INTRODUCTION AND OBJECTIVES: We evaluated the efficacy of ureteroscopic therapy (electrohydraulic lithotripsy (EHL) and intraductal laser lithotripsy (ILL)) in patients with challenging biliary stones secondary to anatomic variations resulting from a previous surgical procedure, including liver transplantation.
METHODS: A retrospective chart review was performed for all patients with prior surgical alteration of the gastrointestinal (GI) tract who underwent EHL or ILL via peroral or percutaneous access for choledocholithiasis by a single surgeon at our institution from 2000-2012. A database containing clinical and surgical variables was created, and long term follow-up was conducted (3-138 months; median, 99 months).
RESULTS: Thirteen patients (51.7 ± 20.0 years; M:F, 10:3) that failed endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTHC), or both were identified. Failure of ERCP/PTHC was due to inaccessibility of the calculi in all cases. Stone clearance was achieved in 12/13 patients (93%); 8/12 (62%) after 1 procedure, and 4/12 (31%) after 2 procedures. One patient with biliary cast syndrome required 4 interventions over 9 years. Major complications were low with only one patient with hypotension and cholangitis that resolved with 24 hours of intravenous fluids and antibiotics.
CONCLUSIONS: Both endoscopic and percutaneous lithotripsies are effective treatments for refractory biliary calculi resulting from the post-surgical GI tract. Although a staged second procedure may be necessary in patients with significant stone burden, this is significantly better than extensive open surgery.
Written by:
Sninsky BC, Sehgal PD, McDermott JC, Hinshaw JL, Nakada SY. Are you the author?
University of Wisconsin School of Medicine and Public Health, Urology, Madison, Wisconsin, United States.
Reference: J Endourol. 2014 Mar 11. Epub ahead of print.
doi: 10.1089/end.2014.0083
PubMed Abstract
PMID: 24617771
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