Background
The high incidence of residual stones has been a major problem in the treatment of hepatolithiasis. Although various imaging techniques have been used to locate the stones, and many different postoperative procedures have been used as remedial modalities to remove the residual calculi, results have been far from satisfactory.
Objectives
To remove obstinate hepatic stones and reduce the incidence of residual calculi.
Design
Prospective clinical trial.
Setting
Medical university-affiliated hospital.
Patients and Methods
Ten patients who had residual intrahepatic stones after conventional operative procedures underwent intraoperative ultrasound (IOUS)–guided transhepatic lithotomy between July 1988 and July 1995. This surgical technique includes accurately locating stones with IOUS, choosing a surgical approach path under the guidance of IOUS while avoiding critical blood vessels and uninvolved biliary tracts, dividing hepatic parenchyma to the involved biliary ducts, and removing the obstinate calculi using the real-time image of IOUS, which is able to monitor the movement of the lithotomy instruments without interruption.
Main Outcome Measures
Clinical practical value of IOUS-guided transhepatic lithotomy in the treatment of residual hepatic stones.
Results
Complete removal of the stones was achieved in all 10 patients. There were no severe complications or mortality at a median follow-up of 39 months.
Conclusions
IOUS-guided transhepatic lithotomy can greatly decrease the incidence of residual hepatic stones. It is accurate and safe. As a new surgical procedure, IOUS-guided transhepatic lithotomy should be an alternative modality in the management of hepatolithiasis, although the long-term benefits still need to be observed.
Arch Surg. 1997;132:300-303
