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. 1998 May;42(5):708–710. doi: 10.1136/gut.42.5.708

Ductal dilatation and stenting for residual hepatolithiasis: a promising treatment strategy

S Sheen-Chen 1, Y Cheng 1, F Chen 1, F Chou 1, T Lee 1
PMCID: PMC1727092  PMID: 9678975

Abstract

Background and aims—Hepatolithiasis is prevalent in south-east Asia and presents a difficult management problem. Intrahepatic strictures with or without awkward ductal angulation of the biliary tree are the main reasons for the reported high incidence of postoperative residual stones. Without proper treatment, biliary strictures and residual stones can lead to repeated episodes of cholangitis, liver abscess, secondary biliary cirrhosis, portal hypertension, and death from sepsis or hepatic failure. The purposes of our treatment strategy were to achieve complete clearance of the stones and relief of bile stasis. 
Methods—From January 1991 to July 1992, 90 patients with residual postoperative hepatolithiasis and intrahepatic strictures were treated. Postoperative ductal dilatation with percutaneous transhepatic cholangioscopy tube stenting through a mature T tube tract was performed. Choledochoscopic electrohydraulic lithotripsy was applied when impacted or large stones were encountered. 
Results—Complete clearance of stones was achieved in 78 patients (87%). Mild haemobilia occurred in five patients (5.5%) and fever developed in seven patients (7.7%), and these patients recovered after conservative treatment. The rate of stone recurrence after a mean follow up of 43 months was 8%. Intrahepatic cholangiocarcinoma developed in one patient (1.1%). 
Conclusion—Postoperative ductal dilatation and stenting, combined with endoscopic electrohydraulic lithotripsy when indicated, is an effective and safe treatment with a low recurrence rate for complicated residual hepatolithiasis with biliary stricture. 



Keywords: hepatolithiasis; biliary stricture; electrohydraulic lithotripsy

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Figure 1 .

Figure 1

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After ductal dilatation the stones (arrowheads) were clearly visualised. The basket (arrows) was then used to extract the calculi. 


Figure 2 .

Figure 2

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(A) Residual stones with PTCS tube stenting. (B) Complete clearance of stones was achieved and excellent visualisation of the biliary tree was shown by cholangiography. 


Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Burhenne H. J. Electrohydrolytic fragmentation of retained common duct stones. Radiology. 1975 Dec;117(3 Pt 1):721–723. doi: 10.1148/117.3.721. [DOI] [PubMed] [Google Scholar]
  2. Chang T. M., Passaro E., Jr Intrahepatic stones: the Taiwan experience. Am J Surg. 1983 Aug;146(2):241–244. doi: 10.1016/0002-9610(83)90382-3. [DOI] [PubMed] [Google Scholar]
  3. Chen M. F., Jan Y. Y. Percutaneous transhepatic cholangioscopic lithotripsy. Br J Surg. 1990 May;77(5):530–532. doi: 10.1002/bjs.1800770519. [DOI] [PubMed] [Google Scholar]
  4. Choi T. K., Wong J., Ong G. B. The surgical management of primary intrahepatic stones. Br J Surg. 1982 Feb;69(2):86–90. doi: 10.1002/bjs.1800690210. [DOI] [PubMed] [Google Scholar]
  5. Falchuk K. R., Lesser P. B., Galdabini J. J., Isselbacher K. J. Cholangiocarcinoma as related to chronic intrahepatic cholangitis and hepatolithiasis. Case report and review of the literature. Am J Gastroenterol. 1976 Jul;66(1):57–61. [PubMed] [Google Scholar]
  6. Jeng K. S., Shih S. C., Chiang H. J., Chen B. F. Secondary biliary cirrhosis. A limiting factor in the treatment of hepatolithiasis. Arch Surg. 1989 Nov;124(11):1301–1305. doi: 10.1001/archsurg.1989.01410110059012. [DOI] [PubMed] [Google Scholar]
  7. Jeng K. S., Yang F. S., Chiang H. J., Ohta I. Bile duct stents in the management of hepatolithiasis with long-segment intrahepatic biliary strictures. Br J Surg. 1992 Jul;79(7):663–666. doi: 10.1002/bjs.1800790722. [DOI] [PubMed] [Google Scholar]
  8. Ker C. G., Hwang C. H., Chen J. S., Lee K. T., Sheen P. C. Extracorporeal shockwave lithotripsy for treatment of intrahepatic stones: in vitro and in vivo studies. Hepatogastroenterology. 1993 Apr;40(2):159–162. [PubMed] [Google Scholar]
  9. Koch H., Rösch W., Walz V. Endoscopic lithotripsy in the common bile duct. Gastrointest Endosc. 1980 Feb;26(1):16–18. doi: 10.1016/s0016-5107(80)73252-2. [DOI] [PubMed] [Google Scholar]
  10. Koga A., Ichimiya H., Yamaguchi K., Miyazaki K., Nakayama F. Hepatolithiasis associated with cholangiocarcinoma. Possible etiologic significance. Cancer. 1985 Jun 15;55(12):2826–2829. doi: 10.1002/1097-0142(19850615)55:12<2826::aid-cncr2820551219>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  11. Lee W. J., Chang K. J., Lee C. S., Chen K. M. Surgery in cholangitis: bacteriology and choice of antibiotic. Hepatogastroenterology. 1992 Aug;39(4):347–349. [PubMed] [Google Scholar]
  12. Liu T. J. Acute biliary septic shock. HPB Surg. 1990 Jul;2(3):177–183. doi: 10.1155/1990/71059. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Mo L. R., Hwang M. H., Yueh S. K., Yang J. C., Lin C. Percutaneous transhepatic choledochoscopic electrohydraulic lithotripsy (PTCS-EHL) of common bile duct stones. Gastrointest Endosc. 1988 Mar-Apr;34(2):122–125. doi: 10.1016/s0016-5107(88)71276-6. [DOI] [PubMed] [Google Scholar]
  14. Nakanuma Y., Yamaguchi K., Ohta G., Terada T. Pathologic features of hepatolithiasis in Japan. Hum Pathol. 1988 Oct;19(10):1181–1186. doi: 10.1016/s0046-8177(88)80150-3. [DOI] [PubMed] [Google Scholar]
  15. Sheen-Chen S. M., Chou F. F. Choledochotomy for biliary lithiasis: is routine T-tube drainage necessary? A prospective controlled trial. Acta Chir Scand. 1990 May;156(5):387–390. [PubMed] [Google Scholar]
  16. Sheen-Chen S. M., Chou F. F., Eng H. L. Intrahepatic cholangiocarcinoma in hepatolithiasis: A frequently overlooked disease. J Surg Oncol. 1991 Jun;47(2):131–135. doi: 10.1002/jso.2930470213. [DOI] [PubMed] [Google Scholar]
  17. Sheen-Chen S. M., Chou F. F. Is sterile water irrigation safe during postoperative choledochoscopy? A prospective trial. Eur J Surg. 1996 Oct;162(10):801–804. [PubMed] [Google Scholar]
  18. Sheen-Chen S. M., Chou F. F. Postoperative choledochoscopy: is routine antibiotic prophylaxis necessary?--A prospective randomized study. Surgery. 1994 Feb;115(2):170–175. [PubMed] [Google Scholar]
  19. Sheen-Chen S. M., Eng H. L., Cheng Y. F., Chou F. F., Chen W. J. Circulating intercellular adhesion molecule-1 (ICAM-1) in patients with hepatolithiasis. Dig Dis Sci. 1996 Aug;41(8):1682–1686. doi: 10.1007/BF02087925. [DOI] [PubMed] [Google Scholar]
  20. Su C. H., Lui W. Y., P'eng F. K. Relative prevalence of gallstone diseases in Taiwan. A nationwide cooperative study. Dig Dis Sci. 1992 May;37(5):764–768. doi: 10.1007/BF01296436. [DOI] [PubMed] [Google Scholar]

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