Treatment of postoperative residual hepatolithiasis after progressive stenting of associated bile duct strictures through the T-tube tract.

Abstract

The authors report their experience with the treatment of intrahepatic bile duct strictures associated with hepatolithiasis. Eighty patients had multiple postoperative retained intrahepatic duct stones trapped behind intrahepatic biliary strictures. Before stone extraction, the strictures were opened gradually by semirigid dilators, followed by stent placement to create enough patency for stone removal. All procedures were carried out through the T-tube tracts and were aided by cholangioscopy and electrohydraulic lithotripsy. Complete clearance of stones was achieved in 69 patients. Failure to dilate the strictures was due to acute and multiple ductal angulations. These included the right posterior inferior intrahepatic duct at its junction with the left intrahepatic ducts when it was more than 2 cm distal to the hepatic bifurcation, when the angle between the T-tube tract and the common bile duct was smaller than 90 degrees, and when stones were located in peripheral intrahepatic ducts with more than five angulations. This technique is considered safe and effective for complicated hepatolithiasis with intrahepatic biliary strictures.