Subparietal hepaticojejunal access loop for intrahepatic stones

Abstract Background The increasing use of imaging has led to incidental findings in the liver. The Western experience of managing focal intrahepatic duct dilatation (FIDD) is not well recorded. We present our experience based on a large prospectively maintained database at a tertiary hepatobiliary surgical unit. Method Patients with liver resection for FIDD between January 2003-December 2019 were retrospectively identified from the liver unit database. The demographics, symptomatology, blood test results, imaging, type of liver resection, morbidity, mortality, and histology of resected specimens were recorded. Results 9 patients had FIDD among 994 liver resections performed (0.9%). 6 patients were asymptomatic, 2 upper abdominal pain and 1 recurrent gram-negative sepsis. Liver function tests were normal in all patients. Two patients had cholangiocarcinoma (CCA), 4 intrahepatic stones, 1 intraductal papillary neoplasm of bile duct (IPN –B) and 2 benign strictures. Conclusions FIDD is rare in the Western population. Most patients are asymptomatic with an incidental finding of FIDD on cross-sectional imaging. Differentiating benign and malignant pathology is difficult warranting liver resection in fit patients to resolve the diagnosis. Liver resection is safe and can be potentially curative in patients with a neoplasm, which can occur in 30% of patients with FIDD.

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Cholangioscopic Extraction of Intrahepatic Stones Associated with Biliary Strictures using a Rendezvous Technique

Endoscopy ◽

10.1055/s-2007-1010322 ◽

1993 ◽

Vol 25 (04) ◽

pp. 303-306 ◽

Cited By ~ 5

Author(s):

I. Maetani ◽

H. Hoshi ◽

S. Ohashi ◽

H. Yoshioka ◽

Y. Sakai

Keyword(s):

Biliary Strictures ◽

Intrahepatic Stones ◽

Rendezvous Technique

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Liver Resection for Primary Intrahepatic Stones: Focus on Postoperative Infectious Complications

World Journal of Surgery ◽

10.1007/s00268-015-3227-x ◽

2015 ◽

Vol 40 (2) ◽

pp. 433-439 ◽

Cited By ~ 5

Author(s):

Gennaro Clemente ◽

Agostino M. De Rose ◽

Rita Murri ◽

Francesco Ardito ◽

Gennaro Nuzzo ◽

...

Keyword(s):

Liver Resection ◽

Infectious Complications ◽

Intrahepatic Stones

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Double-balloon endoscopic retrograde cholangiography can make a reliable diagnosis and good prognosis for postoperative complications of congenital biliary dilatation

Scientific Reports ◽

10.1038/s41598-021-90550-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Chiyoe Shirota ◽

Hiroki Kawashima ◽

Takahisa Tainaka ◽

Wataru Sumida ◽

Kazuki Yokota ◽

...

Keyword(s):

Bile Duct ◽

Postoperative Complications ◽

Radical Surgery ◽

Endoscopic Retrograde Cholangiography ◽

Endoscopic Retrograde ◽

Congenital Biliary Dilatation ◽

Intrahepatic Stones ◽

Biliary Dilatation ◽

Double Balloon ◽

Anastomotic Strictures

AbstractBile duct and anastomotic strictures and intrahepatic stones are common postoperative complications of congenital biliary dilatation (CBD). We performed double-balloon endoscopic retrograde cholangiography (DBERC) for diagnostic and therapeutic purposes after radical surgery. We focused on the effectiveness of DBERC for the treatment of postoperative complications of CBD patients. Bile duct and anastomotic strictures and intrahepatic stones are common postoperative complications of congenital biliary dilatation (CBD). We performed double-balloon endoscopic retrograde cholangiography (DBERC) for diagnostic and therapeutic purposes after radical surgery. We focused on the effectiveness of DBERC for the treatment of postoperative complications of CBD patients. This retrospective study included 28 patients who underwent DBERC (44 procedures) after radical surgery for CBD between January 2011 and December 2019. Strictures were diagnosed as “bile duct strictures” if endoscopy confirmed the presence of bile duct mucosa between the stenotic and anastomotic regions, and as “anastomotic strictures” if the mucosa was absent. The median patient age was 4 (range 0–67) years at the time of primary surgery for CBD and 27.5 (range 8–76) years at the time of DBERC. All anastomotic strictures could be treated with only by 1–2 courses of balloon dilatation of DBERC, while many bile duct strictures (41.2%) needed ≥ 3 treatments, especially those who underwent operative bile duct plasty as the first treatment (83.3%). Although the study was limited by the short follow-up period after DBERC treatment, DBERC is recommended as the first-line treatment for hepatolithiasis associated with biliary and anastomotic strictures in CBD patients, and it can be safely performed multiple times.

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Endoscopic laser lithotripsy for complicated bile duct stones: is cholangioscopic guidance necessary?

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032007000200010 ◽

2007 ◽

Vol 44 (2) ◽

pp. 137-140 ◽

Cited By ~ 18

Author(s):

Ralf Jakobs ◽

Julio C. Pereira-Lima ◽

Aline W. Schuch ◽

Lucas F. Pereira-Lima ◽

Axel Eickhoff ◽

...

Keyword(s):

Bile Duct ◽

Laser Lithotripsy ◽

Bile Duct Stones ◽

Distal Bile Duct ◽

Laser Guidance ◽

Endoscopic Papillotomy ◽

Intrahepatic Stones ◽

Bile Duct Stenosis ◽

Extracorporeal Shock Wave ◽

Fluoroscopic Control

BACKGROUND: Endoscopic papillotomy is successful in more than 95% of the cases of choledocholithiasis. For patients with difficult bile duct stones not responding to mechanical lithotripsy, different methods for stone fragmentation have been developed. AIM: To compare the results of laser lithotripsy with a stone-tissue recognizing system, when guided by fluoroscopy only or by cholangioscopy. METHODS: Between 1992 and 2002 we have treated 89 patients with difficult bile duct stones by endoscopic retrograde cholangiopancreatography and laser lithotripsy. Unsuccessful extracorporeal shock-wave lithotripsy and electrohydraulic were also performed before laser in 35% and 26% of the cases, respectively. RESULTS: Laser was effective in 79.2% of 72 patients guided by cholangioscopy and in 82.4% of 17 cases steered by fluoroscopy. The median number of impulses in the latter was 4,335 and 1,800 with the former technique. Two parameters influenced the manner of laser guidance. In cases of stones situated above a stricture, cholangioscopic control was more effective (64.7% vs. 31.9%). When the stones were in the distal bile duct, fluoroscopic control was more successful. CONCLUSION: In cases of difficult stones in the distal bile duct, laser lithotripsy under fluoroscopic control is very effective and easily performed. Cholangioscopic guidance should be recommended just in cases of intrahepatic stones or in patients with stones situated proximal to a bile duct stenosis. In these cases, cholangioscopy should be performed either endoscopically or percutaneously.

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