Percutaneous transhepatic choledochoscopic removal of intrahepatic stones

Background: Treatment of hepatolithiasis is complex and difficult. With the advent of biliary endoscopy and radiological intervention, percutaneous choledochoscopic removal of intrahepatic stones has become a well established procedure. Methods: Seventy-nine patients with intrahepatic stones that were removed by percutaneous transhepatic choledochoscopy (PTCS) between 1993 and 2001 were studied retrospectively. The results of the procedure and the long-term outcome of these patients were analysed. Results: The success rate of choledochoscopic removal of intrahepatic stones was 76.8 per cent. Complications occurred in 17 patients (21.5 percent). Removal of stones predominantly on the right side was difficult using this method. Cholangitis occurred in about one third of patients within 3-5 years after PTCS. For patients with a stricture, cholangitis recurred gradually over the years of follow-up. Conclusion: Intrahepatic stricture was the major determinant for the recurrence of stones or symptoms. Hepatic resection should be offered to these patients if the disease is localized in one liver segment or lobe. In other cases, percutaneous choledochoscopy and stricture dilatation is a useful solution, and may reduce further damage to the liver.