Name of the Procedure:

Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (e.g., mechanical, electrohydraulic, lithotripsy), with imaging guidance (e.g., fluoroscopy).

Summary

This procedure involves the removal of stones or debris from the bile ducts or gallbladder through the skin using various techniques to break down the stones and imaging tools to guide the process.

Purpose

The procedure addresses blockages or obstructions in the biliary ducts or gallbladder, often due to gallstones. The goal is to relieve symptoms such as pain, jaundice, or infection and prevent further complications.

Indications

• Symptoms like intense abdominal pain, nausea, vomiting, jaundice (yellowing of skin/eyes), or signs of infection.
• Diagnosis of gallstones or debris in the bile ducts or gallbladder.
• Patients who are poor candidates for more invasive surgical procedures due to other health conditions.

Preparation

• Patients may need to fast for several hours before the procedure.
• Certain medications, particularly blood thinners, may need to be adjusted.
• Pre-procedure imaging tests (e.g., ultrasound, MRI) to locate stones.
• Blood tests to evaluate liver function and rule out infections.

Procedure Description

1. The patient is positioned and given anesthesia or sedation to ensure comfort.
2. Imaging guidance (usually fluoroscopy) is used to locate the stones or debris.
3. A catheter is inserted percutaneously (through the skin) into the biliary ducts or gallbladder.
4. Tools like mechanical devices, electrohydraulic probes, or lithotripsy instruments are used to break down the stones.
5. Fragments of stones and debris are removed through the catheter.
6. Imaging verifies the complete removal of stones/debris.
7. The catheter is removed, and the site is dressed.

Duration

The procedure typically takes 1 to 2 hours.

Setting

It is performed in a hospital or a specialized surgical center equipped with fluoroscopic imaging.

Personnel

• Interventional radiologist or a specially trained surgeon
• Nurses to assist with the procedure and patient care
• Anesthesiologist or sedation specialist

Risks and Complications

• Infection at the puncture site
• Bleeding or injury to surrounding tissues
• Pancreatitis (inflammation of the pancreas)
• Reaction to anesthesia or sedation
• Rarely, incomplete removal of stones requiring further procedures

Benefits

• Relief from symptoms like pain and jaundice
• Reduced risk of future complications such as infections
• Minimally invasive compared to open surgical procedures
• Quicker recovery time

Recovery

• Patients typically can go home the same day or the next day.
• Pain and discomfort at the puncture site are usually managed with over-the-counter pain medications.
• Patients should avoid heavy lifting and strenuous activities for a few days.
• Follow-up appointments may be scheduled to ensure no recurrence of stones.

Alternatives

• Endoscopic retrograde cholangiopancreatography (ERCP): Involves the insertion of an endoscope through the mouth to the biliary ducts.
• Surgical removal of the gallbladder (cholecystectomy) for chronic gallstones.
• Medications to dissolve gallstones, although this is rarely effective.

Patient Experience

• The patient may feel mild discomfort or pressure during catheter insertion.
• Post-procedure, there may be some soreness at the puncture site.
• Pain is usually minimal and manageable with medication.
• Most patients can resume normal activities within a few days, although they may need to avoid certain activities in the immediate recovery period to allow healing.