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.
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.
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