Postoperative choledochoscopic removal of intrahepatic stones via a T tube tract

Abstract

All intrahepatic stones should be removed. T tube choledochoscopy is the preferred method for treating retained intrahepatic stones. This should be supplemented with other modalities of treatment, such as endoscopic and radiological approaches, especially in patients with strictures.

Open common bile duct exploration without T-tube insertion- two decade experience from a limited resource setting in the Caribbean

“…Despite this, T-tubes are still in vogue largely due to the theoretical advantages of providing temporary drainage during a period of ampullary oedema and the possibility of retrieving a residual stone via the Ttube tract [20]. Again, the equipment used for retrieval of residual stones either by percutaneous transhepatic removal [21] or via T-tube tracts is seldom available in most ThirdWorld countries.…”

Clinical applications of plasma shock wave lithotripsy in treating postoperative remnant stones impacted in the extra- and intrahepatic bile ducts

“…Stone fragmentation and clearance rates of 50% (22/44) [3] to 92% (46/50) [2] have been achieved. Our study shows that PSWL is more eective than ESWL.…”

“…One is extracorporeal, aimed where the shock wave is emitted by discharge. The other is 5 intracorporeal, aimed where stones are located [2,3,14,16].…”

Routine guidewire application facilitates cholangioscopy in the management of postoperative residual hepatolithiasis

“…Step two, which is reinsertion of the guidewire through the accessory channel of the cholangioscope to locate the targeted bile duct and calculus, also has its advantages. For example, in cases of complicated hepatolithiasis, where repeated manipulation of the cholangioscope is necessary to accurately locate the exact position of calculi, and where the vision is obscured by the constant irrigation, basket extraction and lithotripsy, the guidewire can serve as a road sign, indicating the exact path to target the calculi. In addition, the volume of saline flowing into the intestine is significantly less in the wire‐guided procedure, which is important to reduce the incidence of adverse reactions such as diarrhea.…”