Choledochoscopic Electrohydraulic Lithotripsy and Lithotomy for Stones in the Common Bile Duct, Intrahepatic Ducts, and Gallbladder

Choledochoscopic lithotomy with the aid of electrohydraulic lithotripsy was performed in 40 patients, including 16 patients with choledocholithiasis, 15 with hepatolithiasis, and 9 with cholecystolithiasis. As a route for the choledochoscopy, a T-tube tract, external cholecystostomy, or jejunal limb of hepaticojejunostomy was used in nine patients, while percutaneous transhepatic biliary drainage followed by dilatation of the track was established in 31 patients. The largest cholesterol stone measured 55 mm by 33 mm and the largest bilirubinate stone measured 52 mm by 37 mm. The stones were disintegrated in all but one patient in whom choledochoscopic access to a gallstone was difficult due to deformity of the gallbladder. Complete removal of the stones was achieved in 38 of 39 patients. In a patient with hepatolithiasis, small stones located deep in inaccessible branches of the intrahepatic duct remained unremovable. There were no serious complication. Minor complications occurred, including bleeding from the bile duct mucosa in four patients and postprocedure chills and fever in three. Choledochoscopic lithotomy with electrohydraulic lithotripsy is efficient and useful to remove biliary calculi in patients who are poor surgical risks.