Percutaneous Transhepatic Electrohydraulic Lithotripsy for Stones in Billiary Tracts

Yang, Ung Suk; Cho, Mong; Song, Chul Soo; Kim, Gwang Ha; Ok, Chang Min; Lee, Jae Seung; Huh, Jung; Song, Geun Am

Abstract

BACKGROUND AND AIMS: The advent of endoscopic sphincterotomy and percutaneous techniques has allowed for nonoperative removal of biliary calculi from the common bile duct, from intrahepatic ducts, and even from the gallbladder. These days, electrohydraulic lithotripsy (EHL) has been used widely in case of large stones difficult to remove by nonoperative methods such as Dormia basket, balloon dilatation, and so on,
METHODS
Percutaneous transhepatic choledochoscopic lithotorny with EHL was performed in 19 patients, including 7 patients with only hepatolithiasis, 7 with only choledocholithiasis and 5 with both. As a route for choledochoscopy, a T-tube tract was used in 5 patients while percutaneous transhepatic biliary drainage (PTBD) followed by dilatation of the tract was established in 14.
RESULTS
Complete removal of the stones was achieved in 18 of 19 patients. In one patient with hepatolithiasis, small stones located deep in inaccessible braches of the intrahepatic duct due to the stricture remained incompletely removable. The mean number of choledochoscopic sessions from biliary catheterization to completion of lithotomy was 2.7, and that of EHL sessions was 1.7. Minor complications occurred in 5 patients, including minor bleeding in one patient, mild right upper quadrant pain in 2, and transient fever and chills in 2. One case had severe hemorrhage during PTBD tract dilatation and needed transarterial embolization by metallic coil to control the active bleeding.
CONCLUSIONS
Choledochoscopic lithotomy with EHL is safe, efficient, and useful in patients with hepatolithiasis who are in high surgical risks as the first choice and in patients who have large common bile duct stones unrernovable by other nonsurgical methods.