Treatment Of Bile Duct Lithiasis Research Articles

Percutaneous treatment of biliary stones: sphincteroplasty and occlusion balloon for the clearance of bile duct calculi.

Our study describes the percutaneous expulsion of bile duct calculi into the duodenum by dilating the papilla with a balloon catheter. SUBJECTS AND METHODS. Patients (n = 212; 101 men and 111 women; mean age, 73 years; range, 31-95 years) had their calculi (single, 131; multiple, 81) percutaneously expelled into the duodenum in 73 patients via an indwelling T tube, and in 139 via transhepatic or transcystic duct route. Stone expulsion was facilitated with an occlusion balloon after balloon sphincteroplasty and with prior mechanical fragmentation in only 37 patients. After the expulsion of the calculi into the duodenum, drainage of the main bile duct to the exterior was maintained for 2-8 days. Technical success was initially 90.4%, increasing to 93% at the second attempt. There were 13 failures due to the large size of the calculi in nine patients, excessive tortuosity of the T tube (Kher tube) in one, and breaches of the established protocol in two. Residual lithiasis was resolved in 98.6% of cases, decreasing to 92% in the group of native, or nonresidual, lithiasis. There were 10 major complications (hemobilia) with three cases of poor clinical outcome: hepatic necrosis, multiorgan failure, or death. Percutaneous anterograde evacuation of bile duct stones with dilatation of the papilla using an angioplasty catheter and assisted with an occlusion balloon to expel the calculi is a cost-effective, nontraumatic, and safe procedure that retains the anatomic and functional integrity of the sphincter. It is a viable alternative procedure in the treatment of bile duct lithiasis.

Combined Endoscopic and Laparoscopic Treatment of Gallstones and Bile Duct Stones

The best treatment of bile duct lithiasis in the era of the laparoscopic cholecystectomy has not yet been defined, as we can choose between different kinds of therapies which range from the traditional laparotomic treatment to the more modern endoscopic and laparoscopic techniques. Although in some centres a wholly laparoscopic access to the bile duct is used, we believe that the fastest, safest and most reliable method is still the sequential treatment, endoscopic and laparoscopic. In our experience the endoscopic cleaning of the choledochus was performed in 87.1% of the cases, with no mortality and 4.2% morbidity.