Surgical Removal of Intrahepatic Bile Duct Stones Using a Rigid Nephroscope: A First Case Report

신장경을 이용한 간내담석제거술: 세계 첫 증례 보고

  • Kim, Say-June (Department of Surgery, Deajeon St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Doo-Bae (Department of Urology, Deajeon St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • 김세준 (가톨릭대학교 의과대학 대전성모병원 외과학교실) ;
  • 김두배 (가톨릭대학교 의과대학 대전성모병원 비뇨기과학교실)
  • Published : 2010.03.30

Abstract

Hepatolithiasis is characterized by its frequent recurrence, and its requirement for multiple interventions which can be performed radiologically, endoscopically or surgically. Although hepatic resection - concomitant removal of hepatic stones and its provocative pathology as well - has remained the definitive treatment of hepatolithiasis, the burden of the surgery limits its widespread application. In a certain proportion of patients, those for whom hepatic resection and endoscopic/percutaneous approaches are not indicated, surgical removal of intrahepatic stones can be attempted. In those circumstances, hepatic stones located outside the direct visual field can make the stone-extracting procedure cumbersome. We experienced an operation of a 66-year-old patient who had already received left lateral sectionectomy, cholecystectomy and choledochojejunostomy. His condition was due to impacted, recurrent stones packed between the hepatic hilum and the second confluence of the hepatic duct. Instead of revising the prior choledochojejunostomy site, after entering the jejunum 4 cm below the choledochojejunostomy site, we inserted a rigid nephroscope into the hepatic duct. Under the magnified view presented by a telescope inside the nephroscope, stone extracting was easily done using forceps inserted into the nephroscope. We think a nephroscope is useful in extracting intrahepatic stones, especially for large impacted stones located below the second confluence of the hepatic duct.

Keywords

References

  1. Al-Sukhni W, Gallinger S, Pratzer A, et al. Recurrent pyogenic cholangitis with hepatolithiasis--the role of surgical therapy in North America. J Gastrointest Surg 2008;12:496- 503. https://doi.org/10.1007/s11605-007-0398-2
  2. Uenishi T, Hamba H, Takemura S, et al. Outcomes of hepatic resection for hepatolithiasis. Am J Surg 2009;198:199-202. https://doi.org/10.1016/j.amjsurg.2008.08.020
  3. Jan YY, Chen MF, Wang CS, Jeng LB, Hwang TL, Chen SC. Surgical treatment of hepatolithiasis: long-term results. Surgery 1996;120:509-514. https://doi.org/10.1016/S0039-6060(96)80071-7
  4. Tsunoda T, Tsuchiya R, Harada N, et al. Long-term results of surgical treatment for intrahepatic stones. Jpn J Surg 1985;15:455-462. https://doi.org/10.1007/BF02470091
  5. Neuhaus H. Intrahepatic stones: the percutaneous approach. Can J Gastroenterol 1999;13:467-472. https://doi.org/10.1155/1999/847954
  6. Cheung MT, Wai SH, Kwok PC. Percutaneous transhepatic choledochoscopic removal of intrahepatic stones. Br J Surg 2003;90:1409-1415. https://doi.org/10.1002/bjs.4327
  7. Sarkar S, Sadhu S, Jahangir T, Pandit K, Dubey S, Roy MK. Laparoscopic common bile duct exploration using a rigid nephroscope. Br J Surg 2009;96:412-416. https://doi.org/10.1002/bjs.6579
  8. Mori T, Sugiyama M, Atomi Y. Gallstone disease: management of intrahepatic stones. Best Pract Res Clin Gastroenterol 2006;20:1117-1137. https://doi.org/10.1016/j.bpg.2006.05.010
  9. Tazuma S. Gallstone disease: epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Clin Gastroenterol 2006;20:1075- 1083. https://doi.org/10.1016/j.bpg.2006.05.009
  10. Sakpal SV, Babel N, Chamberlain RS. Surgical management of hepatolithiasis. HPB (Oxford) 2009;11:194-202. https://doi.org/10.1111/j.1477-2574.2009.00046.x
  11. Pockros PJ. Natural progression of untreated hepatolithiasis. J Clin Gastroenterol 2001;33:95-96. https://doi.org/10.1097/00004836-200108000-00001
  12. Hazey JW, McCreary M, Guy G, Melvin WS. Efficacy of percutaneous treatment of biliary tract calculi using the holmium: YAG laser. Surg Endosc 2007;21:1180-1183. https://doi.org/10.1007/s00464-006-9168-6
  13. Shamamian P, Grasso M. Management of complex biliary tract calculi with a holmium laser. J Gastrointest Surg 2004;8:191-199. https://doi.org/10.1016/j.gassur.2003.10.007
  14. Huang MH, Chen CH, Yang JC, et al. Long-term outcome of percutaneous transhepatic cholangioscopic lithotomy for hepatolithiasis. Am J Gastroenterol 2003;98:2655-2662. https://doi.org/10.1111/j.1572-0241.2003.08770.x
  15. Lam SK, Wong KP, Chan PK, Ngan H, Ong GB. Recurrent pyogenic cholangitis: a study by endoscopic retrograde cholangiography. Gastroenterology 1978;74:1196-1203.
  16. Choi TK, Wong J, Ong GB. The surgical management of primary intrahepatic stones. Br J Surg 1982;69:86-90. https://doi.org/10.1002/bjs.1800690210