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Surgical treatment of complicated hepatolithiasis using the ultrasound-guided fiberoptic choledochoscope

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Abstract

Background

The residual stones of postsurgical intrahepatic calculi have been among the most difficult problems in hepatobiliary surgery. Intraoperative ultrasound can clearly display the morphology of intrahepatic bile ducts and the distribution of calculi as well as the position of the choledochoscope and the calculus extraction instruments. Therefore, intraoperative ultrasound can guide the choledochoscope and its auxiliary equipment for calculus extraction. It is necessary to evaluate the effectiveness and safety of surgeries using an ultrasound-guided fiberoptic choledochoscope for the treatment of complicated hepatolithiasis.

Methods

The 56 cases in group A were selected from patients who had complicated hepatolithiasis treated with calculus extraction therapy using an ultrasound-guided fiberoptic choledochoscope in the authors’ hospital between January 2006 and June 2009. The 63 cases of complicated hepatolithiasis in group B were chosen from patients treated with calculus extraction surgeries using a fiberoptic choledochoscope without the guidance of ultrasound from September 2001 through December 2005. Transabdominal ultrasound, T-tube cholangiography, and computed tomography (CT) examination were performed on day 15 after the surgery to compare the complete stone clearance rate, the residual stone rate, and the incidence rate of postoperative complications between groups A and B.

Results

The intrahepatic calculi were completely removed in 53 group A cases. The complete stone clearance rate was 94.6%, and the residual stone clearance rate was 5.4%. In group B, 51 cases had complete stone removal, for a stone clearance rate of 81% and a residual stone rate of 19%. The difference in the residual stone rates between the two groups is statistically significant (p = 0.025). No hemobilia, biliary perforation, or other complications were observed in either group.

Conclusion

Use of the intraoperative ultrasound-guided fiberoptic choledochoscope in the treatment of complicated hepatolithiasis can significantly reduce the residual stone rate of intrahepatic biliary calculi and significantly improve the treatment effect of hepatolithiasis.

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Disclosures

Weidong Pan, Erjiao Xu, Heping Fang, Meihai Deng, and Ruiyun Xu have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China

    Weidong Pan, Heping Fang, Meihai Deng & Ruiyun Xu

  2. Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China

    Erjiao Xu

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  1. Weidong Pan
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  2. Erjiao Xu
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  3. Heping Fang
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  4. Meihai Deng
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Correspondence to Weidong Pan.

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Pan, W., Xu, E., Fang, H. et al. Surgical treatment of complicated hepatolithiasis using the ultrasound-guided fiberoptic choledochoscope. Surg Endosc 25, 497–502 (2011). https://doi.org/10.1007/s00464-010-1200-1

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  • DOI: https://doi.org/10.1007/s00464-010-1200-1

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