A simple catheter suction technique for nonoperative retrieval of a retained common bile duct stone

Postoperative T-tube tract choledochoscopy

One hundred twenty-six patients underwent postoperative fiberoptic T-tube tract choledochoscopy for the management of retained biliary calculi as demonstrated by T-tube cholangiography. Extraction was successful in 94% of patients with retained stones. Thirty-nine patients had more than 1 stone, 20 patients had heptic duct stones, and 14 patients had large stones requiring electrohydraulic lithotripsy or laser fragmentation. Stone removal was not possible in six patients, secondary to either slippage of the T-tube with obliteration of the tract, inability to remove the stones with available instruments, a tortuous tract, or choledochoscope malfunction. Minor complications, most commonly transient fever, occurred in 12 patients. No serious complications or deaths occurred. The advantages of T-tube tract choledochoscopy include direct visualization of the biliary tree, avoidance of radiation exposure, and easy access to hepatic duct stones. This is the preferred method for treating retained biliary calculi in patients with a T-tube in situ.

Balloon dilatation of intrahepatic biliary strictures for percutaneous extraction of residual intrahepatic stones

Intrahepatic ductal strictures in cholangiohepatitis present an obstacle to successful removal of retained ductal stones via T-tube tracts. We studied the effectiveness of stricture dilatation for stone removal. Fifteen patients with intrahepatic gallstones retained behind strictures underwent balloon dilatation of their strictures to allow stone extraction. All had prior surgical T-tube placement allowing percutaneous access. Balloon dilatation was successful in reducing or eliminating strictures in 86.7% (13 of 15 patients), and complete stone extraction after the successful dilatation was possible in 76.9% (10 of 13 patients). The reasons for failure were impacted stones and acute ductal angulation which prevented passage of catheters. It is concluded that balloon dilatation of intrahepatic biliary strictures is an effective adjunct for extraction of intrahepatic biliary calculi associated with recurrent pyogenic cholangiohepatitis.

Early removal of retained biliary stone without T-tube removal: case report

Techniques for removal of retained common bile duct stones through mature tracts are safe and well established. When symptomatic, the stones may require removal prior to the 4-6 week period required for tract maturation. We report a case in which substituting a Teflon sheath for the standard polyethylene basket sheath allowed manipulation through the T-tube lumen and basketing of an impacted distal common bile duct stone, which had caused pancreatitis. This technique is simple and avoids the problem of loss of access to the biliary tree in the early postoperative period.

Adjuncts and modifications to basket retrieval of retained biliary calculi

Although current techniques for percutaneous biliary stone extraction are highly successful, many patients require manipulation of the calculi before such extraction is possible. This article describes several adjunctive techniques for biliary stone retrieval that have proven to be effective. These include the modification of angiographic catheters for catheterization of ipsilateral ducts from the transhepatic approach, extractions of calculi from smaller ducts using constant irrigation and balloon catheters, and balloon-aided transampullary expulsion.