Laparoscopic treatment for intrahepatic stones / 中国微创外科杂志

ABSTRACT

Objective To discuss surgical techniques of laparoscopic treatment for intrahepatic stones.Methods A total of 57 cases of intrahepatic stones from March 2000 to March 2005 were studied. Under laparoscopic visualization,openings of left and right hepatic bile ducts were exposed through a longitudinal incision in the common hepatic duct to the bifurcation of left and right hepatic ducts.Stones in left and right hepatic bile ducts were evacuated with the use of a lithotomy forceps,a tiny basket,or pressure irrigation.Then openings of secondary hepatic ducts were exposed through the dilated primary ducts for the removal of stones in secondary hepatic ducts.Sometimes even openings of tertiary hepatic ducts could be seen for stone removal.When mud-or sand-like calculi were encountered,repeated irrigation of bile ducts was carried out.Results Conversions to open surgery were required in 3 cases(3/57,5.3%).The time of operation was 75～275 min(136?54 min).Residual stones were found in 49 cases(49/57,86.0%),which required postoperative choledochoscopy for 1~4 times to clear the intrahepatic stones.Complete clearance of all intrahepatic stones was achieved in 53 cases(53/57,93.0%).In 2 cases of calculi impacted in the lower common bile duct,laparoscopic electrohydraulic lithotripsy was performed for stone extraction.Postoperative bile leakage occurred in 5 cases(5/57,8.8%),and was cured with tube drainage.Follow-up observations for 0.5~5 years(2.3+1.5 years) in 43 cases showed excellent outcomes in 38 cases(88.4%),good outcomes in 3 cases(7.0%),and poor in 2(4.6%).Conclusions Intrahepatic stones can be removed laparoscopically through a longitudinal incision in the common hepatic duct to the bifurcation of left and right hepatic ducts for the exposure of primary and secondary hepatic ducts,or even tertiary hepatic ducts.