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Intraoperative Ultrasound–Guided Transhepatic Lithotomy: A New Alternative Surgical Procedure for the Management of Residual Hepatic Stones

Intraoperative Ultrasound–Guided Transhepatic Lithotomy: A New Alternative Surgical Procedure for... Abstract Background: The high incidence of residual stones has been a major problem in the treatment of hepatolithiasis. Although various imaging techniques have been used to locate the stones, and many different postoperative procedures have been used as remedial modalities to remove the residual calculi, results have been far from satisfactory. Objectives: To remove obstinate hepatic stones and reduce the incidence of residual calculi. Design: Prospective clinical trial. Setting: Medical university-affiliated hospital. Patients and Methods: Ten patients who had residual intrahepatic stones after conventional operative procedures underwent intraoperative ultrasound (IOUS)–guided transhepatic lithotomy between July 1988 and July 1995. This surgical technique includes accurately locating stones with IOUS, choosing a surgical approach path under the guidance of IOUS while avoiding critical blood vessels and uninvolved biliary tracts, dividing hepatic parenchyma to the involved biliary ducts, and removing the obstinate calculi using the real-time image of IOUS, which is able to monitor the movement of the lithotomy instruments without interruption. Main Outcome Measures: Clinical practical value of IOUS-guided transhepatic lithotomy in the treatment of residual hepatic stones. Results: Complete removal of the stones was achieved in all 10 patients. There were no severe complications or mortality at a median follow-up of 39 months. Conclusions: IOUS-guided transhepatic lithotomy can greatly decrease the incidence of residual hepatic stones. It is accurate and safe. As a new surgical procedure, IOUS-guided transhepatic lithotomy should be an alternative modality in the management of hepatolithiasis, although the long-term benefits still need to be observed.Arch Surg. 1997;132:300-303 References 1. Nakayama F, Soloway RD, Nakama T, et al. Hepatolithiasis in East Asia: retrospective study . Dig Dis Sci . 1986;31:21-26.Crossref 2. Sato T, Suzuki N, Takahashi W, Uematsu I. Surgical management of intrahepatic gallstones . Ann Surg . 1980;192:28-32.Crossref 3. Chang TM, Passaro E Jr. Intrahepatic stones: the Taiwan experience . Am J Surg . 1983;146:241-244.Crossref 4. Kga A, Miyazaki K, Ichimiya H, Nakayama F. Choice of treatment for hepatolithiasis based on pathological findings . World J Surg . 1984;8:36-40.Crossref 5. Huang ZQ, Gu ZY, Zhang XW, Zhou YL, Wang YS, Lin SC. Present status of surgical treatment of intrahepatic lithiasis in China: nationwide surgery of 4197 operative cases (1981-1985) [in Chinese] . Chin J Surg . 1989;26:513-522. 6. Fan ST, Wong J. Complications of hepatolithiasis . J Gastroenterol Hepatol . 1992; 7:324-327.Crossref 7. Falchuk KR, Lesser PB, Galdabini JJ. Cholangiocarcinoma is related to chronic intrahepatic cholangitis and hepatolithiasis . Am J Gastroenterol 1976;66:57-61. 8. Koga A, Ichimiya H, Yamaguchi K, Miyazaki K, Nakayama F. Hepatolithiasis associated with cholangiocarcinoma: possible etiologic significance . Cancer . 1985;55:2826-2829.Crossref 9. Tompkins RK. Surgical management of bile duct stones . Surg Clin North Am . 1990;70:1329-1339. 10. Bergdahl L, Holmlund DEW. Retained bile duct stones . Acta Chir Scand . 1976; 142:145-149. 11. Bismuth H, Castaing D. Operative Ultrasound of the Liver and Biliary Ducts . Berlin, Germany: Springer-Verlag Inc; 1985:68-70. 12. Reynolds BM, Dargan EL. Acute obstructive cholangitis, a distinct clinical syndrome . Ann Surg . 1959;150:299-303.Crossref 13. Pitt HA, Venbrux AC, Coleman J, et al. Intrahepatic stones: the transhepatic team approach . Ann Surg . 1994;219:527-535.Crossref 14. Yarmuch J, Csendes A, Diaz JC, et al. Results of surgical treatment in patients with 'Western' intrahepatic lithiasis . Hepatogastroenterology . 1989;36:128-131. 15. Chen MF, Jan YY, Wang CS, et al. A reappraisal of cholangiocarcinoma in patient with hepatolithiasis . Cancer . 1993;71:2461-2465.Crossref 16. Chijiiwa K, Ichimiya H, Kuroki S, Koga A, Nakayama F. Late development of cholangiocarcinoma after the treatment of hepatolithiasis . Surg Gynecol Obstet . 1993;177:279-282. 17. Choi TK, Lee MJR, Lui R, Fok M, Wong J. Postoperative flexible choledochoscopy for residual primary intrahepatic stones . Ann Surg . 1986;203:260-265.Crossref 18. Ker CG, Chen JS, Lee KT, Sheen PC. Percutaneous post-operative choledochofiberscopic lithotripsy for residual biliary stones . Surg Endosc . 1990;4:191-194.Crossref 19. Hieken TJ, Birkett DH. Postoperative T-tube tract choledochoscopy . Am J Surg . 1992;163:28-30.Crossref 20. Binmoeller KF, Bruckner M, Thonke F, Soehendra N. Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy . Endoscopy . 1993;25:201-206.Crossref 21. Taylor MC, Marshall JC, Fried LA, LeBrun GP, Norman RW. Extracorporeal shock wave lithotripsy (ESWL) in the management of complex biliary tract stone disease . Ann Surg . 1988;208:586-592.Crossref 22. Sauerbruch T, Stern M. Fragmentation of bile duct stones by extracorporeal shock waves: a new approach to biliary calculi after failure of routine endoscopic measures . Gastroenterology . 1989;96:146-152. 23. Sheen-Chen SM, Chou FF, Lee CM, Cheng YF, Lee TY. The management of complicated hepatolithiasis with intrahepatic biliary stricture by the combination of T-tube tract dilation and endoscopic electrohydraulic lithotripsy . Gastrointest Endosc . 199339:168-171.Crossref 24. Han JK, Choi BI, Park JH, Han MC. Percutaneous removal of retained intrahepatic stones with a pre-shaped angulated catheter: review of 96 patients . Br J Radiol . 1992;65:9-13.Crossref 25. Dawson SL, Mueller PR, Lee MJ, Saini S, Kelsey P, Nishioka NS. Treatment of bile duct stones by laser lithotripsy: results in 12 patients . AJR Am J Roentgenol . 1992;158:1007-1009.Crossref 26. Berci G, Hamlin JA, Grundfest WW, Daykhovsky L, Paz-Partlow M. Percutaneous endoscopic laser lithotripsy of retained stones in the left hepatic duct: the role of the surgeon . Surg Endosc . 1990;4:36-38.Crossref 27. Hwang MH, Mo LR, Yang JC, Lin CS. Percutaneous transhepatic cholangioscopic ultrasonic lithotripsy (PTCS-USL) in the treatment of retained or recurrent intrahepatic stones . Gastrointest Endosc . 1987;33:303-306.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Intraoperative Ultrasound–Guided Transhepatic Lithotomy: A New Alternative Surgical Procedure for the Management of Residual Hepatic Stones

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1997.01430270086018
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: The high incidence of residual stones has been a major problem in the treatment of hepatolithiasis. Although various imaging techniques have been used to locate the stones, and many different postoperative procedures have been used as remedial modalities to remove the residual calculi, results have been far from satisfactory. Objectives: To remove obstinate hepatic stones and reduce the incidence of residual calculi. Design: Prospective clinical trial. Setting: Medical university-affiliated hospital. Patients and Methods: Ten patients who had residual intrahepatic stones after conventional operative procedures underwent intraoperative ultrasound (IOUS)–guided transhepatic lithotomy between July 1988 and July 1995. This surgical technique includes accurately locating stones with IOUS, choosing a surgical approach path under the guidance of IOUS while avoiding critical blood vessels and uninvolved biliary tracts, dividing hepatic parenchyma to the involved biliary ducts, and removing the obstinate calculi using the real-time image of IOUS, which is able to monitor the movement of the lithotomy instruments without interruption. Main Outcome Measures: Clinical practical value of IOUS-guided transhepatic lithotomy in the treatment of residual hepatic stones. Results: Complete removal of the stones was achieved in all 10 patients. There were no severe complications or mortality at a median follow-up of 39 months. Conclusions: IOUS-guided transhepatic lithotomy can greatly decrease the incidence of residual hepatic stones. It is accurate and safe. As a new surgical procedure, IOUS-guided transhepatic lithotomy should be an alternative modality in the management of hepatolithiasis, although the long-term benefits still need to be observed.Arch Surg. 1997;132:300-303 References 1. Nakayama F, Soloway RD, Nakama T, et al. Hepatolithiasis in East Asia: retrospective study . Dig Dis Sci . 1986;31:21-26.Crossref 2. Sato T, Suzuki N, Takahashi W, Uematsu I. Surgical management of intrahepatic gallstones . Ann Surg . 1980;192:28-32.Crossref 3. Chang TM, Passaro E Jr. Intrahepatic stones: the Taiwan experience . Am J Surg . 1983;146:241-244.Crossref 4. Kga A, Miyazaki K, Ichimiya H, Nakayama F. Choice of treatment for hepatolithiasis based on pathological findings . World J Surg . 1984;8:36-40.Crossref 5. Huang ZQ, Gu ZY, Zhang XW, Zhou YL, Wang YS, Lin SC. Present status of surgical treatment of intrahepatic lithiasis in China: nationwide surgery of 4197 operative cases (1981-1985) [in Chinese] . Chin J Surg . 1989;26:513-522. 6. Fan ST, Wong J. Complications of hepatolithiasis . J Gastroenterol Hepatol . 1992; 7:324-327.Crossref 7. Falchuk KR, Lesser PB, Galdabini JJ. Cholangiocarcinoma is related to chronic intrahepatic cholangitis and hepatolithiasis . Am J Gastroenterol 1976;66:57-61. 8. Koga A, Ichimiya H, Yamaguchi K, Miyazaki K, Nakayama F. Hepatolithiasis associated with cholangiocarcinoma: possible etiologic significance . Cancer . 1985;55:2826-2829.Crossref 9. Tompkins RK. Surgical management of bile duct stones . Surg Clin North Am . 1990;70:1329-1339. 10. Bergdahl L, Holmlund DEW. Retained bile duct stones . Acta Chir Scand . 1976; 142:145-149. 11. Bismuth H, Castaing D. Operative Ultrasound of the Liver and Biliary Ducts . Berlin, Germany: Springer-Verlag Inc; 1985:68-70. 12. Reynolds BM, Dargan EL. Acute obstructive cholangitis, a distinct clinical syndrome . Ann Surg . 1959;150:299-303.Crossref 13. Pitt HA, Venbrux AC, Coleman J, et al. Intrahepatic stones: the transhepatic team approach . Ann Surg . 1994;219:527-535.Crossref 14. Yarmuch J, Csendes A, Diaz JC, et al. Results of surgical treatment in patients with 'Western' intrahepatic lithiasis . Hepatogastroenterology . 1989;36:128-131. 15. Chen MF, Jan YY, Wang CS, et al. A reappraisal of cholangiocarcinoma in patient with hepatolithiasis . Cancer . 1993;71:2461-2465.Crossref 16. Chijiiwa K, Ichimiya H, Kuroki S, Koga A, Nakayama F. Late development of cholangiocarcinoma after the treatment of hepatolithiasis . Surg Gynecol Obstet . 1993;177:279-282. 17. Choi TK, Lee MJR, Lui R, Fok M, Wong J. Postoperative flexible choledochoscopy for residual primary intrahepatic stones . Ann Surg . 1986;203:260-265.Crossref 18. Ker CG, Chen JS, Lee KT, Sheen PC. Percutaneous post-operative choledochofiberscopic lithotripsy for residual biliary stones . Surg Endosc . 1990;4:191-194.Crossref 19. Hieken TJ, Birkett DH. Postoperative T-tube tract choledochoscopy . Am J Surg . 1992;163:28-30.Crossref 20. Binmoeller KF, Bruckner M, Thonke F, Soehendra N. Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy . Endoscopy . 1993;25:201-206.Crossref 21. Taylor MC, Marshall JC, Fried LA, LeBrun GP, Norman RW. Extracorporeal shock wave lithotripsy (ESWL) in the management of complex biliary tract stone disease . Ann Surg . 1988;208:586-592.Crossref 22. Sauerbruch T, Stern M. Fragmentation of bile duct stones by extracorporeal shock waves: a new approach to biliary calculi after failure of routine endoscopic measures . Gastroenterology . 1989;96:146-152. 23. Sheen-Chen SM, Chou FF, Lee CM, Cheng YF, Lee TY. The management of complicated hepatolithiasis with intrahepatic biliary stricture by the combination of T-tube tract dilation and endoscopic electrohydraulic lithotripsy . Gastrointest Endosc . 199339:168-171.Crossref 24. Han JK, Choi BI, Park JH, Han MC. Percutaneous removal of retained intrahepatic stones with a pre-shaped angulated catheter: review of 96 patients . Br J Radiol . 1992;65:9-13.Crossref 25. Dawson SL, Mueller PR, Lee MJ, Saini S, Kelsey P, Nishioka NS. Treatment of bile duct stones by laser lithotripsy: results in 12 patients . AJR Am J Roentgenol . 1992;158:1007-1009.Crossref 26. Berci G, Hamlin JA, Grundfest WW, Daykhovsky L, Paz-Partlow M. Percutaneous endoscopic laser lithotripsy of retained stones in the left hepatic duct: the role of the surgeon . Surg Endosc . 1990;4:36-38.Crossref 27. Hwang MH, Mo LR, Yang JC, Lin CS. Percutaneous transhepatic cholangioscopic ultrasonic lithotripsy (PTCS-USL) in the treatment of retained or recurrent intrahepatic stones . Gastrointest Endosc . 1987;33:303-306.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Mar 1, 1997

References