Postoperative choledochofiberscopic removal of intrahepatic stones.

An endoscopic approach for the diagnosis and treatment of intrahepatic stones is presented based on the experience of 4 cases, in which complete removal of intrahepatic stones was done by postoperative choledochoscopy. Postoperative choledochoscopy for the diagnosis and treatment of gallstone disease is not difficult to perform. The choledochofiberscope is inserted into the bile duct via choledochal fistula 3 weeks after the operation. Stones are crushed or grasped with forceps under direct vision. In some cases, the stricture in the intrahepatic biliary tree is dilated with the use of a high frequency waves cutting knife to facilitate stone removal. In fact, over 410 stones were successfully removed in one case by 28 postoperative choledochoscopies without any complications. The details of the choledochofiberscope developed by us with the close cooperation of Machida Company of Tokyo was presented. Postoperative choledochoscopy seems to be a safe and simple procedure and is useful in the treatment of intrahepatic stones.