesthesia
- High-risk patients with severe systemic disease
- Patients who are unresponsive to medical management (no improvement after 72 hours of medical treatment)
- Severe acute cholecystitis according to Tokyo guidelines
There are some contraindications that require special attention when performing this surgery, including:
- Abnormal coagulation function
- The presence of digestive tract contents between the gallbladder and the skin (increased risk of organ perforation)
- Bile peritonitis
- Ascites
Percutaneous cholecystostomy procedure
Surgical approach
Percutaneous cholecystostomy is usually performed under image guidance, mainly using ultrasound or computer radiation imaging.
The most common route is the transhepatic route, which reduces the risk of bile leakage but increases the risk of liver bleeding.
The two main approaches include:
- Hepatic route: This is the most common route, which goes directly through the liver into the gallbladder. The advantage is that it reduces the risk of bile leakage.
- Peritoneal route: This approach is chosen when anatomical challenges or liver disease preclude hepatic access but may be associated with greater bile leakage.
Surgical Technique
Before surgery, the doctor will comprehensively review the patient's imaging data and conduct relevant clinical assessments to ensure the patient's stability.
During surgery, a cholecystostomy is usually performed using the Seldinger technique or the Trocar technique to insert a drainage tube.
Whichever technique is used, the doctor will ensure that the instrument is inserted with minimal risk and effectiveness.
Complications of surgery
Although the complication rate of cholecystostomy is about 10%, you should still be alert to the following complications:
- Catheter dislodged or blocked Bile leakage Severe bleeding or infection
It is worth noting that the transhepatic approach has shown its advantages in reducing organ perforation and bile leakage.
Choices for endoscopic cholecystostomy
Endoscopic cholecystostomy is considered an alternative to percutaneous cholecystostomy and is primarily indicated for patients who are unable to undergo surgery.
Endoscopic Ultrasound-Guided Gallbladder DrainageThis is a technique with a high success rate and relatively few complications, but it also carries the risk of stent obstruction and future surgery.
ConclusionAlthough cholecystostomy can relieve the symptoms of cholecystitis, it is also accompanied by certain potential risks. From surgical indications and contraindications to postoperative management and possible complications, doctors and patients need to work together to reduce risks and ensure the best treatment outcomes. How should patients weigh these potential risks and benefits in their surgical decision-making?
