Multidisciplinary approach and use of laser lithotripsy in management of recurrent complex intrahepatic stones (Tricks of the trade)

Abstract

Background: Complex biliary stones are managed via endoscopic, radiological or surgical approach. Failure of clearance may lead to repeated attacks of cholangitis or even biliary cirrhosis that may lead to liver failure. The aim of this presentation is to show the impact and safety of utilization of laser lithotripsy in such complex scenarios in a multidisciplinary fashion. Case: We are presenting a 38-year-old gentleman known to have oriental cholangitis. He underwent multiple operations including drainage procedures (hepaticojejunostomy) and even revision of hepaticojejunostomy before presenting to our institution (Hamad Medical Corporation). We adopted a multidisciplinary staged approach utilizing laser lithotripsy to successfully clear his diseased biliary segments. The patient required multiple attempts to clear the volume of stone disease within his biliary system. Over a short-term follow-up period the patient remains sepsis free with clear biliary system within the treated biliary segments. Conclusion: Multidisciplinary HPB approach and utilization of laser lithotripsy in management of complex intrahepatic stones may spare patients repeated surgical drainage procedures; However, such patients may require multiple sessions to minimize the volume of stone disease within the diseased biliary segments.