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Author Notes:

Address correspondence to: Kenneth Ogan, MD, The Emory Clinic, Department of Urology, 1365 Clifton Rd., Suite B, Atlanta, GA 30322, USA. Telephone: (404) 778-3038, Fax: (404) 778-4006, E-mail: kenneth.ogan@emoryhealthcare.org

Kelly Healy, Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.

Abbas Chamsuddin, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.

James Spivey, Department of Hepatology, Emory University School of Medicine, Atlanta, Georgia, USA.

Louis Martin, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.

Peter Nieh, Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.

Kenneth Ogan, Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.

Subjects:

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Surgery
  • SURGERY
  • Biliary calculi
  • Holmium laser
  • Endoscopic
  • Lithotripsy
  • COMMON BILE-DUCT
  • EXPLORATION

Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi

Tools:

Journal Title:

JSLS, Journal of the Society of Laparoendoscopic Surgeons

Volume:

Volume 13, Number 2

Publisher:

, Pages 184-189

Type of Work:

Article | Final Publisher PDF

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.

Copyright information:

© 2009 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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