Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi

• Type of Material: Article
• Authors: Kelly Healy, Emory University; Abbas Chamsuddin, Emory University; James Spivey, Emory University; Louis Martin, Emory University; Peter Nieh, Emory University; Kenneth Ogan, Emory University
• Language: English
• Date: 2009-04-01
• Publisher: Society of Laparoendoscopic Surgeons, Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2009 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://sls.org/
• Title of Journal or Parent Work: JSLS, Journal of the Society of Laparoendoscopic Surgeons
• Volume: 13
• Issue: 2
• Start Page: 184
• End Page: 189
• Keywords: EXPLORATION; Holmium laser; COMMON BILE-DUCT; Lithotripsy; Endoscopic; SURGERY; Science & Technology; Life Sciences & Biomedicine; Surgery; Biliary calculi
• Research Categories: Health Sciences, General; Health Sciences, Medicine and Surgery

Abstract

Background and Objectives: Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi. Methods: We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra-and postoperatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging. Results: Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted. Conclusions: Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach.