Min-Huo Hwang

Percutaneous transhepatic choiedochoscopic electrohydraulic lithotripsy (PTCS-EHL) of common bile duct stones

Electrohydraulic lithotripsy was first developed in the Soviet Union about 35 years ago as an industrial technique to fragment rocks. In 1968, Reuter! first applied this method for the treatment of urinary bladder stones. Successful treatment of bladder stones via a transurethral route was achieved in 45 patients the next year. The application of this new device in the biliary tract was first introduced by Burhenne to fragment a large retained stone through aT-tube tract under fluroscopic guidance. Koch et a1. combined a lithotripsy probe with a Dormia basket and successfully treated three patients with large common bile duct (CBD) stones after endoscopic papillotomy. Electrohydraulic lithotripsy had also been used to fragment CBD stones through a percutaneous route with a 4.5 F electrode in a few cases.,6 Both methods require accurate fluroscopic guidance and the stones must be captured in a Dormia basket to avoid bile duct injury. To date, little data are available concerning the in vivo efficacy of electrohydraulic lithotripsy, and no clinical report has appeared about electrohydraulic lithotripsy under direct endoscopic vision. We describe our clinical experience with percutaneous transhepatic choledochoscopic electrohydraulic lithotripsy (PTCS-EHL) in the treatment of CBD stones.

Percutaneous choledochoscopic biliary tract stone removal: experience in 645 consecutive patients

Our experience in non-operative retrieval of biliary tract stones through PTCS (percutaneous transhepatic cholangioscopy, n = 103) and POC (post-operative choledochoscopy, n = 542) plus the use of Dormia basket and EHL (electrohydraulic lithotripsy) is presented. The results of transhepatic and T-tube routes are compared, with emphasis on the technical difficulties encountered. The success rates were 96% and 97% in POC and PTCS, respectively. No mortality was related to these procedures. Intrahepatic duct angulation and stricture were the factors most often responsible for failure. Postoperative choledochoscopic stone removal is safe and the method of choice for retained biliary tract calculi, while PTCS is highly indicated for those high-risk patients with or without previous biliary surgery. POC and PTCS have, therefore, their own indications and differ in their clinical applications.