Primary intrahepatic lithiasis: Report of a case treated by laparoscopic bilioenteric anastomosis

Recent advances in videolaparoscopic surgery have made this method the trea tment of choice for many biliary diseases. However, it has not been used in certain cases, such as primary intrahepatic lithiasis. The authors report a case of a 62-year-old woman with a history of several episodes of cholang itis. Investigation revealed dilated intra- and extrahepatic bile ducts wit h intrahepatic stones. The patient underwent laparoscopy, and intraoperativ e cholangiography disclosed an enlarged common duct with absence of stones and the presence of multiple calculi in the intrahepatic biliary tree. A ch oledochotomy followed by choledochoscopy was performed, which revealed seve ral intrahepatic pigmented stones that were completely retrieved, followed by a laterolateral choledochoduodenostomy to decompress the biliary tree an d to allow the migration of residual or recurrent stones. The patient had a n uneventful recovery and was discharged on the fourth postoperative day. A fter 15 months of follow-up the patient is asymptomatic with normal results of liver function tests. Late postoperative upper digestive endoscopy show ed a patent choledochoduodenostomy.