Percutaneous transhepatic choledochoscopic removal of intrahepatic stones.
BACKGROUND
Treatment of hepatolithiasis is complex and difficult. With the advent of biliary endoscopy and radiological intervention, percutaneous choledochoscopic removal of intrahepatic stones has become a well established procedure.


METHODS
Seventy-nine patients with intrahepatic stones that were removed by percutaneous transhepatic choledochoscopy (PTCS) between 1993 and 2001 were studied retrospectively. The results of the procedure and the long-term outcome of these patients were analysed.


RESULTS
The success rate of choledochoscopic removal of intrahepatic stones was 76.8 per cent. Complications occurred in 17 patients (21.5 per cent). Removal of stones predominantly on the right side was difficult using this method. Cholangitis occurred in about one third of patients within 3-5 years after PTCS. For patients with a stricture, cholangitis recurred gradually over the years of follow-up.


CONCLUSIONS
Intrahepatic stricture was the major determinant for the recurrence of stones or symptoms. Hepatic resection should be offered to these patients if the disease is localized in one liver segment or lobe. In other cases, percutaneous choledochoscopy and stricture dilatation is a useful solution, and may reduce further damage to the liver.
Cheung
M-T
MT
Department of Surgery, Queen Elizabeth Hospital, Gascoigne Road, Kowloon, Hong Kong. qehsurg@ha.org.hk
Wai
S-H
SH
Kwok
P C-H
PC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002761:Cholangitis / Q000209:etiology / Q000601:surgery; D002769:Cholelithiasis / Q000601:surgery*; D002780:Cholestasis, Intrahepatic / Q000209:etiology / Q000601:surgery; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome