X-Rays Endobiliary Interventions in Intrahepatic Cholelithiasis
Aim. To improve the results of minimally invasive treatment of intrahepatic cholelithiasis. Material and Methods. There were 37 patients with intrahepatic cholelithiasis under observation. In 12 cases intrahepatic cholelithiasis was isolated on background of biliodigestive anastomosis stricture. In 25 cases multiple cholelithiasis was diagnosed. Cholelithiasis was cured by percutaneous transhepatic pneumatic contact lithotripsy. We performed dislocation of stones from intrahepatic ducts through dilated biliodigestive anastomosis into duodenal papilla or intestinal loop. In 25 patients with cholangiolithiasis there were combined antegrade and retrograde endovascular interventions in a consistent format or “rendezvous” format. Results. 12 patients with multiple cholelithiasis underwent open surgery after relief of obstructive jaundice syndrome. In this group of patients intrahepatic cholangiolithotomy with lithoextraction and overlaing of choledochoduodenal anastomosis have been traditionally performed. Cholangiostomy was maintained perioperatively to control completeness of lithoextraction. In 4 patients residual stones of intrahepatic ducts were removed through the choledochoduodenal anastomosis using cholangiostomy in postoperative period. In 13 high risk patients percutaneous lithotripsy and lithoextraction were the only acceptable way of cholelithiasis elimination. All cases of intrahepatic cholelithiasis on background of biliodigestive anastomosis stricture were treated using X-ray surgery after antegrade balloon dilatation of the anastomosis. Complications were observed in 5 (13.5%) patients. There were no motality. Conclusion. Antegrade percutaneous interventions for intrahepatic cholelithiasis can be considered as intervention of the “first line” due to predictable adequate biliary decompression and conditions for subsequent treatment. Antegrade minimally invasive interventions can be used as ultimate treatment and integrated into individual algorithm for gallstone disease in conjunction with endoscopic techniques and conventional surgery.