Intrahepatic stones: the percutaneous approach

Area of Science:

• Hepatobiliary surgery
• Interventional radiology
• Gastroenterology

Background:

• Intrahepatic stones (hepatolithiasis) are common in the Far East but rare in Western countries.
• Hepatolithiasis can lead to recurrent cholangitis, liver abscesses, sepsis, and hepatic failure.
• Current treatments focus on biliary decompression and complete stone/bile stasis elimination.

Purpose of the Study:

• To review the management of intrahepatic stones.
• To highlight the effectiveness of percutaneous transhepatic procedures.
• To discuss challenges and optimal management strategies.

Main Methods:

• Review of endoscopic and percutaneous transhepatic drainage techniques.
• Discussion of hepatic resection for localized disease.
• Analysis of percutaneous approaches using catheters, miniscopes, and lithotripsy for stone removal and stricture dilation.

Main Results:

• Endoscopic retrograde choledochopancreatography has limitations for intrahepatic stones.
• Percutaneous procedures are effective, especially via T-tube tracts or transhepatic fistulas.
• Techniques include balloon dilation for strictures and lithotripsy for impacted stones.
• Transhepatic intubation is beneficial for patients with biliary stenosis and high recurrence risk.

Conclusions:

• Complete elimination of bile stasis and stones is crucial for definitive treatment.
• Percutaneous transhepatic approaches offer a targeted, less invasive option for intrahepatic stones.
• Optimal management requires a multidisciplinary team approach, especially for complex cases with biliary strictures.