Percutaneous transhepatic Laser lithotripsy for intrahepatic cholelithiasis

Purpose: To report the technical success, complications and long-term outcomes of patients with intrahepatic cholelithiasis not amenable to endoscopic retrograde cholangiopancreatogra-phy (ERCP) who were treated with percutaneous transhepatic biliary Laser lithotripsy (PTBLL). Patients and methods: A retrospective review of 12 patients who underwent PTBLL for intrahep-atic cholelithiasis was performed. There were 5 men and 7 women with a mean age of 46 +/- 18 (SD) years (range: 23-75 years). PTBLL was performed when stone clearance using ERCP had previously failed or was not appropriate due to unfavourable anatomy or the presence of multiple stones or a large stone. Percutaneous biliary access into intrahepatic ducts was obtained if not already present and lithotripsy was performed using a HolmiumYAG 2100 nM Laser. Patients files were analyzed to determine the technical success, complications and long-term outcomes. Results: Eleven patients (11/12; 92%) had a history of previous hepatobiliary surgery and nine (9/12; 75%) had multiple stones confirmed on preprocedure imaging. A 100% success rate in fragmenting the target stone(s) was achieved and 11/12 patients (92%) had successful first pass extraction of target stone fragments. Two patients (2/12; 17%) required repeat lithotripsy. One patient (1/12; 8%) experienced a major complication in the form of cholangitis. Of patients with tong-term follow-up, 4/10 (40%) had recurrence of intrahepatic calculi with a mean time interval of 31 months (range 3-84 months). Conclusion: For patients with intrahepatic biliary calculi not amenable to ERCP, PTBLL provides an effective and safe alternate treatment. (C) 2019 Societe francaise de radiologie. Published by Elsevier Masson SAS. All rights reserved.