Percutaneous removal of retained intrahepatic stones utilizing combination of techniques with emphasis on a preshaped angulated catheter: review of 170 patients

Abstract

Intrahepatic stones are frequently associated with recurrent cholangiohepatitis and complete surgical removal of the stones is almost always difficult because of the large number of stones and the associated bile duct strictures. One hundred and seventy patients with retained intrahepatic stones underwent percutaneous stone removal utilizing pre-shaped angulated catheters, 9-F polyethylene tubes with different angles of distal tip, and Dormia baskets under fluoroscopy with a combination of techniques including irrigation-suction, crushing of large stones, balloon dilatation of strictures and extracorporenal shock wave lithotripsy. The procedure was performed through a mature T-tube tract (168 patients) and a mature transhepatic tube tract (two patients). Stones were exclusively intrahepatic in 125 patients, whereas 45 patients also had stones in the common bile duct.

In 84 (49.4%) of 170 patients, the stones were completely removed and in 36 (21.2%) patients, most of the stones were removed. Overall success rate was 70.6%. Angulation deformity, stricture of bile ducts and impacted stones were the factor mosto ften responsible for failure. No significant complications were observed.

Fluoroscopically-guided percutaneous interventional procedures with a pre-shaped angulated catheter is a useful complementary procedure to surgery for patients with intrahepatic stones. The major benefits of an individually fitted angulated catheter are its safety and easy access to small peripheral bile ducts.