Success Rate Of Stone Removal Research Articles

Choledochoscopic laser fithotripsy for refractory residual biliary calculi after surgery

Objective To explore the efficacy and safety of choledochoscopy combined with laser lithotripsy for refractory residual biliary calculi after operation. Methods Clinical data of 22 patients, who underwent choledochoscopy together with laser lithotripsy for refractory intra- and extra-hepatic calculi after operation from February 2007 to February 2009, were retrospectively studied. Results The success rate of stone removal was 95.5% （21/22）, with one session success rate of 86.4% （19/22）, and two sessions of 9. 1% （2/22）. Stone removal could not be performed in one patient due to multiple intra-hepatic calculi, difficult calculi location at bile ducts of grade Ⅱ, and wide biliary angle with no access. No biliary duct hemorrhage, perforation, or infection occurred. Conclusion Choledochoscopy combined with laser lithotripsy is an effective and safe procedure for refractory residual biliary calculi after operation. Key words: Choledochoscope ; Lithotripsy, laser; Calculi ; Refractory

Sialendoscopie des glandes salivaires

Sialoendoscopy is a simple efficient mode of treatment for major salivary gland sialoliths and strictures.Sialendoscopy procedure requires specific devices, diagnostic and therapeutic sialendocopes, minigrasping forceps, wire baskets, lasers, balloons and stents. The sialendoscopy procedure is divided in three steps: the duct introduction step (through the papilla or through the duct wall); the diagnostic step (from main duct to third or fourth salivary division branches) and the therapeutic step (stone removal with a Dormia basket or miniforceps and stenosis balloon dilatation). The feasibility of stone removal depends on the size, the position, the mobility and the shape of the stone. The only contraindication is acute sialadenitis.Sialendoscopy complications are minor. Its success rate for stone removal is greater than 90%, and it has dramatically reduced the rate of sialadenectomy (to less than 5%).

Percutaneous Lithotripsy for Removing Difficult Bile Duct Stones Using Endoscopy

Purpose: To describe efficacy of percutaneous lithotripsy for removing difficult bile duct stones using endoscopy. Materials and Methods: A total of 88 patients with difficulties for the removal of bile duct stones using endoscopy (an impacted stone, stone size >15 mm, intrahepatic duct (IHD) stone, stone size to bile duct diameter ratio >1.0), were enrolled in this study. A 12 Fr sheath was inserted through the percutaneous transhepatic biliary drainage (PTBD) tract, and then nitrol stone baskets and a 0.035” snare wire were used to capture, fragment and remove the stones. The technical and clinical success rates were analyzed, together with an analysis of any complications. Results: The overall technical success rate of stone removal was achieved in 79 of 88 patients (89.8%). In five of nine patients with failed stone removal, small residual IHD stones were noted on a cholangiogram. Even if stone removal failed in these cases, cholangitic symptoms were improved and the drainage catheter was successfully removed. Therefore, clinical success was achieved in 84 of 88 patients (95.5%). There were no significant procedure-related complications, except for sepsis in one case. Conclusion: Billiary stone removal using the stone basket and guide-wire snare technique through the PTBD tract is a safe and effective procedure that can be used as a primary method in patients with difficulties for the removal of bile duct stones using endoscopy.

Efficacy and safety of low‐pressured and short‐time dilation in endoscopic papillary balloon dilation for bile duct stone removal

Endoscopic papillary balloon dilation (EPBD) has been advocated as an alternative therapy to endoscopic sphincterotomy for bile duct stones. However, studies have shown that EPBD may increase the risk for pancreatitis. Pancreatitis after EPBD is believed to be related to papillary damage after balloon dilation. We changed the dilation method to a theoretically less hazardous one. This modified dilation method was compared with the initial method. A total of 324 patients with bile duct stones underwent EPBD by the modified method between June 1999 and June 2003. Three hundred and twenty-four patients undergoing EPBD by the initial method served as a historical control group. The success rate of stone removal and the incidence of procedure-related pancreatitis were compared between the two groups. In the modified method, the balloon was inflated until disappearance of the balloon waist, and the pressure was then maintained for 15 s. In the initial method, the balloon was inflated at 8 atmospheres for 2 min. Bile duct stones were successfully removed in 313 of 324 patients (96.6%) in the modified group and in 314 of 324 patients (96.9%) in the initial group (not significant). The incidence of post-procedure pancreatitis showed a lower tendency in the modified group (4.0%, 13/324) than in the initial group (7.4%, 24/324) (P-value = 0.0626). The severity of pancreatitis was significantly reduced in the modified group. The modified method of EPBD is feasible for extraction of bile duct stones, and may potentially decrease the incidence of severe post-EPBD pancreatitis.

Minor EST with EPLBD Is a Safe Treatment Modality for Removal of Difficult Bile Duct Stones in Patients with Periampullary Diverticuli

Background/Aims: Periampullary diverticuli (PAD), which are frequently noticed during endoscopic retrograde cholangiopancreatography (ERCP) examination in patients with pancreaticobiliary diseases, have been reported to be associated with difficult bile duct canulation and an increased incidence of endoscopic sphincterotomy (EST). The aim of this study is to investigate the safety of combined minor EST and endoscopic papillary large balloon dilatation (EPLBD) for the removal of difficult CBD stones in patients with periampullary diverticuli group by comparing the success rate of stone removal and complications with patients who have normal ampullas. Patients and Methods: Between May 2005 and Sep. 2006, 69 patients underwent minor EST with EPLBD for the removal of CBD stones. Thirty two patients(mean age 71.8 years; 12 men, 20 women) had periampullary diverticului and thirty seven patients(mean age 66.9 years; 17 men, 20 women) had normal ampulla. Results: The mean number of CBD stones was 2.5 in PAD and 3.2 in normal. The mean diameter of stones was 17.5 mm and 18.2 mm, respectively. The success rate of complete stone removal for first endosocopic session was 93.8% (30/32) in the PAD group and 89.2% (33/37) in the normal ampullary group (p > 0.05). The complication rate was 3.1% (1/32; delayed bleeding) in the PAD group and 10.8% (4/37; all were mild pancreatitis) in the normal ampullary group (p > 0.05). The overall success rate of stone removal was 100% in both group. Conclusion: Minor EST with EPLBD in PAD is a safe treatment modality for removal of large CBD stones.

Do Endoscopic Sphincterotomy and Periampullary Diverticulum Affect the Result of Endoscopic Large Balloon Sphincteroplasty Along with Endoscopic Sphincterotomy in Patients with Large Bile Duct Stones?

Background/Aims: Endoscopic large balloon sphincteroplasty along with endoscopic sphincterotomy (ELBS-EST) is a newly developed technique to remove large bile duct stones. Patients with periampullary diverticulum (PD) may have a higher risk of perforation after EST, especially after major EST. The aim of this study was to evaluate whether the PD could be a risk factor of ELBS-EST, also to evaluate the type of EST affecting the result of the stone clearance rate or complication rate. Methods: In 40 patients (14 men, 26 women; mean age 66.2 ± 10.3 years) with large EHD stones, the ampulla was dilated by a large balloon (CRETM wire-guided balloon dilator, Boston Scientific, U.S.A) with 18 or 20 mm in diameter after major or minor EST. EHD stone removal was tried with a basket. Results: 1) 25 patients underwent minor EST and 15 underwent major EST. 2) PD was present in 24 patients. 3) Overall success rate of stone removal by ELBS-EST was 85% (34/40 patients). The mean stone diameter was 19.2 ± 4.3 mm (range, 15∼34 mm). Overall complication rate was 12.5% (3 cases were minor bleeding, 2 cases were pancreatitis). 4) The success and complication rate between patients who had minor EST [84% (21/25) and 8% (2/25)] and major EST [86.7% (13/15) and 20%(3/15)] were not statistically different. 5) The success and complication rate between patients with PD [84% (20/24) and 8.3% (2/24) and those without PD [87.5% (14/16) and 18.8% (2/16)] were not statistically different. 6) Patients were divided into 4 groups according to the presence of PD and the type of EST [PD (+) with minor EST, PD (+) with major EST, PD (-) with minor EST, PD (-) with major EST]. The success rate for each group was 84%, 80%, 83% and 90% respectively. The complication rate was 5.3%, 20%, 16.7% and 20% respectively. There was statistically significant difference in the success rate between each group (P = 0.015), but there was no statistically significant difference in the complication rate between each group (P = 0.067). Conclusion: Endoscopic large balloon sphincteroplasty along with EST is a safe and useful alternative technique in patients with large EHD stones without regard to the type of EST and presence of the periampullary diverticulum.

Percutaneous transhepatic cholangioscopy.

Since 1983, percutaneous transhepatic cholangioscopy has been performed in 50 patients for both therapeutic and diagnostic purposes. Percutaneous transhepatic cholangioscopy was used to evaluate the nature of obstructive jaundice in 15 patients and bile duct stones were removed in 35 patients, 27 of whom also had intrahepatic duct stones. The overall success rate for stone removal was 80 per cent. Complications were few with no mortality. Emergency surgery was necessary in two patients, one for subphrenic haematoma, the other for a bile leak. Percutaneous transhepatic cholangioscopy is an effective and safe method for management of biliary stones and is a useful procedure for establishing the diagnosis of obstructive jaundice.

Liver Resection for Intrahepatic Stones

Long-term outcome is good for a selected group of patients with hepatolithiasis treated with liver resection. Liver resection should also be offered to patients with complex hepatolithiasis such as bilateral stones or those with strictures. Retrospective study. Regional hospital. A total of 174 patients with hepatolithiasis (201 procedures) treated between January 1, 1989, and September 30, 2003. Liver resection (52 procedures) or removal of stones primarily by percutaneous choledochoscopy (149 procedures). Recurrence of cholangitis. Most patients in the liver resection group had stones localized to the left side. The overall success rate in this group was 98.0% (49 of 50 patients, excluding 2 patients found to have cholangiocarcinoma). The chance of biliary sepsis at 5 years after resection was 13.3%. The overall success rate of stone removal primarily by percutaneous choledochoscopy was 70.5%. The bilaterality of stones, the presence of stricture, and the presence of atrophy were found to be significant risk factors for a poor long-term outcome after stone removal alone. The chance of biliary sepsis at 5 years was 26.4% and 43.2% for those without and with stricture, respectively. The long-term outcome after liver resection for hepatolithiasis was excellent for a selected group of patients. Poor outcomes were recorded for patients whose intrahepatic stones were removed primarily by percutaneous choledochoscopy, especially those with strictures. The indication for liver resection for hepatolithiasis should be extended to patients with strictures and those with bilateral stones. A combination of different treatment modalities is necessary to improve the outcome of these patients.

Transcystic Common Bile Duct Exploration in the Management of Patients With Choledocholithiasis

Common bile duct stones are found in approximately 16% of patients undergoing laparoscopic cholecystectomy. If the diagnosis of choledocholithiasis is made at the preoperative workup, it is common practice to refer the patient for endoscopic retrograde cholangiography and endoscopic sphincterotomy. However, if the diagnosis is established during intraoperative cholangiography, the surgeon is confronted with a therapeutic dilemma—that is, the choice between laparoscopic common bile duct exploration, conversion to open surgery, or postoperative endoscopic sphincterotomy. We have opted to treat patients with choledocholithiasis in only one session during the laparoscopic cholecystectomy; we use the transcystic common bile duct exploration technique employing the choledochoscope. We report our early experience in terms of success of stone removal, operative time, morbidity and mortality, and length of hospital stay. From 1992 to 2002, we performed 350 laparoscopic cholecystectomies. Selective cholangiography was used in 105 patients (30%); 40 of them were found to have common bile duct stones, for an incidence of 11.4%. Among this group, we performed laparoscopic transcystic common bile duct exploration in all but six patients. Our success rate for stone removal was 94.1% (32 of 34 patients), with only two failures related to multiple stones and impaction at the ampulla, for a conversion rate of 5.8%. The mean operative time was 120±40 minutes. The morbidity rate was 8.8%, and there were no deaths. Length of hospital stay was 24 to 48 hours. Mean recovery time was 7 days, and time to return to work was 15±3 days. We concluded that most of the patients with common bile duct stones found during laparoscopic cholecystectomy could be treated successfully by means of the transcystic technique with choledochoscopy, with no increase in morbidity or mortality and a shortened hospital stay and recovery time, similar to patients who undergo only laparoscopic cholecystectomy. On the basis of our results, we recommend that this method become the primary strategy in the great majority of patients with common bile duct stones found during intraoperative cholangiography.

Urologist-Acquired Renal Access for Percutaneous Renal Surgery

Objectives. In most endourology programs an interventional radiologist is employed to acquire renal access for percutaneous renal surgery. Over the last 13 years the senior endourologist at Oregon Health Sciences University has acquired access without employing a radiologist. We report our experience with urologist-acquired renal access for percutaneous renal surgery in 522 cases. Methods. We reviewed the records of all patients at our hospital who underwent percutaneous renal surgery between August 1983 and December 1996 with renal access being obtained in the operating room by a urologist. Results. Four hundred fifty-six patients underwent 522 procedures. Indications for percutaneous renal surgery were renal and proximal ureteral calculi (n = 516), retained ureteral stent (n = 3), and intrarenal collecting system tumor (n = 3). We were successful in gaining access to 513 of 522 kidneys (98.3%). Access was obtained via a subcostal approach in 344 procedures, over the 12th rib in 152 procedures, over the 11th rib in 15 procedures, and transabdominally in 2 procedures. Sixty-five patients (12.7%) required a second or multiple sites to facilitate complete removal of calculi. Our overall complication rate was 15.3%. Blood transfusion was required in 5.4% of the cases, ileus developed in 1.9%, pneumothorax in 1.1%, intraoperative hydrothorax in 1.1%, postoperative pleural effusion requiring aspiration in 0.9%, and septic shock in 0.9%. Our overall success rate for stone removal was 94.5%. Conclusions. In our experience, the urologist is able to safely and effectively obtain percutaneous access to the collecting system for percutaneous renal surgery as a one-stage procedure without the aid of interventional radiologists.

Endoscopic Dilatation of the Biliary Sphincter for Removal of Bile Duct Stones: an Overview of Current Indications and Limitations

Endoscopic balloon dilatation (EBD) of the biliary sphincter may be an alternative to endoscopic sphincterotomy (EST) for removal of bile duct stones. After EBD of the biliary sphincter to a diameter of 8 mm, stones are removed according to standard guidelines. In the event that stone removal fails after EBD, an additional EST is performed. The overall success rate of stone removal after EBD (90%) is comparable to that of EST. After EBD, an additional EST and mechanical lithotripsy are required in 10% and 30% of patients, respectively. In patients with bile duct stones < 10 mm and a stone number h 3, EBD is nearly always successful without the need for additional EST or mechanical lithotripsy. Pancreatitis post-EBD occurs at a rate of 5-7%, which is not significantly different from that after EST. Significant bleeding post-EBD has not been observed in over 400 patients undergoing EBD. EBD is a valuable alternative to EST, especially in patients with smaller bile duct stones and in patients with haemostatic disorders.

Method to Obviate Dilatation in Ureterorenoscopy: Uromat

Continuous irrigation with the Uromat has obviated dilatation in ureterorenoscopy and converted this endoscopic technique into a procedure almost as easy as conventional urethroscopy. Severe complications were reduced to 0.9%, the average hospital stay was reduced to 1.6 days, and the success rate for stone removal was increased to 98%.

Percutaneous Nephrolithotomy in the Spinal Cord Injury Population

We evaluated 23 male spinal cord injury patients who underwent percutaneous nephrolithotomy for the success rate of stone removal and the incidence of operative complications. There were 18 quadriplegic and 5 paraplegic patients, and 5 had bilateral procedures. Of the kidneys 7 had staghorn calculi, 8 had pelvic and caliceal combinations, 6 had large multiple caliceal stones, 4 had large (more than 2.5cm.) pelvic stones and 3 had pelvic stones less than 2.5cm. Placement of a nephrostomy tube and stone extraction were performed as a single procedure with the use of general anesthesia in all but 4 patients.Our results showed that 19 of 21 compliant patients (90.4 per cent) were free of stone, with an average of 2.04 procedures per patient. A total of 47 procedures was performed, with an average operative time of 1 hour 45 minutes. Major complications were associated with 4 of the 47 procedures (8.5 per cent), and consisted of a respiratory arrest, 2 perirenal abscesses and a hydrothorax. Minor complications included fever (more than 101.5F) in 64.3 per cent and retained stones in 14.3 per cent of the kidneys operated upon, dislodged nephrostomy tubes in 12.6 per cent of the procedures (21.4 per cent of the kidneys operated upon), and anemia requiring transfusion in 17.0 per cent (8 of 47) of the procedures (27.8 per cent of the kidneys operated upon).The presence of infected stones, prior operative procedures and medical complexity of these patients make complications more frequent. Nevertheless, percutaneous nephrolithotomy is a safe and effective procedure for the spinal cord injury population.