Treatment of complicated hepatolithiasis with intrahepatic biliary stricture by ductal dilatation and stenting: Long-term results

A group of 190 cases of hepatolithiasis with postoperative residual stones located proximal to the stricture sites were managed with the aim of comple te clearance of stones and relief of bile stasis to decrease the potential risk of recurrence. All procedures were performed through a T-tube track wi th gradual dilatation and stent placement through the stricture sites, crea ting a channel that allows cholangioscopy and electrohydraulic lithotripsy. Complete clearance of intrahepatic duct (IHD) stones was achieved in 88.4% of cases. Multiple sharply angulated IHD strictures in right-sided hepatol ithiasis constituted a major cause of failure. Recurrent stone formation an d repeated cholangitis, subsequent drainage, and liver resection are associ ated with high mortality rates particularly if there is late development of a cholangiocarcinoma. We concluded that postoperative ductal dilatation an d stenting through the T-tube track combined with endoscopic electrohydraul ic lithotripsy is effective and safe fur managing complicated hepatolithias is. Persistent irreversible aneurysmal dilatation of IHD and atrophic chang e of the affected hepatic lobe at follow-up were ominous signs of recurrenc e and cholangiocarcinoma development. Early drainage with stone extraction combined with surgical intervention can prevent subsequent morbidity and mo rtality.