Percutaneous treatment of intrahepatic lithiasis

Aim-To present our experience with percutaneous intracorporeol electrohydro lic lithotripsy in the treatment of intrahepatic lithiasis. Subjects and methods-From January 1989 to November 1998, 53 patients with i ntrahepatic lithiosis were treated with percutaneous intracorporeal electro hydrolic lithotripsy. Twenty-six patients had primary intrahepatic lithiasi s. Intrahepatic stones were associated with intrahepatic duct abnormalities in 11 patients, 9 had strictures and 2 had cystic dilatations. Twenty-seve n patients had secondary intrahepatic lithiasis formed a biliodigestive byp ass in 20 patients. Intracorporeal electrohydrolic lithotripsy was performe d under cholangioscopic guidance in all patients. The endoscope was introdu ced into the biliary ducts through a cutaneobiliary tract in 51 patients, t hrough a cutaneocholecystic tract in one and through a cutaneojejunal tract in one. These tracts were created and gradually dilated in two sessions th ree days a art. In twenty-two patients stenosis or sharp angulation prevent ed adequate positioning of the scope which was only successful after balloo n dilation or insertion of a stiff wire. Results-Complete clearance of stones was achieved in 49 patients (92%). Bil iary or hepaticojejunostomy strictures were successfully dilated with an an gioplasty balloon in. patients. Ten patients (19%) had early complications: four had bilomas treated by percutaneous drainage, three had resolutive on set of cholangitis, two had transient arterial hemobilia, and one had a pne umothorax. The mean duration of follow-tip was five years, During this peri od, 5 patients (9%) had recurrent symptoms of biliary obstruction. Among th ese patients, three (5.7%) had recurrent symptomatic infrahepatic lithiasis , one had a recurrent biliary stricture and one had secondary sclerosing ch olangitis. Treatment of recurrent stones was repeated intracorporeal electr ohydrolic lithotripsy in two and the hepatectomy in one; recurrent biliary stricture was treated by hepaticojejunostomy and secondary sclerosing chola ngitis by antibiotics. Conclusion-Intracorporeal electrohydrolic lithotripsy is effective and safe and should be proposed as the first line treatment of primary or secondary intrahepatic lithiasis.