title: The benefits of a second transhepatic route in failed percutaneous management of difficult intrahepatic biliary strictures with recurrent hepatolithiasis.
abstract: Percutaneous stricture dilatation and cholangioscopic lithotomy has become a mainstay in the treatment of patients with recurrent hepatolithiasis associated with intrahepatic biliary strictures. In a consecutive series of 125 patients who underwent percutaneous management of recurrent hepatolithiasis from 1987 to 1999, there were 15 patients in whom the procedure failed to clear the stones. A second percutaneous transhepatic route was established for subsequent treatment. A reappraisal of its indications and efficacy was done. Treatment through a second route was helpful for patients with bilateral strictures, angulated duct, difficult strictures, large impacted stones, a subcutaneous jejunal limb, or hemobilia developing in the first route. Strictures remained impacted in 1 of the 15 patients (failure rate, 7%), with the remaining having complete clearance of stones. Cholangitis occurred in two patients; no other complications were encountered. A second percutaneous route is very helpful for the management of complicated hepatolithiasis and biliary stricture.
authors.affiliation: Departments of Surgery, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China. issheen@gcn.net.tw
authors.forename: K S
authors.initials: KS
authors.lastname: Jeng
authors.forename: I S
authors.initials: IS
authors.lastname: Sheen
authors.forename: F S
authors.initials: FS
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D001653:Bile Ducts, Intrahepatic / Q000473:pathology* / Q000601:surgery*; D002769:Cholelithiasis / Q000601:surgery*; D003251:Constriction, Pathologic; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D017211:Treatment Failure