J Korean Surg Soc.  2008 Dec;75(6):388-393.

Significance of Intra & Extra Hepatic Duct Stone Removal via Percutaneous Transhepatic Biliary Drainage Tube in Patients Undergoing Laparoscopic Cholecystectomy

• Sun Y
• Park JS
• Kim YS
• Choi YS
• Kim BG
• Cha SJ
• Chang IT

Abstract

PURPOSE
One of the popular and widespread treatments for intra- & extra-hepatic duct (IEHD) stone associated gallbladder (GB) stone is laparoscopic cholecystectomy (LC) with stone removal through endoscopic retrograde cholangiopancreatography (below ERCP). Because LC with stone removal through percutaneous transhepatic biliary drainage (below PTBD) is well known for its safety and feasibility in removing IEHD stones, we did this study to see the significance (safety, feasibility, effectiveness etc) of PTBD and stone removal.
METHODS
We compared the odds by collecting 71 retrospective cases, victims of IEHD stone associated GB stone from January, 2004 to December, 2007 in Chung-Ang University Hospital. Comparative analysis took place in 51 cases who underwent PTBD and 20 cases treated with ERCP. We excluded 6 patients who underwent PTBD for intra hepatic duct stone. Age, sex, American Society of Anesthesiologists score, pain, nausea, pre- and post- laboratory value, symptoms, size, location and number of stones, diameter of extra hepatic duct, recurrence and clearance rate, frequency of each procedure, complications, cost were investigated in this study.
RESULTS
There were no statistical differences in each group in recurrence and clearance rate or frequency of procedure. However post-procedure pancreatitis and amylase level were significantly difference in each group. PTBD group experienced much longer hospital stay but was not significantly different. Although procedure cost is three times more expensive than that of PTBD group, there were no differences in total cost and patients' expenses between the two groups.
CONCLUSION
PTBD would be an alternative solution in managing IEHD stone associated with GB stone for its lower rate of complication, higher clearance with minimal discomfort.

Keyword

Percutaneous Transhepatic Biliary Drainage (PTBD); Hepatic duct stone; Laparoscopic Cholecystectomy (LC)

MeSH Terms

Amylases
Cholangiopancreatography, Endoscopic Retrograde
Cholecystectomy, Laparoscopic
Dioxolanes
Drainage
Fluorocarbons
Gallbladder
Hepatic Duct, Common
Humans
Hypogonadism
Length of Stay
Mitochondrial Diseases
Nausea
Ophthalmoplegia
Pancreatitis
Recurrence
Retrospective Studies
Amylases
Dioxolanes
Fluorocarbons
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia