The Efficacy of Percutaneous Transhepatic Choledochoscopic Removal of Intrahepatic Stones

Bong, Hyung Keun; Cho, Young Doek; Kim, Jin Oh; Cho, Joo Young; Kim, Yun Soo; Lee, Jun Seong; Lee, Moon Sung; Hwang, Seong Gyu; Shim, Chan Sup

Abstract

OBJECTIVE
Intrahepatic stones provide a quite different spectrum of problems faced by surgeons in the Eastern hemisphere. Although unilateral left intrahepatic stones have been treated by left hepatic lobectomy, bilateral or right intrahepatic stones can be even more troublesome because they frequently cannot be completely removed by conventional surgical stone extraction procedure. Recently, the use of a flexible fiberoptic choledochoscope, electrohydraulic lithotriptor(EHL) and dilators make it possible to completely remove intrahepatic stones by nonsurgical procedures in the majority of cases.
METHODS
During the last 5 years, we treated intrahepatic stones in 114 patients with a fiberoptic choledochoscope, EHL and dilators via percutaneous transhepatic route. For construction of percutaneous transhepatic routes, we punctured intrahepatic ducts by ultrasonographic guidance and then dilated the tracts by PTBD set(Nipro Co., Japan) under fluoroscopic guidance. Choledochoscopy were performed at 4-6 weeks later, and Dormina basket, EHL, balloon or bougie dilators were used for removal of stones.
RESULTS
Success rates according to the locations of stones were 87.5%(14/16) in unilateral right intrahepatic stones, 92.9%(39/42) in unilateral left intrahepatic stones, and 89.3%(50/56) bilateral intrahepatic stones. Overall success rate was 90.4%(103/114). Causes of incomplete removal of the stones in our patients included the failure of construction or maintenance of percutaneous transhepatic routes in 4 cases, intrahepatic bile duct stricture proximal to impacted stones in 3, acute ductal angulation in 2, and stones located at the very distal branches of intrahepatic ducts in 2 cases. Complications associated with the procedure were transient fever in 8 cases, severe hemobila in 2 cases and biliary perforation in 3 cases. CONCLUSON: These results suggest that percutaneous transhepatic choledochoscopic approach is a relatively safe and effective method for treatment of intrahepatic stones.