Percutaneous transhepatic biliary stone removal: A single-center retrospective study

Abstract

Objectives: To report, the authors’ experience with percutaneous transhepatic biliary stone removal, focusing on the technical aspects and overall performance, as well as reviewing few challenging cases. Material and Methods: All cases of percutaneous transhepatic biliary stone removal from 2015 to 2022 were retrieved, including intrahepatic locations. Cases with negative initial cholangiogram suggestive of stone passage were excluded from the study. The demographic data, procedural indications and details, stone characteristics, fluoroscopic images, success rate, and complications were retrospectively evaluated by two experienced observers. Results: The final study included 67 patients (mean age = 76.8). Majority of indications were altered gastric anatomy and failed endoscopic retrograde cholangiopancreatography. The mean largest stone size was 9 mm and most cases had multiple stones. Balloon sphincteroplasty was performed in all cases and mechanical lithotripsy in 24%. Fourteen cases required repeated trials, and they were mostly staged, depending on technical factors and patient condition. Recurrent pyogenic cholangitis (RPC) usually required repeated trials, and two separate sites of catheterization were made in the same lobe for one challenging case. Complete stone retrieval was not achieved in 9% (six out of 67) of cases: failure of mechanical lithotripsy (n = 2); failure of balloon occlusion technique (n = 1); refluxed stone (n = 1); and multiplicity of intrahepatic stones (n = 2). Three minor complications were encountered, including sepsis and self-controlled hemobilia. No major complications. Conclusion: Percutaneous extrahepatic biliary stone removal is a safe and technically feasible procedure after a failed endoscopic approach or altered biliary tract anatomy. Cases of RPC or previous Whipple’s operation could be technically challenging. Careful pre-procedural planning and anatomical review are crucial.