Using Percutaneous Transhepatic Cholangioscopic Lithotripsy for Intrahepatic Calculus in Hostile Abdomen.
Kow A W C; Wang B; Wong D; Sundeep P J; Chan C Y; Ho C K; Liau K H
The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 2011 Apr;9(2):88-94
Hepatolithiasis is a challenging condition to treat especially in patients with previous hepatobiliary surgery. Percutaneous Transhepatic Cholangioscopic Lithotripsy (PTCSL) is an attractive salvage option for the treatment of recurrent hepatolithiasis. We reviewed 4 patients, with previous complex abdominal surgery, who underwent PTCSL. This was performed using 3 mm cholangioscope & Holmium Laser through a Percutaneous Transhepatic Cholangio-catheter inserted by interventional radiologists. The median age was 50 (43-69) years and median duration of the condition prior to PTCSL was 102 (60-156) months. Three patients had recurrent pyogenic cholangitis (RPC) with recurrent intrahepatic stone. They all had prior complex hepatobiliary operations. The median duration of procedure was 130 (125-180) min. The number of stones ranged from one to three with the largest size of stone comparable to the size of bile duct. The median follow up was 18 (10-24) months. All patients were symptom free with neither stone recurrence or cholangitis at the last follow up. In summary, PTCSL is a feasible and an effective treatment method for patients with recurrent biliary stone following complex abdominal surgery as the success rates from open surgery and endoscopic procedures are limited. Excellent results can be expected with this minimally invasive technique.
Hepatolithiasis is a challenging condition to treat especially in patients with previous hepatobiliary surgery. Percutaneous Transhepatic Cholangioscopic Lithotripsy (PTCSL) is an attractive salvage option for the treatment of recurrent hepatolithiasis. We reviewed 4 patients, with previous complex abdominal surgery, who underwent PTCSL. This was performed using 3 mm cholangioscope & Holmium Laser through a Percutaneous Transhepatic Cholangio-catheter inserted by interventional radiologists. The median age was 50 (43-69) years and median duration of the condition prior to PTCSL was 102 (60-156) months. Three patients had recurrent pyogenic cholangitis (RPC) with recurrent intrahepatic stone. They all had prior complex hepatobiliary operations. The median duration of procedure was 130 (125-180) min. The number of stones ranged from one to three with the largest size of stone comparable to the size of bile duct. The median follow up was 18 (10-24) months. All patients were symptom free with neither stone recurrence or cholangitis at the last follow up. In summary, PTCSL is a feasible and an effective treatment method for patients with recurrent biliary stone following complex abdominal surgery as the success rates from open surgery and endoscopic procedures are limited. Excellent results can be expected with this minimally invasive technique.
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