Treatment of difficult intrahepatic stones by using extracorporeal and intracorporeal lithotripsy techniques: 10 years' experience in 55 patients

Background: Intrahepatic lithiasis still is a complicated disease and merit s special attention during therapeutic intervention. Although resection of the affected Liver lobe or segment is the best therapeutic option to comple tely remove the source of recurrent infection, the need for endoscopic trea tment modalities is evident because hepatic resections are combined with a high morbidity and mortality rate. Methods: Over a 10-year period (1988-199 7) 55 patients with intrahepatic stones that were not accessible to routine endoscopic extraction were treated at our department. These patients under went either extracorporeal shock-wave lithotripsy (n=27) or intracoporeal e lectrohydraulic (n=12) or laser Lithotripsy (n=16). Results: Using these te chniques, we achieved stone fragmentation in 33.3%, 41.6%, and 75%, respect ively. With a combination of the different methods, more than 90% of intrah epatic stones could be removed endoscopically. Overall complication rate wa s 12.7%; complete recovery was achieved in all patients with conservative m anagement. Conclusion: The endoscopic approach to intrahepatic lithiasis ap pears to be a useful alternative to surgery, with a lower morbidity and mor tality. If endoscopic therapy fails, surgery is still possible.