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. 2022 Feb;76(1):29-33.
doi: 10.5455/medarh.2022.76.29-33.

Percutaneous Transhepatic Cholecystolithotomy by Holmium Laser for Non-high-Risk Patients with Symptomatic Gallbladder Stones

Nguyen Thai Binh  1 , Ngo-Thi Ly Ly  1 , Phan Nhan Hien  2 , Le Tuan Linh  2 , Bui-Van Lenh  2 , Nguyen Minh Duc  3
Affiliations

Percutaneous Transhepatic Cholecystolithotomy by Holmium Laser for Non-high-Risk Patients with Symptomatic Gallbladder Stones

Nguyen Thai Binh et al. Med Arch. 2022 Feb.

Abstract

Background: The development of gallstones, also known as cholelithiasis, is one of the most common diseases associated with the gastrointestinal tract. In developing countries 10% to 15% of men and >25% of women experience gallstones.

Objective: The aim of the study was to evaluate the outcomes following percutaneous transhepatic cholecystolithotomy by holmium laser in non-high-risk patients with symptomatic gallbladder stones.

Methods: This was an intervention study without control and with longitudinal follow-up. Subjects included patients who had only gallbladder stones, a normal gallbladder contractility index, and required a conservative treatment.

Results: The study included 44 patients (20 men, 24 women), with a mean age of 41.5 ± 13.4 years. The success rate was 97.7%, and only 1 of 44 patients required follow-up laparoscopic cholecystectomy. Gallstones were successfully removed from 43 of 44 patients (97.7%). The complication rate was 13.6% (6/44 patients), and only minor complications were reported for 5 of the 6 patients with complications. In 34 of 43 patients, follow-up examinations were performed after 1 and 6 months. The gallstone recurrence rate at six-month follow-up was 11.8%, and a collapsed gallbladder was detected in 1 of 34 patients, with the remaining 33 patients retaining normal gallbladder contractility indices (>40%).

Conclusion: Percutaneous transhepatic cholecystolithotomy by holmium laser has a high gallstone removal rate (97.7%); however, recurrence remains a major problem. The complication rate was about 13.6%, most of which were minor complications. Cases associated with treatment failure or serious complications should be detected and treated promptly.

Keywords: cholecystolithotomy; holmium laser; transhepatic.

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Conflict of interest statement

There are no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.. Gallbladder contractility indices pre-intervention and 1- and 6-months post-intervention
Figure 2.
Figure 2.. A 30-year-old woman with multiple gallstones (arrow) and a pre-intervention contractility index of 66%: A. Fasting gallbladder volume. B. Postprandial gallbladder volume.
Figure 3.
Figure 3.. Representative images from a 40-year-old woman A. DSA-guided percutaneous cholecystostomy revealing multiple gallstones inside the gallbladder (arrow). B. Endoscope view. C. The removed gallstones. D. Post-cholecystolithotomy examination revealed that the gallstones were completely removed, and the gallbladder was empty.
See this image and copyright information in PMC

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