Korean J Gastrointest Endosc.  2010 Nov;41(5):273-279.

Bilateral Biliary Approach in Patients with Hepatolithiasis

• Kim DU
• Song GA
• Kim KH
• Kim S
• Kim HW
• Kang DH

Abstract

BACKGROUND/AIMS
Percutaneous procedures for treating patients with hepatolithiasis associated with intrahepatic biliary stricture (IHBS) have been shown to have a relatively lower rate of successful stone removal than without IHBS. The reason is tight stenosis or acute angulation of intrahepatic bile ducts (IHDs). We suggest that a bilateral approach to IHDs would improve the success rate of stone removal in patients with complicated IHBS.
METHODS
Conventional cholangioscopic electrohydrolithotripsy (EHL) was performed in 82 patients without IHBS. Percutaneous transhepatic stricture dilation and cholangioscopic EHL through unilateral access was performed to treat 41 patients with hepatolithiasis with IHBS. In 21 patients with complicated stricture and multiple stones, removal of hepatolithiasis was achieved by a bilateral approach. The rate of complete stone clearance and complication was reviewed retrospectively.
RESULTS
Complete stone clearance was achieved in 92.7% (76/82) of patients using a unilateral approach without IHBS, in 61.0% (25/41) of cases using a unilateral approach with IHBS, and in 85.7% (18/21) of cases using a bilateral approach with IHBS (p<0.05). The number of sessions of PTCS was 2.7+/-0.3, 3.9+/-0.3, and 2.7+/-0.5 respectively. The overall complication rate was 14.6% (21/144), and didn't differ between groups.
CONCLUSIONS
A bilateral approach to IHDs may be a useful alternative treatment in unresectable patients with multiple hepatolithiasis associated with complicated IHBS.

Keyword

Hepatolithiasis; Intrahepatic biliary stricture; Percutaneous transhepatic cholangioscopic lithotomy (PTCSL)

MeSH Terms

Bile Ducts, Intrahepatic
Constriction, Pathologic
Factor IX
Humans
Retrospective Studies
Factor IX