A Lamanna1, J Maingard2, J Tai3, D Ranatunga4, M Goodwin4. 1. Interventional Radiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia. Electronic address: anton.lamanna92@gmail.com. 2. Department of Imaging, Monash Health, Monash, Australia; School of Medicine, Deakin University, Waurn Ponds, Australia. 3. Department of Surgery, Austin Health, Melbourne, Australia. 4. Interventional Radiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia.
Abstract
PURPOSE: To report the technical success, complications and long-term outcomes of patients with intrahepatic cholelithiasis not amenable to endoscopic retrograde cholangiopancreatography (ERCP) who were treated with percutaneous transhepatic biliary Laser lithotripsy (PTBLL). PATIENTS AND METHODS: A retrospective review of 12 patients who underwent PTBLL for intrahepatic cholelithiasis was performed. There were 5 men and 7 women with a mean age of 46±18 (SD) years (range: 23-75 years). PTBLL was performed when stone clearance using ERCP had previously failed or was not appropriate due to unfavourable anatomy or the presence of multiple stones or a large stone. Percutaneous biliary access into intrahepatic ducts was obtained if not already present and lithotripsy was performed using a HolmiumYAG 2100nM Laser. Patients files were analyzed to determine the technical success, complications and long-term outcomes. RESULTS: Eleven patients (11/12; 92%) had a history of previous hepatobiliary surgery and nine (9/12; 75%) had multiple stones confirmed on preprocedure imaging. A 100% success rate in fragmenting the target stone(s) was achieved and 11/12 patients (92%) had successful first pass extraction of target stone fragments. Two patients (2/12; 17%) required repeat lithotripsy. One patient (1/12; 8%) experienced a major complication in the form of cholangitis. Of patients with long-term follow-up, 4/10 (40%) had recurrence of intrahepatic calculi with a mean time interval of 31 months (range 3-84 months). CONCLUSION: For patients with intrahepatic biliary calculi not amenable to ERCP, PTBLL provides an effective and safe alternate treatment.
PURPOSE: To report the technical success, complications and long-term outcomes of patients with intrahepatic cholelithiasis not amenable to endoscopic retrograde cholangiopancreatography (ERCP) who were treated with percutaneous transhepatic biliary Laser lithotripsy (PTBLL). PATIENTS AND METHODS: A retrospective review of 12 patients who underwent PTBLL for intrahepatic cholelithiasis was performed. There were 5 men and 7 women with a mean age of 46±18 (SD) years (range: 23-75 years). PTBLL was performed when stone clearance using ERCP had previously failed or was not appropriate due to unfavourable anatomy or the presence of multiple stones or a large stone. Percutaneous biliary access into intrahepatic ducts was obtained if not already present and lithotripsy was performed using a HolmiumYAG 2100nM Laser. Patients files were analyzed to determine the technical success, complications and long-term outcomes. RESULTS: Eleven patients (11/12; 92%) had a history of previous hepatobiliary surgery and nine (9/12; 75%) had multiple stones confirmed on preprocedure imaging. A 100% success rate in fragmenting the target stone(s) was achieved and 11/12 patients (92%) had successful first pass extraction of target stone fragments. Two patients (2/12; 17%) required repeat lithotripsy. One patient (1/12; 8%) experienced a major complication in the form of cholangitis. Of patients with long-term follow-up, 4/10 (40%) had recurrence of intrahepatic calculi with a mean time interval of 31 months (range 3-84 months). CONCLUSION: For patients with intrahepatic biliary calculi not amenable to ERCP, PTBLL provides an effective and safe alternate treatment.