Percutaneous Transhepatic Endoscopic Holmium Laser Lithotripsy for Intrahepatic and Choledochal Biliary Stones
| Autor: | Boris Khaitovich, Alexander Garniek, Paul Bensaid, Gil Golan, Nir Kleinmann, Harry Winkler, Uri Rimon |
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| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Percutaneous medicine.medical_treatment Treatment outcome Holmium laser chemistry.chemical_element Lithotripsy Radiography Interventional urologic and male genital diseases Holmium Cholelithiasis Fiber Optic Technology Humans Medicine Radiology Nuclear Medicine and imaging Aged Aged 80 and over business.industry Endoscopy Middle Aged Lithotripsy Laser Laser lithotripsy female genital diseases and pregnancy complications Treatment Outcome chemistry Biliary tract Fluoroscopy Female Radiology Cardiology and Cardiovascular Medicine business human activities BILIARY STONES |
| Zdroj: | CardioVascular and Interventional Radiology. 34:1262-1266 |
| ISSN: | 1432-086X 0174-1551 |
| Popis: | To report our approach for treating complicated biliary calculi by percutaneous transhepatic endoscopic biliary holmium laser lithotripsy (PTBL).Twenty-two symptomatic patients (11 men and 11 women, age range 51 to 88 years) with intrahepatic or common bile duct calculi underwent PTBL. Nine patients had undergone previous gastrectomy and small-bowel anastomosis, thus precluding endoscopic retrograde cholangiopancreatography. In the other 13 patients, stone removal attempts by ERCP failed due to failed access or very large calculi. We used a 7.5F flexible ureteroscope and a 200-μm holmium laser fiber by way of a percutaneous transhepatic tract, with graded fluoroscopy, to fragment the calculi with direct vision. Balloon dilatation was added when a stricture was seen. The procedure was performed with the patient under general anaesthesia. A biliary drainage tube was left at the end of the procedure.All stones were completely fragmented and flushed into the small bowel under direct vision except for one patient in whom the procedure was aborted. In 18 patients, 1 session sufficed, and in 3 patients, 2 sessions were needed. In 7 patients, balloon dilatation was performed for benign stricture after Whipple operation (n = 3), for choledochalenteric anastomosis (n = 3), and for recurrent cholangitis (n = 1). Adjunctive "balloon push" (n = 4) and "rendezvous" (n = 1) procedures were needed to completely clean the biliary tree. None of these patients needed surgery.Complicated or large biliary calculi can be treated successfully using PTBL. We suggest that this approach should become the first choice of treatment before laparoscopic or open surgery is considered. |
| Databáze: | OpenAIRE |
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