Faculty Collaboration Database

Operative choledochoscopic laser lithotripsy for impacted intrahepatic gallstones: a novel surgical approach. Surg Endosc 2009 Jan;23(1):221-4

Date

05/13/2008

Pubmed ID

18470555

DOI

10.1007/s00464-008-9953-5

Scopus ID

2-s2.0-58149177526 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

INTRODUCTION: Occasionally patients present with hepatic duct stones or impacted common bile duct stones that either fail or are not amenable to endoscopic retrograde cholangiopancreatography (ERCP) extraction. More troublesome are patients with prior surgeries resulting in altered anatomy that makes traditional endoscopic extraction of ductal stones very difficult. We present a novel approach to these ductal stones using a combination of surgery, biliary endoscopy, and laser lithotripsy.

METHODS: We report on five patients with ductal stones that either failed ERCP or were not candidates for ERCP extraction. Data was collected via chart review with Institutional Review Board approval.

RESULTS: The average age of patients was 70.1 years. All patients presented with hepaticolithiasis and symptoms of cholangitis including elevated liver function tests and recurrent fever and chills. Patients had a mean of 2.8 failed ERCP or percutaneous attempts at stone clearance (range 2-4). A combination of surgery and intraoperative biliary endoscopy with laser lithotripsy (holmium laser) was used in all patients. In four patients the lithotripter was introduced via a choledochotomy or hepaticodochotomy. One patient had previously undergone a Roux-en-Y hepaticojejunostomy and was found to have a large hepatic duct stone sitting above a strictured anastomosis. Access was gained via an enterotomy in the Roux limb. Complete stone clearance was obtained in all patients. Average operative time was 349 min. All patients have normal liver function tests (27-36 month follow-up).

CONCLUSION: Laser lithotripsy has been described as an adjunct to ERCP in the past for stones refractory to balloon or basket retrieval. The combination of a surgical enterotomy, biliary endoscopy, and laser lithotripsy provides a novel approach to treat patients with large intrahepatic stones who are not candidates for or have failed ERCP.

Author List

Bark K, Gamblin TC, Zuckerman R, Geller DA

Author

Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Choledocholithiasis
Choledochostomy
Cohort Studies
Endoscopy
Hepatic Duct, Common
Humans
Lithotripsy, Laser
Radiography
Retrospective Studies
Treatment Outcome