PERCUTANEOUS TRANSHEPATIC ENDOSCOPIC ELECTROHYDRAULIC LITHOTRIPSY OF BILIARY-TRACT CALCULI AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

The development of biliary tract calculi after orthotopic liver transp lantation presents a unique clinical problem. Previously described tec hniques for removing biliary stones by shock wave lithotripsy, litholy tic therapy with oral bile acids, and endoscopic mechanical extraction may be ineffective or contraindicated in liver transplant patients. F or this reason, percutaneous transhepatic electrohydraulic lithotripsy (EHL) was performed using an 11 French flexible ureteroscope in two p ediatric patients who developed biliary tract calculi following orthot opic liver transplant. There were no complications and postoperative f ollow-up over 4 years has been uneventful. To our knowledge, these rep resent the first reported cases of percutaneous transhepatic endoscopi c EHL to fragment biliary tract stones in a transplanted liver, which for us has been a safe and effective therapeutic option.