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March 1997

Intraoperative Ultrasound–Guided Transhepatic Lithotomy: A New Alternative Surgical Procedure for the Management of Residual Hepatic Stones

Author Affiliations

From the Department of Surgery, Second Affiliated Hospital, Henan Medical University, Zhengzhou, Henan, People's Republic of China.

Arch Surg. 1997;132(3):300-303. doi:10.1001/archsurg.1997.01430270086018

Background:  The high incidence of residual stones has been a major problem in the treatment of hepatolithiasis. Although various imaging techniques have been used to locate the stones, and many different postoperative procedures have been used as remedial modalities to remove the residual calculi, results have been far from satisfactory.

Objectives:  To remove obstinate hepatic stones and reduce the incidence of residual calculi.

Design:  Prospective clinical trial.

Setting:  Medical university-affiliated hospital.

Patients and Methods:  Ten patients who had residual intrahepatic stones after conventional operative procedures underwent intraoperative ultrasound (IOUS)–guided transhepatic lithotomy between July 1988 and July 1995. This surgical technique includes accurately locating stones with IOUS, choosing a surgical approach path under the guidance of IOUS while avoiding critical blood vessels and uninvolved biliary tracts, dividing hepatic parenchyma to the involved biliary ducts, and removing the obstinate calculi using the real-time image of IOUS, which is able to monitor the movement of the lithotomy instruments without interruption.

Main Outcome Measures:  Clinical practical value of IOUS-guided transhepatic lithotomy in the treatment of residual hepatic stones.

Results:  Complete removal of the stones was achieved in all 10 patients. There were no severe complications or mortality at a median follow-up of 39 months.

Conclusions:  IOUS-guided transhepatic lithotomy can greatly decrease the incidence of residual hepatic stones. It is accurate and safe. As a new surgical procedure, IOUS-guided transhepatic lithotomy should be an alternative modality in the management of hepatolithiasis, although the long-term benefits still need to be observed.Arch Surg. 1997;132:300-303