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The role of cholangioscopic laser lithotripsy in residual calculi of the biliary tree.

Author

Alex A Erasmo,
Maita Theresa P. Rigor,
Vitus S Hobayan

Related Institution

Department of Surgery - Cardinal Santos Medical Center

Publication Information

Publication Type
Journal
Publication Sub Type
Journal Article, Reprint
Title
Philippine Journal of Surgical Specialties
Frequency
Quarterly
Publication Date
July-September 2004
Volume
59
Issue
(3)
Page(s)
89-96

Abstract

Objective: This paper aimed to evaluate the indications and procedure-related outcome of cholangioscopic laser lithotripsy in postoperative patients with residual duct calculi
Methods: This was a prospective case series of 31 patients with prior common duct exploration who availed of initial T-tube tract cholangioscopy within an 11-month period; 25 (81 percent) with 1.5 cm or impacted stones received lithothripsy. Early clinical measures assessed were stone fragmentation, duct clearance, and procedure-associated complication rates
Results: The male to female ratio was 1:2 with a mean age of 41 years. Reasons for cholangioscopy included retained stone, non-visualized left duct, undetermined common duct obstruction, and linear defect. Intrahepatic calculi comprised 20 out of 31 (65 percent) whereas impacted stones accounted for 13 out of 31 (42 percent). Strictures were seen in 8 out of 31 (26 percent). Laser Group (N=25). Among the complex features viewed were: Stone- impaction, 1.5 cm size, multiple, intrahepatic, duct-angulation and deformity. All patients complied with the required sessions. For difficult retrievals, the average number of sessions was as follows: abnormal duct-4.5, acute-angled duct-3.5, impaction- 2.0, and 1.5 cm stone-1.5. While laser and basket were sufficient in 22 patients (88 percent), the rest required balloon dilatation. Laser attained 100 percent fragmentation and facilitated complete clearance. Transient low-grade fever in 7 patients (28 percent) was the only complication noted
Conclusion: Documented as a low-morbidity and high-clearance therapeutic choice in this preliminary account, cholangioscopic laser lithotripsy may be a reasonable option in postoperative patients with retained calculi identified to have complex cholangioscopic features.

References

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